Assess the clinical and biochemical response over the next 5-10 minutes. If the blood glucose levels remains <4.4 mmol/l give a second IV injection of 20-50 mls 50% dextrose

Continue the IV infusion of 10% dextrose in water at a rate of about one litre over 6 hours to prevent recurrent hypoglycemia,if induced by long-acting insulin and /or a sulphonylurea

Administer an immediate , rapid IV injection of 20-50 mls of 50% dextrose solution

If the patient has not regained consciousness after 30 minutes whether elevated or normal blood glucose levels other causes of coma will need to be considered . Urgent referral to specialist is considered.

If the patient is awake provide him / her with snacks whether blood glucose level is normal or elevated

If the dextrose cannot be administered for any reason inject 1mg glucagon IM or subcutaneously it will take 10-15 minutes for blood glucose level to rise

In hospital, monitor the clinical state and blood glucose four hourly for 24 - 48 hours