While glucose tablets have been advocated for treating symptomatic hypoglycemia in awake patients, dietary sugars may be more convenient and more effective in treating hypos. A systematic review compared the impact of these treatment options on the relief of symptomatic hypoglycemia, time to resolution of symptoms, blood glucose levels, complications and hospital length of stay. PubMed, Embase and the Cochrane Library through June 28, 2016 was searched and assessed the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation approach. Reference lists from a subset of the resulting articles were mined for additional, potentially eligible papers. Then the risk ratio (RR) of each treatment option for the preselected outcomes of interest was done. Results showed that of  the 1,774 identified papers, four studies met the inclusion criteria; three randomized controlled trials totaling 502 hypoglycemic events treated with dietary sugars and 223 with glucose tablets, and one observational study with 13 events treated with dietary sugars and 9 with glucose tablets. The dietary forms of sugar included sucrose, fructose, orange juice, jelly beans, Mentos, cornstarch hydrolysate, Skittles and milk. In the pooled analysis, patients treated with dietary sugars had a lower resolution of symptoms 15 minutes after treatment compared with glucose tablets. From the results, it was concluded that compared with dietary sugars, glucose tablets result in a higher rate of relief of symptomatic hypoglycemia 15 minutes after ingestion and should be considered first, if available, when treating symptomatic hypoglycemia in awake patients. — Emerg Med J. 2017;34(2):100-106. © 2017  BMJ Publishing Group; co-owned by the Royal College of Emergency Medicine and BMJ