Recognizing Severe Hypoglycemia: A Guide for Persons with Diabetes

Severe hypoglycemia, or severely low blood sugar, is a critical and potentially life-threatening condition that can occur in people with diabetes who take insulin or certain oral medications. It's crucial to understand what severe hypoglycemia is, how to recognize its signs and symptoms, and how to respond effectively. This comprehensive guide provides essential information for individuals with diabetes, their families, and caregivers.

What is Severe Hypoglycemia?

Hypoglycemia refers to a condition in which blood glucose levels fall below the normal range, typically defined as below 70 mg/dL (3.9 mmol/L). While mild to moderate hypoglycemia can often be self-treated with fast-acting carbohydrates, severe hypoglycemia is characterized by a blood sugar level so low that the individual is unable to treat themselves and requires assistance from another person. This usually involves glucagon administration or intravenous glucose in a medical setting.

Severe hypoglycemia can lead to serious complications, including:

Loss of consciousness
Seizures
Coma
Brain damage (in rare cases)
Death (in extremely rare cases)

Therefore, being able to recognize and respond to severe hypoglycemia promptly is paramount for people with diabetes and those around them.

Why Does Severe Hypoglycemia Occur?

Several factors can contribute to the development of severe hypoglycemia in people with diabetes:

Excessive Insulin or Medications: Taking too much insulin or certain oral diabetes medications (sulfonylureas, such as glipizide, glyburide, and glimepiride) can lead to blood sugar levels dropping too low.
Skipping Meals or Eating Too Little: Not eating enough carbohydrates or skipping meals altogether can reduce the available glucose in the bloodstream.
Increased Physical Activity: Engaging in strenuous physical activity without adjusting insulin dosages or increasing carbohydrate intake can deplete glucose stores rapidly.
Alcohol Consumption: Alcohol can impair the liver's ability to release glucose, especially when consumed without food.
Kidney or Liver Disease: Impaired kidney or liver function can affect the body's ability to regulate blood sugar levels. Managing Type 1 Diabetes A Guide For Newly Diagnosed Persons
Incorrect Insulin Injection Techniques or Timing: Variations in the absorption of insulin caused by incorrect injection techniques or timing in relation to meals can lead to unpredictable glucose fluctuations.
Illness or Infection: Infections can change insulin needs due to increased stress hormones and changes in appetite.

Recognizing the Signs and Symptoms of Severe Hypoglycemia

Recognizing the signs and symptoms of hypoglycemia is essential for timely intervention. Symptoms can vary from person to person and can evolve as the condition progresses. Here's a breakdown of the warning signs:

Early Symptoms of Hypoglycemia:

These symptoms usually appear before the blood sugar level drops to a dangerous level. They serve as an early warning.

Shakiness: Feeling shaky or trembling, even when sitting still.
Sweating: Breaking into a cold sweat without exertion or apparent reason.
Dizziness or Lightheadedness: Experiencing a feeling of unsteadiness or faintness.
Hunger: Intense feelings of hunger, even after recently eating.
Irritability or Anxiety: Feeling unusually irritable, anxious, or nervous.
Confusion: Difficulty concentrating, thinking clearly, or making decisions.
Rapid Heartbeat: Noticeably increased heart rate.

Symptoms of Progressing Hypoglycemia:

If early symptoms are not addressed, hypoglycemia can worsen and lead to more severe symptoms.

Difficulty Speaking: Slurred speech or difficulty finding the right words.
Blurred Vision: Changes in vision, such as seeing double or blurry images.
Weakness or Fatigue: Feeling extremely tired and weak.
Coordination Problems: Difficulty walking, moving limbs, or performing fine motor tasks.
Personality Changes: Exhibiting unusual or erratic behavior.

Symptoms of Severe Hypoglycemia:

These symptoms indicate a medical emergency and require immediate intervention. The person will likely need help from others to treat themselves.

Unconsciousness: Losing consciousness or becoming unresponsive.
Seizures: Experiencing convulsions or uncontrolled muscle spasms.
Inability to Swallow: Being unable to swallow food or liquids.

Note: Some individuals may experience hypoglycemia unawareness, a condition in which they do not experience the early warning signs of hypoglycemia. This increases the risk of severe hypoglycemia and necessitates more frequent blood glucose monitoring and consultation with a healthcare professional.

How to Respond to Severe Hypoglycemia

If you suspect someone is experiencing severe hypoglycemia, it's crucial to act quickly. Here's a step-by-step guide:

Check for Responsiveness: Gently shake the person and ask if they are okay. If they are unresponsive or unable to answer, assume they need help.
Do NOT give food or liquid if the person is unconscious: Giving food or liquid can cause choking and further complications.
Administer Glucagon: Glucagon is a hormone that raises blood sugar levels. Individuals at risk for severe hypoglycemia should have a glucagon emergency kit readily available, along with trained family members or caregivers who know how to administer it. Glucagon comes in two forms:
- Injectable Glucagon: The glucagon is reconstituted (mixed) and injected intramuscularly (into the muscle).
- Nasal Glucagon: The glucagon is administered via nasal spray.
Follow the instructions included in the glucagon kit carefully. Always check the expiration date before using.
Call for Emergency Medical Assistance: After administering glucagon, call emergency services (911 in the United States, or your local emergency number) immediately. Even if the person regains consciousness, they need medical evaluation and follow-up care. Inform the emergency responders that the person is experiencing severe hypoglycemia and has received glucagon.
Monitor Breathing and Circulation: While waiting for emergency assistance, monitor the person's breathing and circulation. If they are not breathing, begin CPR if you are trained to do so.
Provide Information to Medical Professionals: When paramedics or other medical professionals arrive, provide them with information about the person's diabetes, medications, and any known allergies. Also, inform them when and how much glucagon was administered.
Follow Up with a Healthcare Professional: After an episode of severe hypoglycemia, schedule an appointment with the person's healthcare provider to discuss the event, review their diabetes management plan, and identify potential causes of the hypoglycemia. The diabetes treatment plan may need adjustments.

