Obviously, prevention of iatrogenic hypoglycemia, as just discussed, is preferable to treatment of hypoglycemia. Episodes of asymptomatic hypoglycemia (detected by self-monitoring of blood glucose) and most episodes of mild to moderate symptomatic hypoglycemia, are effectively self-treated by ingestion of glucose tablets or carbohydrate in the form of juices, soft drinks, milk, crackers, candy or a meal. A glucose dose of 20 g is reasonable (26). However, in the setting of ongoing hyperinsulinemia, the glycemic response to oral glucose is transient, typically < 2 hours (26). Therefore, ingestion of a snack or meal shortly after the glucose level is raised is generally advisable.
Parenteral treatment is necessary when a hypoglycemic patient is unable or unwilling (because of neuroglycopenia) to take carbohydrate orally. While subcutaneous or intramuscular glucagon (1.0 mg in adults) is often used, by family members, to treat hypoglycemia in type 1 diabetes, glucagon is less useful in many patients with type 2 diabetes because it stimulates insulin secretion. Thus, intravenous glucose (25 g initially) is the preferable treatment for severe hypoglycemia in type 2 diabetes. Because sulfonylurea-induced hypoglycemia can persist for hours and even days, prolonged glucose infusion and frequent feedings are often required. This may require hospitalization. Clearly, it is critical that the absence of recurrent hypoglycemia is established unequivocally before the patient is discharged.
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