Severe Hypoglycemia: An Emergency Guide for Low Blood Sugar Events

17 Sep 2025 By Sergey Turchin, M.D.

Severe Hypoglycemia: An Emergency Guide for Low Blood Sugar Events

Hypoglycemia, or low blood sugar, is a common complication of diabetes treatment, particularly in individuals using insulin or certain oral medications. While mild hypoglycemia can often be managed with quick-acting carbohydrates, severe hypoglycemia represents a medical emergency requiring immediate intervention. This guide provides a comprehensive overview of severe hypoglycemia, its recognition, treatment, and prevention, aimed at empowering individuals with diabetes, their families, and caregivers to respond effectively during such events. Understanding the intricacies of low blood sugar events is crucial for ensuring safety and minimizing potential long-term complications.

Understanding Severe Hypoglycemia

Severe hypoglycemia is defined as a state of very low blood sugar where the individual is unable to treat themselves due to confusion, unconsciousness, seizures, or other neurological impairments. It typically occurs when blood glucose levels drop below 70 mg/dL (3.9 mmol/L) and can progress rapidly, leading to serious consequences if left untreated.

Key Characteristics of Severe Hypoglycemia

Inability to Self-Treat: The individual is unable to take oral carbohydrates or administer their own medications.
Altered Mental Status: Confusion, disorientation, difficulty concentrating, or loss of consciousness.
Neurological Symptoms: Seizures, slurred speech, blurred vision, or unusual behavior.
Requirement for External Assistance: Requires assistance from another person to administer treatment, such as glucagon or calling for emergency medical services.

Why Severe Hypoglycemia is a Medical Emergency

Untreated severe hypoglycemia can lead to:

Brain Damage: The brain relies on glucose as its primary energy source, and prolonged deprivation can result in irreversible neurological damage.
Seizures: Low blood sugar can trigger seizures, potentially leading to physical injury.
Cardiac Arrhythmias: Hypoglycemia can disrupt the heart's normal rhythm, leading to palpitations, dizziness, or even cardiac arrest in susceptible individuals.
Coma: In severe cases, prolonged hypoglycemia can lead to a loss of consciousness and coma, requiring intensive medical care.
Death: Although rare, severe hypoglycemia can be fatal if not treated promptly.

Recognizing the Signs and Symptoms

Early recognition of hypoglycemia is crucial for preventing its progression to a severe event. Individuals with diabetes, their families, and caregivers should be educated on the common signs and symptoms of low blood sugar.

Mild to Moderate Hypoglycemia Symptoms

These symptoms typically appear before severe hypoglycemia sets in and serve as warning signs:

Shakiness: Trembling or feeling unsteady.
Sweating: Excessive perspiration, often cold and clammy.
Dizziness: Feeling lightheaded or faint.
Hunger: Intense cravings for food, especially sweets.
Irritability: Feeling anxious, nervous, or easily agitated.
Confusion: Difficulty thinking clearly or concentrating.
Rapid Heartbeat: Palpitations or a racing pulse.
Blurred Vision: Difficulty focusing or seeing clearly.

Severe Hypoglycemia Symptoms

As hypoglycemia worsens, the following symptoms may appear, indicating a medical emergency:

Loss of Consciousness: Unresponsiveness or fainting.
Seizures: Involuntary muscle contractions or convulsions.
Unusual Behavior: Acting strangely, such as aggression or irrationality.
Slurred Speech: Difficulty speaking clearly.
Inability to Follow Instructions: Difficulty understanding or responding to simple commands.

Responding to a Severe Hypoglycemia Event

When faced with a severe hypoglycemic event, prompt and appropriate action is critical to prevent serious complications.