Glucagon: Your Emergency Backup

Glucagon is a life-saving medication that every person with diabetes who is at risk of hypoglycemia and their family or caregivers should have access to. Here are some essential details about Glucagon:

Types of Glucagon

Injectable Glucagon: This has been around for a long time. It requires mixing before injection.
Nasal Glucagon: This is a more recent innovation, and is user friendly and easier to administer.

Where to Get Glucagon

Obtain a prescription from your doctor.
Fill the prescription at your local pharmacy.
Check that your insurance covers Glucagon, and explore patient assistance programs if needed.

How to Use Glucagon

Training is key: Be trained by your doctor, pharmacist, or diabetes educator on how to use the specific glucagon product you have.
Educate family and friends: Ensure loved ones know where the Glucagon is stored and how to administer it.
Regularly check expiration dates: Replace expired Glucagon immediately.

Preventing Severe Hypoglycemia

Prevention is always better than cure. Here are some strategies to help prevent severe hypoglycemia:

Regular Blood Glucose Monitoring: Check blood glucose levels regularly, especially before meals, bedtime, and exercise. This helps identify trends and make necessary adjustments to insulin dosages or carbohydrate intake. Continuous Glucose Monitors (CGMs) can be particularly helpful for people prone to hypoglycemia because they sound an alarm when blood sugar drops below a pre-set level. Surprising Factors That Affect Your Daily Blood Sugar Range
Adhere to Prescribed Medications: Take insulin or other diabetes medications exactly as prescribed by your healthcare provider. Do not skip doses or change dosages without consulting your doctor.
Match Insulin to Carbohydrate Intake: Work with a registered dietitian or certified diabetes educator to learn how to accurately estimate carbohydrate intake and adjust insulin dosages accordingly.
Plan Meals and Snacks: Eat regular meals and snacks at consistent times throughout the day. Avoid skipping meals, especially when taking insulin or sulfonylureas.
Adjust Insulin for Exercise: Talk to your healthcare provider about adjusting insulin dosages or increasing carbohydrate intake before, during, and after exercise. How To Master The Control Of Blood Glucose Levels For Better Health
Limit Alcohol Consumption: If you choose to drink alcohol, do so in moderation and always with food. Be aware that alcohol can lower blood sugar levels and impair judgment.
Carry Fast-Acting Carbohydrates: Always carry a source of fast-acting carbohydrates, such as glucose tablets, juice boxes, or hard candies, to treat mild to moderate hypoglycemia promptly.
Wear a Medical Identification: Wear a medical ID bracelet or necklace that identifies you as having diabetes and lists any medications you are taking. This can help emergency responders provide appropriate treatment if you are unable to communicate.
Educate Family and Friends: Educate family members, friends, and caregivers about the signs and symptoms of hypoglycemia and how to administer glucagon.
Utilize Technology: Consider using a continuous glucose monitor (CGM) and/or an insulin pump. CGMs can alert you to impending low blood sugar, while insulin pumps can be programmed to deliver basal insulin rates tailored to your individual needs. Some pumps can even shut off insulin delivery when blood sugar is predicted to drop too low.

Special Considerations

Children with Diabetes: Children with diabetes may have difficulty recognizing or communicating the symptoms of hypoglycemia. Parents and caregivers should be vigilant in monitoring blood glucose levels and responding promptly to any signs of low blood sugar.
Elderly Individuals with Diabetes: Elderly individuals with diabetes may be more susceptible to hypoglycemia due to age-related changes in kidney and liver function, cognitive impairment, and medication interactions. They may also have difficulty administering glucagon themselves.
Individuals with Hypoglycemia Unawareness: Individuals with hypoglycemia unawareness should work closely with their healthcare provider to develop a strategy for managing their diabetes and preventing severe hypoglycemia. This may involve more frequent blood glucose monitoring, continuous glucose monitoring, and adjusting insulin dosages or other medications.

Key Takeaways

Severe hypoglycemia is a dangerous condition that requires immediate attention.
Recognize the signs and symptoms of hypoglycemia and act quickly.
Always have a glucagon kit readily available and ensure that family members and caregivers know how to administer it.
Prevention is key. Monitor blood glucose levels regularly, adhere to prescribed medications, and plan meals and snacks carefully.
Educate yourself, your family, and your caregivers about diabetes management and hypoglycemia prevention.

By taking proactive steps to prevent and manage hypoglycemia, people with diabetes can live healthy and fulfilling lives. It is critical to partner with your healthcare team to establish a plan that works for your individual needs.