Abstract
The general recommendation for hypoglycemia treatment is 15 grams (g) of simple carbohydrates, with re-check in 15 minutes. This oral hypoglycemia treatment is universally applied without consideration of the type of diabetes or the cause of hypoglycemia. These recommendations were only based on two small-sized studies of intravenous insulin-induced hypoglycemia in adults living with type 1 diabetes mellitus (T1D). We aimed to determine, in people living with T1D, which oral carbohydrate treatments attain >50% non-severe hypoglycemia (glucose 3.0 to 3.9 mmol/L) resolution at time of first glucose re-check. Medline, Embase, Scopus, and Cochrane Central Register of Controlled Trials were searched for full-text studies of oral treatment for non-severe hypoglycemia in T1D. Two authors screened the results and extracted data. Amongst the four studies of multiple daily insulin injections or non-closed-loop insulin pumps, >50% hypoglycemia resolution at first re-check was only observed in two studies: exercise-induced hypoglycemia study with 20 grams of glucose treatment attaining 60% hypoglycemia resolution at 15 minutes; real-life patient recorded study with 0.2 grams per kilogram body weight (g/kg) or 0.3 g/kg or 15 g glucose tablet treatment attaining 61%, 71%, and 63% hypoglycemia resolution at 10 minutes, respectively. Two of the three studies of closed-loop insulin pumps achieved >50% hypoglycemia resolution at first re-check: 16 grams of glucose tablets at 20 minutes attained 58% hypoglycemia resolution; 10 to 30 g of sucrose attained 79 to 100% hypoglycemia resolution at 15 minutes. The optimal quantity of oral carbohydrate treatments for T1D required to attain hypoglycemia resolution at first glucose re-check varies based on cause of hypoglycemia and type of insulin management.Systematic Review Registration: Prospero registration number: CRD420251033695; no amendments. Study protocol and literature search strategies are available from the authors upon request.