Hypoglycemia (Severe Low Blood Sugar): What to Do in an Emergency

Hypoglycemia, or low blood sugar, is a condition that occurs when the level of glucose (sugar) in your blood drops too low. While mild hypoglycemia can often be managed with quick-acting carbohydrates, severe hypoglycemia requires immediate intervention to prevent serious consequences, including seizures, loss of consciousness, and even death. This article provides a comprehensive guide on recognizing, treating, and preventing severe hypoglycemic episodes. What Does A Normal Blood Sugar Range Look Like For Persons With Diabetes

Understanding Severe Hypoglycemia

Severe hypoglycemia happens when your blood sugar drops to a level where you become confused, disoriented, or unable to treat yourself, and you require assistance from someone else. It’s a serious complication primarily affecting people with diabetes who take insulin or certain oral medications that stimulate insulin production. However, in rare cases, it can also occur in people without diabetes due to various underlying medical conditions. The Best Breakfasts For People With Type 2 Diabetes

What Causes Severe Hypoglycemia?

Several factors can contribute to a significant drop in blood sugar, leading to severe hypoglycemia:

• Overdosing on Insulin or Oral Medications: Taking too much diabetes medication is a primary cause.
• Skipping Meals or Eating Too Little: Inadequate carbohydrate intake can quickly lower blood sugar levels.
• Increased Physical Activity Without Adjusting Medication or Food Intake: Exercise utilizes glucose, and without proper adjustments, hypoglycemia can occur.
• Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream.
• Kidney or Liver Disease: Impaired organ function can affect how medications are processed and glucose is regulated.
• Certain Medical Conditions: Less common causes include tumors that produce insulin (insulinomas) and hormone deficiencies.

Who is at Risk?

While severe hypoglycemia can affect anyone with diabetes taking insulin or certain oral medications, some individuals are at higher risk:

• People with a Long History of Diabetes: Their ability to recognize early symptoms of hypoglycemia may diminish over time (hypoglycemia unawareness).
• Individuals with Strict Blood Sugar Control: Tighter glucose management increases the risk of low blood sugar events.
• People with Coexisting Medical Conditions: Kidney or liver disease, as mentioned earlier, can increase the risk.
• Those with Cognitive Impairment: Difficulty managing medication or meals consistently can contribute to severe hypoglycemia.

| Risk Factor | Description | | ------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Long-Standing Diabetes | Reduced ability to recognize hypoglycemia symptoms over time. | | Strict Blood Sugar Control (A1c <7%) | Lower target ranges increase the risk of blood sugar dipping too low. | | Kidney or Liver Disease | These conditions impair the body's ability to regulate glucose effectively, impacting medication processing and glucose release. | | Cognitive Impairment | Challenges in adhering to medication schedules and meal plans increase the risk of inconsistent glucose levels, leading to severe hypoglycemia. |

Recognizing the Signs and Symptoms

Knowing the symptoms of severe hypoglycemia is crucial for prompt treatment. Recognizing them in yourself and others could be lifesaving. The signs and symptoms can vary from person to person, but often include:

Early Symptoms (May be similar to mild hypoglycemia):

• Shakiness or trembling
• Sweating
• Rapid heartbeat
• Anxiety or nervousness
• Blurred vision
• Dizziness or lightheadedness
• Headache
• Hunger

Severe Symptoms:

• Confusion
• Difficulty concentrating
• Slurred speech
• Irrational behavior or personality changes
• Loss of coordination
• Seizures
• Loss of consciousness

It's crucial to remember that someone experiencing severe hypoglycemia might not recognize their symptoms or be able to help themselves. Don’t hesitate to call for emergency medical assistance if you suspect someone is experiencing severe hypoglycemia.

Emergency Treatment: What to Do When Someone is Unconscious or Unable to Swallow

If someone is experiencing severe hypoglycemia and is unconscious, convulsing, or unable to swallow, the primary goal is to get glucose into their bloodstream as quickly as possible. The following are the two main treatment options in such emergencies:

1. Glucagon Injection

Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It's available as an injectable medication and is typically prescribed to individuals at risk of severe hypoglycemia and their caregivers.

Steps for Administering Glucagon:

1. Call for Emergency Medical Help (911 in the US, or your local emergency number): Even after administering glucagon, immediate medical attention is necessary.
2. Locate the Glucagon Kit: Ensure you know where the glucagon kit is stored and how to use it before an emergency arises.
3. Prepare the Injection: Follow the instructions provided with the glucagon kit. This usually involves mixing the glucagon powder with the provided liquid.
4. Administer the Injection: Inject the glucagon into the thigh, upper arm, or buttock. You can inject through clothing if necessary.
5. Turn the Person on Their Side: This is important to prevent choking if the person vomits.
6. Wait for a Response: It may take 5-15 minutes for the person to regain consciousness.
7. If No Improvement After 15 Minutes: Follow the instructions on the glucagon kit, or if none are available, contact emergency services for advice.
8. Monitor the Person: Once the person regains consciousness, provide them with a fast-acting carbohydrate source (see below) and monitor their blood sugar.

Important Considerations:

• Training is Essential: Caregivers should be trained by a healthcare professional on how to administer glucagon correctly.
• Expiration Date: Check the expiration date on the glucagon kit regularly and replace it before it expires.
• Glucagon Nasal Spray: A glucagon nasal spray is available. Familiarize yourself with its use if prescribed.
• Side Effects: Common side effects of glucagon include nausea and vomiting.

2. Intravenous Glucose (Administered by Medical Professionals)

In a hospital or emergency medical setting, healthcare professionals can administer glucose directly into the bloodstream via an intravenous (IV) line. This is the fastest and most reliable way to raise blood sugar levels in an unconscious person.