Step-by-Step Emergency Response

Assess the Situation:
- Confirm Unresponsiveness: Check if the person is conscious and able to respond to questions or commands.
- Look for Medical Identification: Check for a medical alert bracelet, necklace, or card indicating diabetes or other relevant medical information.
Call for Help:
- Dial Emergency Services: Immediately call 911 (or your local emergency number) and clearly state that the person is experiencing severe hypoglycemia and is unresponsive or having a seizure.
- Provide Accurate Information: Give the dispatcher the person's location, a description of their condition, and any relevant medical history (if known).
Administer Glucagon (If Available):
- Glucagon is a hormone that raises blood sugar levels. It is typically prescribed to individuals at risk of severe hypoglycemia.
- Locate the Glucagon Kit: Check for a glucagon emergency kit, which usually contains a vial of powdered glucagon and a syringe with sterile water.
- Prepare the Glucagon Injection:
  - Follow the instructions in the kit to mix the glucagon powder with the sterile water.
  - Gently swirl the vial until the glucagon is fully dissolved.
  - Draw the solution into the syringe.
- Administer the Injection:
  - Inject the glucagon into the muscle (intramuscularly). Common injection sites include the outer thigh, upper arm, or buttocks.
  - The injection site does not need to be sterilized with alcohol first.
  - Follow the instructions in the glucagon kit for the appropriate dosage. The standard adult dose is 1 mg, while children may require a lower dose based on their weight.
- Monitor the Person:
  - After the glucagon injection, the person should start to regain consciousness within 5-15 minutes.
  - If there is no improvement within 15 minutes, repeat the glucagon injection (if another dose is available) and continue monitoring until emergency medical services arrive.
Do Not Attempt to Give Oral Food or Drink to an Unconscious Person:
- Giving food or drink to someone who is unconscious or having a seizure can cause them to choke or aspirate, leading to serious complications.
If the Person Regains Consciousness:
- Give Fast-Acting Carbohydrates: Once the person is conscious and able to swallow, provide them with fast-acting carbohydrates to quickly raise their blood sugar levels. Examples include:
  - Glucose tablets (follow package instructions for dosage)
  - Fruit juice (4-6 ounces)
  - Regular soda (4-6 ounces)
  - Hard candies (avoid giving to young children due to choking hazard)
- Follow with a Longer-Acting Carbohydrate Source: After giving fast-acting carbohydrates, provide a longer-acting carbohydrate source, such as a granola bar, crackers, or a sandwich, to help stabilize blood sugar levels and prevent another hypoglycemic episode.
- Monitor Blood Sugar Levels: Check blood sugar levels every 15-20 minutes to ensure they are rising and remain within a safe range (above 70 mg/dL).
- Seek Medical Attention: Even if the person recovers fully, it is essential to seek medical attention from a healthcare professional to determine the cause of the severe hypoglycemia and adjust their diabetes management plan accordingly.

Practical Table: Responding to Severe Hypoglycemia

| Action | Description | | ---------------------------- | ---------------------------------------------------------------------------------------------------------------- | | Assess Responsiveness | Check if the person is conscious; look for medical ID. | | Call for Emergency Services | Dial 911, state severe hypoglycemia, and provide the location and details. | | Administer Glucagon | Prepare and inject glucagon (if available) following the kit's instructions into the thigh, arm, or buttocks. | | Monitor and Repeat | Observe for improvement; repeat glucagon injection after 15 minutes if necessary. | | Post-Recovery Care | Give fast-acting carbs, followed by a longer-acting source, and monitor blood sugar levels closely. Seek medical advice. |

Understanding and Using Glucagon

Glucagon is a crucial medication for treating severe hypoglycemia in individuals with diabetes. It works by stimulating the liver to release stored glucose into the bloodstream, rapidly raising blood sugar levels.

Types of Glucagon Kits

Traditional Glucagon Emergency Kit:
- Contains a vial of powdered glucagon and a syringe filled with sterile water.
- Requires mixing the powder and liquid before injection.
Nasal Glucagon (Baqsimi):
- A pre-mixed, ready-to-use nasal spray formulation.
- Delivered into one nostril without the need for inhalation.
- Offers a convenient and user-friendly option for emergency treatment.
Ready-to-Use Injectable Glucagon (Gvoke):
- A pre-filled syringe or auto-injector containing liquid glucagon.
- Eliminates the need for mixing, making it easier and faster to administer.

