Management of Hypoglycaemia 

Hypoglycaemia is defined as a blood glucose of less than 4mmol/L. 

See the full NHSGGC guidance Algorithm for Treatment of Hypoglycaemia in Adults with Diabetes for guidance on how to treat mild, moderate or severe hypoglycaemia.   

How to prevent hypoglycaemia occurring again

Consider: 

• Is the patient eating? 
  • If they have a reduced appetite, consider reducing insulin / gliclazide.
• Look at trends in capillary blood glucose (CBG) and dose of insulin / gliclazide being administered. 
• Are they on twice daily mixed insulin, e.g. Humulin® M3? If hypoglycaemic:
  • Between breakfast and before dinner - consider reducing breakfast dose by 10-20%.
  • After dinner / overnight - consider reducing evening dose by 10-20% and / or taking snack before bed. 
• Are they on a basal bolus regimen, e.g. Levemir® / Lantus® / Tresiba® / Semglee® and Novorapid® / Fiasp®?
  • Consider reducing the fast-acting insulin preceding hypoglycaemia if happening at the same time. 
  • If trend is for CBGs to consistently run close to the lower end of the target range, consider reduction in basal insulin. 
• Are they on basal only e.g. Levemir® / Lantus® / Tresiba® / Semglee®?  
  • Reduce insulin by 10-20%.

Guideline reviewed: February 2025

Page updated: November 2025