How To Manage Hypoglycaemia (Hypos)

An insulinoma can release too much insulin and cause low blood glucose, also called hypoglycaemia or a hypo. This advice is for adults. Agree a personal plan with your specialist team, including when to treat a hypo and when to seek help. [1,2]

Emergency help

Call 999 if someone is unconscious, having a seizure or unable to swallow safely. Give nothing by mouth, including glucose gel, honey or drinks. If they are unconscious but breathing normally, place them in the recovery position. If they are not breathing normally, start CPR and follow the 999 call handler’s instructions. [3,4]

If rescue glucagon has been prescribed and you have been trained to use it, follow the emergency plan. Do not delay emergency help. [1,3]

Recognising a hypo

Symptoms can include shaking, sweating, hunger, palpitations, blurred vision, difficulty concentrating and confusion. Repeated low blood glucose can reduce warning symptoms, so some people may not realise they are having a hypo. [2,3]

When should I treat a hypo?

UKINETS’ standard sequence treats blood glucose below 3.5 mmol/L and repeats treatment until it is above 3.5 mmol/L. The guidance allows the treatment threshold to be adjusted towards 4.0 mmol/L according to individual risk. Agree your treatment and recovery levels with your specialist team. If your plan says 4.0 mmol/L, do not wait until it falls to 3.5 mmol/L. [2]

The NHS’s general hypo advice uses 4.0 mmol/L. If you have no individual plan, treat a reading below 4.0 mmol/L or symptoms of a hypo, and ask your team for a plan. [3]

Treating a hypo when you are awake and can swallow safely

  1. Check your blood glucose with a finger prick test if possible. Use this to confirm a low sensor reading. Do not delay treatment if you have symptoms and cannot check. [2,3]

  2. Take 15–20 g of rapid acting carbohydrate. Examples include glucose tablets or 150–200 ml of orange juice. Check the label to make sure the amount you take provides 15–20 g of carbohydrate. [2]

  3. Recheck with a finger prick test after 10–15 minutes. If still below your agreed treatment threshold, take a further 15 g of rapid acting carbohydrate and recheck after another 10–15 minutes. Seek medical help if the hypo persists after three treatments. If you have no individual plan, use 4.0 mmol/L as the threshold. [2,3]

  4. Once you are above your agreed recovery level (above 4.0 mmol/L if you have no individual plan) and symptoms have improved, have your next meal if it is due, or 15–30 g of slower acting carbohydrate, such as granary toast. [2,3]

UKINETS states: “Seek medical help if hypo persists after 3 treatments”. Get help sooner if you are getting worse. Use the emergency advice above if swallowing or consciousness is affected. [2–4]

Preventing further hypos

ENETS recommends small, frequent meals containing carbohydrates that are absorbed slowly, to avoid long periods without food. UKINETS advises regular meals and snacks based around wholegrain carbohydrates, fibre, protein and fats. Ask a specialist dietitian to help you adjust the amount, type and timing of food, including overnight. [1,2]

If this is not enough, your team may recommend uncooked corn starch or a modified starch product such as Glycosade. The dose and timing need to be tailored to you and monitored. Do not rely on a fixed spoonful or use starch instead of rapid acting carbohydrate to treat an active hypo. If eating and drinking cannot prevent hypos, specialist nutritional support, including tube feeding, may be needed. [2]

Monitoring and specialist treatment

Your team should agree how and when you check your blood glucose. A continuous glucose monitor can warn you about falling levels, including overnight. Sensors can lag behind blood glucose and are less accurate at low levels, so confirm low readings with a finger prick test. Tell your team about recurrent hypos or loss of warning symptoms. [1–3]

Food and monitoring are part of managing an insulinoma. Medicines such as diazoxide, which reduces insulin release, and treatment of the tumour may also be needed. ENETS discusses these options in Question 8, including control of hypoglycaemia while awaiting surgery. See Insulinoma treatments for more information. [1]

Keep rapid acting carbohydrate with you. Show family, friends or carers your hypo plan and explain when to call for help. [3]

Full references

[1] Hofland J, Falconi M, Christ E, et al. European Neuroendocrine Tumor Society 2023 guidance paper for functioning pancreatic neuroendocrine tumour syndromes. Journal of Neuroendocrinology. 2023;35(8):e13318. Question 8, “Insulinoma”. https://doi.org/10.1111/jne.13318

[2] UK and Ireland Neuroendocrine Tumour Society (UKINETS). UKINETS Bitesize Guidance for the Nutritional Management of Insulinomas. Original guidance, pp. 1–4 as numbered in the document. Preparation date 27 November 2023; stated review date November 2025. The quotation, carbohydrate quantities and treatment timings are from “Hypoglycaemia Management”, p. 4. Read the UKINETS guidance.

[3] NHS. Low blood sugar (hypoglycaemia). Last reviewed 3 August 2023. General hypo treatment and emergency advice. Read the NHS guidance.

[4] St John Ambulance. Diabetic emergencies. Clinically reviewed 28 April 2025. Supplementary first aid advice for severe hypoglycaemia. Read the first aid guidance.

Updated and checked against the original UKINETS guidance on 27 September 2026. Online sources accessed 27 September 2026.

Read more