Proper Glucagon Administration Techniques

Traditional Glucagon Kit:
- Follow the instructions provided in the kit for mixing the glucagon powder and sterile water.
- Ensure the glucagon is fully dissolved before drawing it into the syringe.
- Administer the injection intramuscularly into the outer thigh, upper arm, or buttocks.
Nasal Glucagon (Baqsimi):
- Remove the device from its packaging.
- Hold the device between your fingers and thumb.
- Insert the nozzle into one nostril and press the plunger firmly.
- The dose is complete when the plunger is fully depressed.
Ready-to-Use Injectable Glucagon (Gvoke):
- Remove the cap from the pre-filled syringe or auto-injector.
- Administer the injection subcutaneously (under the skin) into the abdomen, thigh, or upper arm.
- Follow the instructions provided with the specific product for proper injection technique.

Considerations for Glucagon Use

Educate Family and Caregivers:
- Ensure that family members, friends, and caregivers are trained on how to recognize severe hypoglycemia and administer glucagon.
- Provide them with clear instructions and demonstrate the proper technique for using the specific type of glucagon kit available.
Check Expiration Dates:
- Regularly check the expiration date on the glucagon kit and replace it before it expires.
- Glucagon may become less effective over time.
Store Glucagon Properly:
- Store glucagon kits in a cool, dry place away from direct sunlight and extreme temperatures.
- Keep glucagon readily accessible in case of an emergency.
Glucagon Side Effects:
- Common side effects of glucagon may include nausea, vomiting, headache, and a temporary increase in heart rate.
- Serious side effects are rare but may include allergic reactions.

Prevention Strategies for Severe Hypoglycemia

Preventing severe hypoglycemia is paramount for maintaining the health and well-being of individuals with diabetes. A comprehensive approach involving education, self-monitoring, medication management, and lifestyle adjustments is essential.

Key Preventive Measures

Education:
- Diabetes Education Programs: Enroll in comprehensive diabetes education programs to learn about blood glucose monitoring, medication management, nutrition, exercise, and hypoglycemia prevention.
- Individualized Counseling: Work with a diabetes educator to develop an individualized management plan tailored to your specific needs and lifestyle.
Self-Monitoring of Blood Glucose (SMBG):
- Regular Monitoring: Check blood glucose levels regularly as recommended by your healthcare provider, especially before meals, after meals, before bedtime, and before, during, and after exercise.
- Continuous Glucose Monitoring (CGM): Consider using a CGM device, which continuously monitors blood glucose levels and provides real-time data, trends, and alerts for impending hypoglycemia.
Medication Management:
- Accurate Dosing: Take diabetes medications (insulin or oral agents) exactly as prescribed by your healthcare provider.
- Meal Timing: Coordinate medication dosages with meal times to prevent mismatches between insulin levels and carbohydrate intake.
- Medication Adjustments: Work closely with your healthcare provider to adjust medication dosages as needed based on blood glucose monitoring results, lifestyle changes, and other factors.
Nutrition:
- Balanced Meals: Eat balanced meals at regular intervals, consisting of carbohydrates, protein, and healthy fats.
- Consistent Carbohydrate Intake: Maintain a consistent carbohydrate intake from day to day to avoid wide fluctuations in blood glucose levels.
- Snacking: Consume snacks between meals if needed to prevent hypoglycemia, especially if you are taking insulin or certain oral medications.
Exercise:
- Monitor Blood Glucose Before, During, and After Exercise: Check blood glucose levels before, during, and after physical activity, as exercise can lower blood glucose levels.
- Adjust Insulin or Carbohydrate Intake: Adjust insulin dosages or carbohydrate intake as needed to prevent hypoglycemia during exercise.
- Carry Fast-Acting Carbohydrates: Always carry fast-acting carbohydrates with you during exercise to treat hypoglycemia if it occurs.
Alcohol Consumption:
- Consume Alcohol with Food: If you choose to drink alcohol, do so in moderation and always consume it with food to prevent hypoglycemia.
- Monitor Blood Glucose: Check blood glucose levels more frequently when consuming alcohol, as alcohol can impair the liver's ability to release glucose.
Travel:
- Plan Ahead: Before traveling, pack all necessary diabetes supplies, including medications, blood glucose monitoring equipment, and fast-acting carbohydrates.
- Adjust Medication Dosages: Consult with your healthcare provider about adjusting medication dosages for time zone changes or changes in meal patterns.
- Carry a Medical Identification: Wear a medical alert bracelet or necklace indicating that you have diabetes and carry a letter from your healthcare provider explaining your condition and medications.
Awareness and Education of Others:
- Inform Family, Friends, and Caregivers: Educate family members, friends, and caregivers about diabetes, hypoglycemia, and how to recognize and treat severe hypoglycemic events.
- Train Others to Administer Glucagon: Ensure that someone close to you knows how to administer glucagon in case of an emergency.

