Hypoglycemia (Severe): When to Seek Immediate Medical Help

Hypoglycemia, commonly known as low blood sugar, occurs when the level of glucose in your blood drops below what is healthy for you. While mild hypoglycemia can often be managed with a quick snack or a sugary drink, severe hypoglycemia can be a medical emergency. This article explains what severe hypoglycemia is, how to recognize it, and, most importantly, when to seek immediate medical help. Glycemic Index Vs Glycemic Load What S Best For Blood Sugar Control

What is Severe Hypoglycemia?

Hypoglycemia is generally defined as a blood sugar level below 70 mg/dL. However, severe hypoglycemia goes beyond just a low number. It's characterized by a blood sugar level that is so low that it causes significant neurological impairment. This means the person experiencing the low blood sugar is unable to treat themselves effectively because they are confused, disoriented, have seizures, or become unconscious. This level of hypoglycemia requires assistance from another person and potentially, emergency medical services. Common Mistakes To Avoid When Trying To Stabilize Blood Sugar

Causes of Severe Hypoglycemia

Several factors can contribute to severe hypoglycemia, particularly in individuals with diabetes:

• Excessive Insulin Dosage: Taking too much insulin, especially for those with Type 1 diabetes, is a primary cause.
• Missed or Delayed Meals: Not eating enough or skipping meals after taking insulin or oral diabetes medications can lead to a drop in blood sugar.
• Increased Physical Activity: Strenuous exercise can deplete glucose stores more quickly, especially if not properly planned or accounted for with adjusted insulin doses or increased carbohydrate intake.
• Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, particularly when consumed without food.
• Certain Medications: Besides diabetes medications, some other drugs can interact and increase the risk of hypoglycemia. Discuss all medications with your healthcare provider.
• Kidney or Liver Problems: These conditions can affect how your body processes glucose and insulin.
• Insulin Pump Malfunction: Issues with insulin delivery systems can result in unpredictable insulin levels.

Recognizing the Signs and Symptoms of Severe Hypoglycemia

It's critical to recognize the signs and symptoms of severe hypoglycemia to act quickly. These can include: The 5 Best Exercises To Help Regulate Blood Sugar In Type 2 Diabetes

• Confusion and Disorientation: Difficulty thinking clearly, confusion about time or place.
• Slurred Speech: Trouble speaking or articulating words clearly.
• Seizures: Uncontrolled muscle spasms and loss of consciousness.
• Loss of Consciousness: Unresponsiveness to stimuli.
• Unusual Behavior: Acting erratically or aggressively.
• Blurred Vision: Difficulty seeing clearly.
• Sweating: Excessive sweating, even when cold.
• Rapid Heartbeat: A noticeably fast or irregular pulse.

The signs of hypoglycemia can vary from person to person. Those who experience frequent low blood sugar may develop hypoglycemia unawareness, where they no longer experience the typical warning signs. This can make severe episodes even more dangerous.

When to Seek Immediate Medical Help

Severe hypoglycemia is a medical emergency that requires immediate intervention. Here's when to call for help:

• The person is unconscious or unresponsive: This is the most critical indicator that immediate medical assistance is needed. Call emergency services (911 in the US) right away.
• The person is having a seizure: Seizures due to hypoglycemia can be life-threatening. Call for emergency help immediately.
• The person is confused or disoriented and unable to follow instructions: If the individual cannot cooperate in treating the low blood sugar themselves, external help is necessary.
• You are unable to administer glucagon: If you have glucagon available but are unable to inject it due to the person's condition or your own lack of experience, call for emergency medical services.
• Blood sugar does not improve after administering glucagon or other treatment: If blood sugar levels don’t rise after attempting treatment, further medical intervention is required.

What to Do While Waiting for Medical Help

While waiting for emergency medical services, here are some steps you can take:

1. Do NOT try to give the person anything to eat or drink if they are unconscious: This could cause choking.
2. If you know how, administer glucagon: Glucagon is a hormone that raises blood sugar levels. It's usually available as an injection or nasal spray. Follow the instructions provided with the glucagon kit.
3. Place the person on their side in the recovery position: This helps prevent choking if they vomit.
4. Stay with the person and monitor their breathing and pulse: Provide reassurance and keep them comfortable.
5. Inform emergency responders about the person's medical history: If known, tell them about the person's diabetes, medications, and recent blood sugar readings (if available).