What Happens After Emergency Treatment?

Once the person regains consciousness and is able to swallow, they should:

• Eat a Fast-Acting Carbohydrate Source: Examples include:
  • 4-6 glucose tablets
  • 4 ounces of juice or regular soda (not diet)
  • 1 tablespoon of honey or syrup
• Follow with a Longer-Acting Carbohydrate Source: This will help stabilize blood sugar levels and prevent another hypoglycemic episode. Examples include:
  • A sandwich with protein
  • Crackers with cheese
  • A glass of milk
• Monitor Blood Sugar Regularly: Check blood sugar levels every 15-30 minutes to ensure they are rising and remain stable.
• Seek Medical Evaluation: It's important to consult with a healthcare professional to determine the cause of the severe hypoglycemic episode and adjust the diabetes management plan accordingly.

| Treatment | When to Use | How to Administer | | ------------------------ | --------------------------------------------------------------- | ----------------------------------------------------------------------------------------- | | Glucagon Injection | Unconscious or unable to swallow; outside a medical setting | Follow kit instructions; inject into thigh, upper arm, or buttock | | IV Glucose | In a hospital or emergency medical setting | Administered by medical professionals through an intravenous line | | Fast-Acting Carbs | Once conscious and able to swallow | 4-6 glucose tablets, 4oz juice/soda, 1 tbsp honey/syrup | | Longer-Acting Carbs | After fast-acting carbs to stabilize blood sugar; when conscious | Sandwich with protein, crackers with cheese, glass of milk | A Beginner S Guide To The Glycemic Index Gi For Blood Sugar Balance

Preventing Severe Hypoglycemia

Prevention is always the best approach. People with diabetes and their caregivers can take several steps to minimize the risk of severe hypoglycemic episodes:

1. Education and Awareness

• Understand Your Diabetes Medications: Know how your insulin or oral medications work, their peak action times, and potential side effects.
• Recognize Early Symptoms of Hypoglycemia: Learn to identify the subtle warning signs so you can treat low blood sugar before it becomes severe.
• Educate Family Members and Friends: Make sure your loved ones know how to recognize the signs of hypoglycemia and how to administer glucagon if needed.

2. Regular Blood Sugar Monitoring

• Check Blood Sugar Frequently: Monitor your blood sugar levels regularly, especially before meals, before bedtime, and before, during, and after exercise.
• Consider Continuous Glucose Monitoring (CGM): A CGM can provide real-time glucose readings and alert you to trends and potential lows, even before you feel symptoms.
• Keep a Log: Track your blood sugar levels, medication dosages, food intake, and physical activity to identify patterns and potential triggers for hypoglycemia.

3. Meal Planning and Carbohydrate Counting

• Eat Regular Meals and Snacks: Avoid skipping meals or going for long periods without eating.
• Carbohydrate Counting: Work with a registered dietitian to learn how to count carbohydrates accurately and adjust your insulin doses accordingly.
• Balance Your Meals: Include a combination of carbohydrates, protein, and healthy fats in each meal to help stabilize blood sugar levels.

4. Medication Management

• Take Medications as Prescribed: Follow your doctor's instructions carefully regarding medication dosages and timing.
• Communicate with Your Healthcare Team: Discuss any changes in your diet, activity level, or health status with your doctor so they can adjust your medication regimen as needed.
• Review Medications Regularly: Periodically review all of your medications with your doctor or pharmacist to identify any potential interactions or side effects that could contribute to hypoglycemia.

5. Exercise Precautions

• Check Blood Sugar Before, During, and After Exercise: Monitor your blood sugar closely during physical activity, as exercise can lower blood sugar levels.
• Adjust Insulin or Carbohydrate Intake: You may need to reduce your insulin dose or consume extra carbohydrates before, during, or after exercise to prevent hypoglycemia.
• Carry a Fast-Acting Carbohydrate Source: Always carry a readily available source of glucose with you when exercising, such as glucose tablets, juice, or a sports drink.

6. Alcohol Consumption

• Drink in Moderation: If you choose to drink alcohol, do so in moderation and with food.
• Monitor Blood Sugar Closely: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, so check your blood sugar frequently while drinking.
• Never Drink on an Empty Stomach: Always eat something before and while drinking alcohol.

7. Medical Alert Identification

• Wear a Medical Alert Bracelet or Necklace: This will alert emergency medical personnel to your diabetes in case you are unable to communicate.
• Carry a Medical Identification Card: Include information about your diabetes, medications, allergies, and emergency contact information.

| Prevention Strategy | Description | | ------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------ | | Education & Awareness | Understand meds, recognize symptoms, educate family/friends | | Regular Monitoring | Check sugar often, consider CGM, keep a log of glucose readings, medication doses, diet, and activities | | Meal Planning | Regular meals/snacks, carb counting with dietician, balanced meals (carbs, protein, fat) | | Medication Mgmt | Take as prescribed, communicate with healthcare team, review meds regularly | | Exercise Precautions | Check sugar before/during/after, adjust insulin/carbs, carry quick carbs | | Alcohol Consumption | Drink moderately, with food, monitor sugar closely | | Medical Alert | Wear bracelet/necklace, carry ID card |

Conclusion

Severe hypoglycemia is a potentially life-threatening condition that requires prompt recognition and treatment. By understanding the causes, symptoms, and treatment options for severe hypoglycemia, and by taking proactive steps to prevent it, individuals with diabetes and their caregivers can significantly reduce the risk of serious complications and maintain better overall health. Remember, knowledge is power, and being prepared can make all the difference in an emergency. Always consult with your healthcare provider for personalized advice and guidance on managing your diabetes effectively.