Recognizing Severe Hypoglycemia: An Emergency Guide for Persons with Diabetes

17 Sep 2025 By Danielle M. Shilling, M.D.

Recognizing Severe Hypoglycemia: An Emergency Guide for Persons with Diabetes

Hypoglycemia, often referred to as low blood sugar, is a common complication for individuals managing diabetes. While mild to moderate hypoglycemia can usually be self-treated, severe hypoglycemia represents a serious medical emergency. Recognizing the signs and knowing how to respond can be life-saving. This guide is designed to provide individuals with diabetes, their families, and caregivers with critical information for identifying and managing severe hypoglycemic episodes.

Understanding Hypoglycemia in Diabetes

Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels. To manage this, many individuals with diabetes use insulin or other medications to lower their blood sugar. Hypoglycemia occurs when blood glucose levels drop too low—typically below 70 mg/dL (3.9 mmol/L). The Best Exercises For Managing Diabetes And Glucose Levels

Several factors can contribute to hypoglycemia:

Excessive insulin dosage: Taking too much insulin relative to food intake or activity level.
Missed or delayed meals: Not eating enough carbohydrates to match insulin levels.
Increased physical activity: Exercise can increase insulin sensitivity and glucose utilization.
Alcohol consumption: Alcohol can impair the liver's ability to release glucose into the bloodstream.
Certain medications: Some non-diabetes medications can also lower blood glucose levels.

Understanding these triggers is crucial for preventing hypoglycemic episodes.

Recognizing the Symptoms of Hypoglycemia

Hypoglycemia presents with a range of symptoms, which can vary in severity. Recognizing these symptoms early is critical for preventing progression to severe hypoglycemia.

Mild to Moderate Hypoglycemia Symptoms

These symptoms usually appear when blood glucose levels drop below 70 mg/dL:

Shakiness
Sweating
Dizziness or lightheadedness
Hunger
Irritability or anxiety
Rapid heartbeat
Blurred vision
Confusion
Headache

Individuals experiencing these symptoms should immediately check their blood glucose levels and take quick-acting carbohydrates, such as glucose tablets, juice, or hard candies.

Severe Hypoglycemia Symptoms

Severe hypoglycemia is characterized by cognitive impairment, loss of consciousness, seizures, or coma. This occurs when the brain does not receive enough glucose to function properly. Symptoms include:

Inability to think clearly or follow instructions
Loss of coordination
Slurred speech
Seizures
Unconsciousness or coma

If someone is experiencing any of the severe hypoglycemia symptoms, it is a medical emergency.

Emergency Response to Severe Hypoglycemia

Responding quickly and effectively to severe hypoglycemia is crucial to prevent serious complications, including brain damage or death. Here’s a step-by-step guide:

Step 1: Do Not Attempt to Give Food or Drink

If the person is unconscious or unable to swallow, do not try to force food or drink into their mouth. This can cause choking.

Step 2: Administer Glucagon

Glucagon is a hormone that raises blood glucose levels by stimulating the liver to release stored glucose. It is typically available as an injectable medication.

Locate the Glucagon Kit: Ensure you have access to a glucagon emergency kit, typically prescribed by the person's physician.
Prepare the Injection: Follow the instructions on the glucagon kit. This usually involves mixing the powder with the liquid.
Administer the Injection: Inject glucagon into the thigh, arm, or buttock. You do not need medical training to administer glucagon in an emergency.
Dosage: Typically, the entire dose is given. Follow the specific instructions provided with the glucagon kit.

Example: If a child has severe hypoglycemia and cannot swallow, a parent should administer glucagon using the prepared kit, following the specific dosage instructions for children.

Step 3: Call for Emergency Medical Assistance

Immediately call emergency services (911 in the United States or the equivalent in your country) after administering glucagon. Even if the person regains consciousness, professional medical evaluation is essential.

Step 4: Provide Information to Emergency Responders

When emergency responders arrive, provide them with the following information:

The person’s diabetes status
That they have received glucagon
Any other relevant medical history or medications

Step 5: Monitor the Person After Glucagon Administration

Glucagon usually takes 10-15 minutes to raise blood glucose levels. After administering glucagon:

Watch for Improvement: The person should gradually regain consciousness and become more responsive.
Prevent Recurrence: Once conscious and able to swallow, give the person a fast-acting source of glucose (such as juice or glucose tablets) followed by a longer-acting source of carbohydrates (such as crackers or a sandwich) to stabilize blood glucose levels and prevent recurrence of hypoglycemia.
Seek Medical Evaluation: Even if the person seems to recover fully, a follow-up with their healthcare provider is crucial to determine the cause of the severe hypoglycemic episode and adjust their diabetes management plan as needed.