Prevention is Key

The best way to deal with severe hypoglycemia is to prevent it from happening in the first place. Here are some strategies:

• Regular Blood Sugar Monitoring: Frequently check your blood sugar levels, especially if you have diabetes or are prone to hypoglycemia.
• Careful Meal Planning: Eat regular meals and snacks, and balance carbohydrate intake with insulin dosages.
• Proper Insulin Management: Work closely with your healthcare provider to adjust insulin doses based on your activity level, diet, and overall health.
• Alcohol Moderation: Be mindful of alcohol consumption, especially on an empty stomach.
• Hypoglycemia Awareness Training: Educate yourself and your family members about the signs and symptoms of hypoglycemia, and how to treat it.
• Carry a Medical ID: Wear a medical ID bracelet or necklace that identifies you as having diabetes and lists any medications you take.
• Always carry a fast-acting source of glucose: Such as glucose tablets, juice, or hard candy.

Emergency Glucagon Administration Training and Resources

Understanding when and how to administer glucagon is paramount for caregivers of individuals at risk of severe hypoglycemia. Formal training, often available through diabetes education programs or your healthcare provider's office, can provide hands-on experience and build confidence. These programs often cover proper injection techniques (if using injectable glucagon), recognizing different glucagon formulations (injection vs. nasal spray), and troubleshooting potential issues.

Here are some resources that provide detailed information on how to administer glucagon:

• American Diabetes Association: The ADA website provides extensive resources on hypoglycemia, including information on glucagon and its administration.
• Diabetes UK: If located in the UK, Diabetes UK is an excellent resource for hypoglycemia information and glucagon administration guidance tailored to the UK healthcare system.
• Insulin Manufacturers Websites: Check the websites of insulin manufacturers for educational materials and videos on glucagon administration related to their specific products.

Managing Hypoglycemia Unawareness

As noted above, one of the more concerning complications of frequent hypoglycemia is the development of hypoglycemia unawareness. When this happens, individuals no longer experience the early warning symptoms of low blood sugar, increasing the risk of severe events. Strategies to regain hypoglycemia awareness include:

• Avoiding Low Blood Sugars: Meticulously avoiding low blood sugar levels for several weeks (typically 2-3 weeks) can help restore the body's sensitivity to low glucose levels. This involves more frequent blood glucose monitoring and careful adjustment of insulin doses with healthcare professional guidance.
• Continuous Glucose Monitoring (CGM): CGMs continuously track glucose levels and provide alerts when levels are trending high or low. They can be invaluable for identifying patterns and preventing significant hypoglycemia.
• Setting CGM Alerts: Working with your healthcare provider to set appropriate high and low alerts on your CGM can allow for proactive management and prevent both hypoglycemia and hyperglycemia (high blood sugar).

Additional Considerations for Specific Populations

Certain populations require specific consideration in managing hypoglycemia:

• Children: Children, particularly young children, may not be able to recognize or communicate the symptoms of hypoglycemia effectively. Caregivers need to be especially vigilant and proactive in monitoring blood sugar levels.
• Elderly Individuals: Older adults may have impaired kidney or liver function or be taking multiple medications, increasing their risk of hypoglycemia. They may also live alone, making timely treatment more challenging.
• Individuals with Cognitive Impairment: People with cognitive impairments may struggle to manage their diabetes and recognize the signs of hypoglycemia. Dedicated caregivers are essential to ensure proper blood sugar monitoring and treatment.

Living with Diabetes and Preventing Severe Hypoglycemia

Living with diabetes requires careful management and awareness. Preventing severe hypoglycemia is a critical aspect of that management. By understanding the causes, recognizing the symptoms, knowing when to seek help, and implementing preventive strategies, you can significantly reduce your risk of experiencing a severe episode. Remember, frequent communication with your healthcare team and ongoing education are essential components of successful diabetes management.

Summary Table of Key Actions

Here's a quick summary of key actions to take in case of severe hypoglycemia:

By being prepared and informed, you can respond effectively in a hypoglycemic emergency and help ensure the safety and well-being of yourself or others.