Practical List: Prevention Strategies

Regular Blood Glucose Monitoring: Crucial for understanding your body's response to food, exercise, and medication.
Consistent Meal Schedule: Eating meals at consistent times helps stabilize blood sugar levels.
Exercise Planning: Balancing physical activity with proper nutrition and medication adjustments.
Alcohol Awareness: Being cautious about alcohol consumption and its effects on blood glucose.
Educating Others: Ensuring that family, friends, and coworkers know how to help in case of a hypoglycemic event.

Addressing Special Circumstances

Certain situations and conditions can increase the risk of hypoglycemia in individuals with diabetes. Recognizing and addressing these special circumstances is crucial for preventing severe events. Master Your Diabetic Diet A Week Of Blood Sugar Friendly Meal Ideas

Factors Increasing Hypoglycemia Risk

Nocturnal Hypoglycemia:
- Hypoglycemia that occurs during sleep can be particularly dangerous, as the individual is unaware of the symptoms.
- Strategies to prevent nocturnal hypoglycemia include:
  - Checking blood glucose levels before bedtime.
  - Eating a bedtime snack containing complex carbohydrates and protein.
  - Adjusting insulin dosages as needed.
  - Using a CGM with alarms to alert you to low blood glucose levels during the night.
Hypoglycemia Unawareness:
- Some individuals with diabetes may lose the ability to recognize the early warning signs of hypoglycemia, a condition known as hypoglycemia unawareness.
- Strategies to improve hypoglycemia awareness include:
  - Avoiding frequent episodes of hypoglycemia, as this can worsen hypoglycemia unawareness.
  - Relaxing glycemic targets temporarily to allow blood glucose levels to run slightly higher.
  - Using a CGM with alarms to alert you to low blood glucose levels, even if you don't feel the symptoms.
  - Working with your healthcare provider to develop a personalized management plan.
Gastroparesis:
- Gastroparesis, or delayed stomach emptying, is a common complication of diabetes that can lead to erratic blood glucose levels and increased risk of hypoglycemia.
- Strategies to manage hypoglycemia in individuals with gastroparesis include:
  - Eating smaller, more frequent meals.
  - Avoiding high-fat foods, which can slow stomach emptying.
  - Taking medications to improve gastric emptying.
  - Adjusting insulin dosages based on blood glucose monitoring results and meal patterns.
Kidney Disease:
- Kidney disease can affect insulin clearance and increase the risk of hypoglycemia.
- Strategies to manage hypoglycemia in individuals with kidney disease include:
  - Monitoring blood glucose levels more frequently.
  - Adjusting medication dosages as needed, as insulin requirements may decrease.
  - Working with a healthcare provider who is experienced in managing diabetes in individuals with kidney disease.
Cognitive Impairment:
- Individuals with cognitive impairment, such as dementia or Alzheimer's disease, may have difficulty managing their diabetes and be at increased risk of hypoglycemia.
- Strategies to manage hypoglycemia in individuals with cognitive impairment include:
  - Simplifying the diabetes management plan.
  - Enlisting the help of caregivers to assist with medication administration and blood glucose monitoring.
  - Using pre-filled insulin pens or syringes to reduce the risk of dosing errors.
  - Avoiding complex insulin regimens that require frequent adjustments.
Pregnancy
- Monitoring blood sugar becomes more critical during pregnancy due to hormonal changes, requiring more frequent checks and adjustments to medications or diet.