The Importance of Education and Preparedness

Being prepared for a hypoglycemic emergency involves more than just knowing how to administer glucagon. Education, communication, and proactive measures are key.

Educate Family and Friends

Ensure that family members, friends, and coworkers know how to recognize hypoglycemia symptoms and how to administer glucagon. Hold regular training sessions to practice glucagon administration and review emergency protocols.

Wear Medical Identification

Individuals with diabetes should wear medical identification (such as a MedicAlert bracelet or necklace) indicating their condition and emergency contact information. This helps ensure appropriate medical care in case of an emergency. Fasting Blood Glucose Why It Matters And What Your Test Results Mean

Carry a Glucagon Kit

Always carry a glucagon emergency kit, especially when traveling or engaging in physical activity. Check the expiration date regularly and replace it as needed.

Monitor Blood Glucose Levels Regularly

Regularly monitor blood glucose levels, especially before meals, after exercise, and before bedtime. This helps identify trends and make necessary adjustments to medication or meal plans to prevent hypoglycemia.

Communicate with Healthcare Providers

Regularly consult with healthcare providers, including endocrinologists and diabetes educators, to review diabetes management plans and address any concerns or challenges. Be proactive in discussing any instances of hypoglycemia and work together to identify strategies for prevention.

Legal and Ethical Considerations

In many jurisdictions, individuals are protected by laws that allow non-medical personnel to administer glucagon in an emergency situation. Understanding these laws and ethical considerations can provide additional confidence and clarity when responding to a hypoglycemic emergency. Type 1 Vs Type 2 Diabetes Understanding The Core Differences In Glucose Control

Good Samaritan Laws: Many regions have Good Samaritan laws that protect individuals who provide assistance to someone in medical distress, provided they act in good faith and without negligence.
Liability Protection: Healthcare providers can advise and train family members or caregivers on how to administer glucagon, offering some level of liability protection if they follow established protocols.

Technological Advancements in Hypoglycemia Management

Technological advancements have greatly improved diabetes management, offering continuous glucose monitoring and automated insulin delivery systems. These innovations help reduce the risk of hypoglycemia.

Continuous Glucose Monitoring (CGM): CGMs continuously measure glucose levels and provide real-time readings, trends, and alerts. Many CGMs have alarms that can warn individuals of impending hypoglycemia, allowing them to take proactive measures to prevent a severe episode.
Insulin Pumps: Insulin pumps deliver a steady basal rate of insulin and can be programmed to deliver bolus doses for meals. Advanced pumps can communicate with CGMs and automatically adjust insulin delivery based on glucose levels, reducing the risk of hypoglycemia.
Artificial Pancreas Systems: These systems combine CGM data with insulin pump technology to create a closed-loop system that automatically adjusts insulin delivery to maintain target glucose levels. These systems can significantly reduce the frequency and severity of hypoglycemia.

Case Studies

Case Study 1: A Teenager with Type 1 Diabetes

A 16-year-old with type 1 diabetes experiences severe hypoglycemia during a soccer game. His coach, trained in recognizing hypoglycemia and administering glucagon, quickly injects him with glucagon. The teenager regains consciousness and is taken to the hospital for evaluation.

Lesson Learned: Training coaches and teachers to recognize and respond to hypoglycemia can be life-saving.

Case Study 2: An Elderly Woman with Type 2 Diabetes

An 80-year-old woman with type 2 diabetes on insulin has a severe hypoglycemic episode at home. Her home healthcare aide, who has received diabetes education, administers glucagon and calls emergency services. The woman recovers fully and her diabetes medication is adjusted to prevent future episodes.

Lesson Learned: Educating home healthcare providers and family members is essential for managing diabetes in elderly individuals.

Conclusion

Recognizing and responding to severe hypoglycemia is a critical skill for individuals with diabetes, their families, and caregivers. By understanding the symptoms, knowing how to administer glucagon, and taking proactive measures to prevent hypoglycemia, it is possible to effectively manage this medical emergency and improve the quality of life for those living with diabetes. Remember that education, preparation, and communication are key to ensuring a safe and healthy life with diabetes. If in doubt, always err on the side of caution and seek professional medical help.