Feeling Shaky? It Could Be Severe Hypoglycemia. Here's What to Do

Feeling shaky, sweaty, and lightheaded can be alarming. While these symptoms can stem from various causes, one potential culprit is severe hypoglycemia, also known as low blood sugar. Understanding the condition, recognizing its symptoms, and knowing how to respond are crucial for individuals with diabetes and anyone at risk. This article will delve into the depths of severe hypoglycemia, offering a clear explanation of what it is, what causes it, how to identify it, and most importantly, what steps to take when it strikes. We aim to equip you with the knowledge to react swiftly and effectively, potentially preventing serious complications.

Understanding Severe Hypoglycemia

Hypoglycemia occurs when your blood glucose levels drop too low. For most people with diabetes, this means a blood sugar level below 70 mg/dL (3.9 mmol/L). Severe hypoglycemia is when low blood sugar becomes so profound that the person needs assistance from someone else to recover. This often involves the individual being unable to treat themselves due to confusion, disorientation, or even unconsciousness. It’s more than just a minor inconvenience; it’s a medical emergency that requires prompt action. Understanding the difference between mild and severe hypoglycemia is crucial. Mild hypoglycemia might manifest as shakiness or sweating and can be self-treated with a quick snack. Severe hypoglycemia, however, can escalate rapidly and become life-threatening.

Why does blood sugar matter so much? Glucose is the primary fuel source for your brain and body. When levels dip too low, the brain doesn't get enough energy to function correctly, leading to a range of symptoms from mild cognitive impairment to seizures and loss of consciousness.

| Feature | Mild Hypoglycemia | Severe Hypoglycemia | | --------------------- | ------------------------------------------ | ------------------------------------------------------------ | | Awareness | Aware and able to self-treat | May be confused, disoriented, or unable to self-treat | | Treatment | Can be treated with fast-acting carbohydrates | Requires assistance from others, often glucagon administration | | Severity | Typically not life-threatening | Potentially life-threatening if untreated | Continuous Glucose Monitor Cgm 101 A Game Changer For Diabetes Control

Causes of Severe Hypoglycemia

Several factors can lead to severe hypoglycemia, especially in people with diabetes. Understanding these causes can help in prevention.

Insulin Overdose: Taking too much insulin is the most common cause, particularly if meal timing is inconsistent. Errors in dosage calculation or administration can also lead to dangerously low blood sugar.
Skipped or Delayed Meals: Without adequate food intake, insulin can lower blood glucose to dangerously low levels. Consistency in meal timing is paramount for those taking insulin or certain oral diabetes medications.
Excessive Exercise: Strenuous physical activity without proper adjustments to insulin or food intake can rapidly deplete blood glucose stores. The muscles use glucose for fuel, pulling it from the bloodstream.
Alcohol Consumption: Alcohol can interfere with the liver’s ability to release glucose into the bloodstream, especially when consumed on an empty stomach. This effect can last for several hours after drinking.
Certain Medications: In addition to diabetes medications, certain other drugs, like quinine (used to treat malaria) can, in rare cases, cause hypoglycemia.
Kidney or Liver Problems: Impaired kidney or liver function can affect how medications are processed, potentially leading to increased levels of insulin in the blood.
Hormone Deficiencies: Certain hormone imbalances, such as cortisol or growth hormone deficiency, can impact blood glucose regulation.

For example, a study published in "Diabetes Care" highlighted that individuals with type 1 diabetes who frequently engage in intense exercise are at a higher risk of experiencing nocturnal hypoglycemia (low blood sugar during the night). It underscores the importance of proactive blood glucose monitoring and appropriate adjustments to insulin dosages and carbohydrate intake. Understanding Your First A1C Test What The Numbers Mean

Recognizing the Symptoms of Severe Hypoglycemia

Early recognition of hypoglycemia symptoms is vital to prevent the progression to a severe episode. The symptoms of severe hypoglycemia can differ from person to person, and some individuals may not experience any warning signs at all (known as hypoglycemia unawareness). Common signs include:

Confusion and Disorientation: Difficulty thinking clearly, confusion about surroundings, or an inability to concentrate.
Loss of Coordination: Difficulty walking or performing simple tasks.
Seizures: Uncontrolled muscle spasms and loss of consciousness.
Loss of Consciousness: Unresponsiveness to stimuli.
Slurred Speech: Difficulty speaking clearly.
Combativeness or Irritability: Unusual aggressiveness or mood swings.
Pale Skin: Due to the body shunting blood away from the skin to preserve vital organ function.
Sweating: Profuse sweating, even in a cool environment.

If someone with diabetes begins to exhibit these symptoms, assume they are experiencing severe hypoglycemia and take immediate action. Time is of the essence.