Actionable Items for Special Circumstances

| Circumstance | Action | | ----------------------- | ----------------------------------------------------------------------------------------- | | Nocturnal Hypoglycemia | Check bedtime glucose; bedtime snack; CGM use. | | Hypoglycemia Unawarness | Avoid frequent lows; relaxed glucose targets; CGM use. | | Gastroparesis | Smaller meals; low-fat diet; medication adjustment. | | Kidney Disease | Frequent monitoring; medication adjustment; expert consultation. | | Cognitive Impairment | Simplified plan; caregiver assistance; pre-filled insulin. | | Pregnancy | Frequent glucose checks, coordination with endocrinologist and adjustments to insulin doses. | The Ultimate Guide To Understanding Insulin And Your Blood Sugar

The Role of Technology in Hypoglycemia Management

Technological advancements have revolutionized diabetes management, providing new tools and strategies for preventing and managing hypoglycemia.

Key Technologies for Hypoglycemia Management

Continuous Glucose Monitoring (CGM) Systems:
- CGM devices continuously monitor blood glucose levels and provide real-time data, trends, and alerts for impending hypoglycemia.
- CGM systems can help individuals identify patterns and trends in their blood glucose levels, allowing them to make proactive adjustments to their medication, diet, and exercise.
- Some CGM systems have alarms that can alert you to low blood glucose levels, even if you don't feel the symptoms of hypoglycemia.
Insulin Pumps with Automated Insulin Delivery (AID) Systems:
- Insulin pumps deliver a continuous basal rate of insulin and bolus doses of insulin for meals.
- AID systems, also known as closed-loop systems or artificial pancreas systems, integrate a CGM with an insulin pump to automatically adjust insulin delivery based on real-time blood glucose levels.
- AID systems can help prevent hypoglycemia by automatically reducing or suspending insulin delivery when blood glucose levels are falling.
Smartphone Apps:
- Numerous smartphone apps are available to help individuals with diabetes manage their condition.
- These apps can track blood glucose levels, medication dosages, carbohydrate intake, and exercise.
- Some apps can also provide alerts and reminders for medication and blood glucose monitoring.

How to Choose the Right Technology

Consult with Your Healthcare Provider: Work with your healthcare provider to determine which technologies are most appropriate for your individual needs and lifestyle.
Consider Your Comfort Level with Technology: Choose technologies that you are comfortable using and that fit into your daily routine.
Evaluate the Cost: Consider the cost of the technology, including the initial purchase price and ongoing supplies.
Read Reviews and Compare Products: Research different products and read reviews from other users before making a purchase.

Final Thoughts

Severe hypoglycemia is a serious and potentially life-threatening complication of diabetes that requires immediate recognition and treatment. By understanding the signs and symptoms of low blood sugar, knowing how to administer glucagon, and implementing preventive strategies, individuals with diabetes, their families, and caregivers can effectively manage and minimize the risk of severe hypoglycemic events. Consistent monitoring, education, and the appropriate use of technology are vital components of a comprehensive diabetes management plan focused on preventing and addressing hypoglycemia. Seeking regular guidance from healthcare professionals is essential to tailor strategies to individual needs and ensure optimal health outcomes. A Complete Guide To Using A Continuous Glucose Monitor Cgm