Management of Severe Hypoglycemia in Diabetic Patients

Severe hypoglycaemia remains a critical concern in both type 1 and insulin-treated type 2 diabetes, with risks ranging from cognitive impairment to cardiovascular events. Management encompasses preventive strategies—such as individualised insulin regimens, carbohydrate counting, patient and caregiver education, and continuous glucose monitoring—and acute rescue interventions. First-line treatment for conscious patients involves rapid ingestion of fast-acting carbohydrates, while unconscious individuals require parenteral glucagon or intravenous dextrose. Traditional glucagon emergency kits, though effective, have been limited by complex preparation steps and under-use. Recent advances include ready-to-use autoinjectors, stable soluble formulations and intranasal powders, all designed to simplify administration and reduce treatment delays. Emergency medical services protocols increasingly integrate simplified glucagon delivery and point-of-care glucose assessment to optimise prehospital rescue. Training programmes for patients, caregivers and healthcare professionals emphasise recognition of early warning signs and hands-on practice with rescue devices. Globally, the adoption of novel glucagon formulations and wearable glucose sensors holds promise for reducing the incidence of severe hypoglycaemia and its associated morbidity, while ongoing efforts aim to address barriers in access, prescription practices and user competence.

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Management of Severe Hypoglycemia in Diabetic Patients publication trend

The graph below shows the total number of articles in management of severe hypoglycemia in diabetic patients across all publications each year (not limited to Nature Index journals).

Technical terms

Severe hypoglycaemia: A clinical emergency characterised by dangerously low blood glucose levels requiring external assistance to restore euglycaemia.

Glucagon: A peptide hormone that raises blood glucose by stimulating hepatic glycogenolysis and gluconeogenesis, used as an antidote to insulin-induced hypoglycaemia.

Autoinjector: A prefilled, spring-loaded device enabling rapid subcutaneous administration of medication with minimal user training.

Intranasal delivery: A non-invasive route of drug administration via the nasal mucosa, allowing rapid systemic absorption without injection.

Continuous glucose monitoring: A wearable technology providing real-time interstitial glucose readings to guide prevention and treatment of hypoglycaemia.

References

1. Human Factors Usability and Validation Studies of a Glucagon Autoinjector in a Simulated Severe Hypoglycemia Rescue Situation. Diabetes Technology & Therapeutics (2019).
2. New Fast Acting Glucagon for Recovery from Hypoglycemia, a Life-Threatening Situation: Nasal Powder and Injected Stable Solutions. International Journal of Molecular Sciences (2021).
3. Use of glucagon in severe hypoglycemia is scarce in most countries, and has not been expanded by new ready-to-use glucagons. Diabetology & Metabolic Syndrome (2022).