What To Do During a Severe Hypoglycemic Episode

When someone is experiencing severe hypoglycemia, swift and decisive action can be life-saving. Here’s a step-by-step guide on what to do:

Do Not Give Anything By Mouth: If the person is unconscious or having seizures, do not attempt to give them food or drink. This could cause choking.
Administer Glucagon: Glucagon is a hormone that raises blood glucose levels quickly. It's available by prescription as an injection or nasal spray.
- Injection: If you have a glucagon emergency kit and know how to use it, administer the injection into the thigh, arm, or buttock. Follow the instructions on the package carefully.
- Nasal Spray: Nasal glucagon is easy to administer. Simply insert the tip of the applicator into one nostril and press the plunger. No need to inhale.
Call for Emergency Medical Assistance: Even after administering glucagon, call emergency services (911 in the US) immediately. It is essential to get professional medical help to ensure the person's condition stabilizes and potential complications are addressed.
Position the Person on Their Side (Recovery Position): If the person is unconscious but breathing, place them in the recovery position to prevent choking should they vomit. This involves gently rolling them onto their side, with their top leg bent at the knee and their head tilted back.
Monitor Breathing and Pulse: While waiting for medical assistance, continually monitor the person's breathing and pulse. If they stop breathing, begin CPR if you are trained to do so.
Communicate Important Information: When medical professionals arrive, provide them with crucial information, including:
- The person's medical history, especially if they have diabetes
- The type and dosage of any diabetes medications they take
- The fact that they were given glucagon, and when

Important Note: It can take 10-15 minutes for glucagon to raise blood glucose levels. Even if the person regains consciousness, they still need medical evaluation to determine the underlying cause of the hypoglycemic episode and to prevent recurrence.

Prevention of Severe Hypoglycemia

The best way to manage severe hypoglycemia is to prevent it from happening in the first place. Several strategies can help reduce the risk: What Is Glucose And Why Is It Critical For Your Body

Regular Blood Glucose Monitoring: Check blood sugar levels frequently, especially before meals, after exercise, and before bedtime. Continuous glucose monitors (CGMs) can be particularly helpful in identifying trends and patterns.
Proper Meal Planning: Eat regular, balanced meals and snacks, especially if taking insulin or certain oral diabetes medications.
Insulin Dosage Adjustment: Work with a healthcare provider to adjust insulin dosages as needed, especially during periods of increased activity or illness.
Carrying a Fast-Acting Source of Glucose: Always carry a source of fast-acting carbohydrates, such as glucose tablets, juice, or hard candy, to treat mild hypoglycemia before it progresses.
Educating Family and Friends: Teach family members, friends, and coworkers how to recognize the symptoms of hypoglycemia and how to administer glucagon.
Wearing Medical Identification: Wear a medical ID bracelet or necklace that indicates you have diabetes. This can alert first responders to your condition in case of an emergency.
Using Technology: Smartphone apps can help track blood glucose levels, medication dosages, and carbohydrate intake. They can also set reminders for blood glucose checks and medication administration.
Reviewing Medications: Regularly review all medications with your healthcare provider to identify potential interactions or medications that could increase the risk of hypoglycemia.

A study in the "Journal of Diabetes Science and Technology" found that the use of continuous glucose monitoring (CGM) significantly reduced the risk of severe hypoglycemia in individuals with type 1 diabetes. CGM devices provide real-time glucose readings and alerts, allowing for proactive management and prevention of low blood sugar.

The Role of Glucagon

Glucagon is a vital hormone produced by the pancreas that works to raise blood glucose levels. In a severe hypoglycemic episode, administered glucagon can be life-saving. Understanding how it works and when to use it is essential for those at risk and their caregivers. Glucagon acts on the liver to release stored glucose (glycogen) into the bloodstream, rapidly increasing blood sugar levels. It is typically administered via injection into the muscle or, more recently, via a nasal spray.

There are different types of glucagon kits available:

Traditional Glucagon Injection Kits: These contain a vial of powdered glucagon and a syringe prefilled with a diluent. The liquid needs to be mixed with the powder before injecting.
Pre-mixed Glucagon Pens: These are prefilled and ready to inject, making them easier and faster to use.
Nasal Glucagon: This is a powder administered directly into the nostril, providing a needle-free option that can be easier for some people to use, particularly on an unconscious person.

Regardless of the type, it's critical that individuals at risk of hypoglycemia and their caregivers are trained on how to use the specific glucagon product they have. Regular refresher training is recommended to ensure familiarity and confidence in administering the medication.

Living with the Risk of Severe Hypoglycemia: Practical Tips

Living with diabetes can be challenging, especially with the constant vigilance required to prevent hypoglycemia. Here are some practical tips to help manage the risk and live a full and active life:

Establish a Routine: Set a consistent schedule for meals, medication, and exercise. Routine helps stabilize blood glucose levels.
Communicate with Your Healthcare Team: Work closely with your doctor, diabetes educator, and other healthcare providers to develop an individualized diabetes management plan.
Join a Support Group: Connecting with others who have diabetes can provide valuable emotional support and practical advice.
Plan Ahead for Travel: When traveling, pack extra supplies of medication, blood glucose testing equipment, and fast-acting glucose sources.
Be Mindful of Alcohol: If you choose to drink alcohol, do so in moderation and always with food.
Adjust Insulin for Exercise: Learn how to adjust insulin dosages or carbohydrate intake based on your activity level. Consult your healthcare provider for personalized guidance.
Get Enough Sleep: Sleep deprivation can affect blood glucose control. Aim for 7-8 hours of quality sleep each night.
Empower Yourself with Knowledge: Staying informed about diabetes management, medications, and potential complications is empowering and can lead to better outcomes.

Severe hypoglycemia is a serious concern, but with education, planning, and vigilance, it can be effectively managed. Being proactive and armed with the right knowledge enables you to take immediate action, potentially averting dire health consequences. Remember, you are not alone in navigating this journey. With diligent management and the support of your healthcare team, family, and friends, you can live a fulfilling life, confident in your ability to handle whatever challenges come your way.