Severe Hypoglycemia: Emergency Signs and What to Do

17 Sep 2025 By Craig R. Jenkins, D.O.

Severe Hypoglycemia: Emergency Signs and What to Do

Severe hypoglycemia, also known as low blood sugar, is a critical condition that can arise, most commonly as a complication of diabetes treatment. It occurs when the glucose levels in your blood drop to a point where your brain doesn’t have enough energy to function properly. This can lead to a variety of serious symptoms and requires immediate attention. Recognizing the signs of severe hypoglycemia and knowing what to do in an emergency can be life-saving.

The most vulnerable people at risk of developing hypoglycemia include those taking insulin or certain oral medications to manage their diabetes. However, certain medical conditions, medications (unrelated to diabetes), and lifestyle factors such as excessive alcohol consumption without adequate food can also cause hypoglycemia. This article delves into the emergency signs of severe hypoglycemia, outlining step-by-step actions you should take to provide immediate assistance and prevent potentially irreversible damage.

Recognizing the Emergency Signs of Severe Hypoglycemia

Being able to identify the emergency signs of severe hypoglycemia is crucial for providing prompt assistance. The signs can vary from person to person, but common symptoms generally fall into several categories. The severity can also change quickly, which underscores the need for a rapid response.

Common Signs of Severe Hypoglycemia:

Confusion or Difficulty Concentrating: One of the earliest signs of severe hypoglycemia is mental confusion. The affected individual may seem disoriented, have trouble focusing, or struggle to perform simple mental tasks.
Loss of Coordination: Motor skills can be significantly impaired. The person may have difficulty walking, stumbling, or appearing generally uncoordinated.
Slurred Speech: Speaking may become difficult, with words coming out slurred or jumbled. This can sometimes be mistaken for intoxication.
Seizures: In very severe cases, hypoglycemia can trigger seizures due to the brain's lack of energy.
Loss of Consciousness: This is the most severe symptom, where the individual becomes unresponsive and unable to be roused.

Here’s a table that summarizes these signs:

Why Quick Recognition is Critical:

Severe hypoglycemia can lead to dangerous complications, including brain damage, coma, and even death if left untreated. Since the brain relies heavily on glucose for energy, a sustained period of low blood sugar can cause irreversible damage. Quick recognition of the signs and prompt intervention are essential to prevent these serious outcomes.

Consider the scenario where a diabetic person begins to show signs of confusion and loss of coordination. Assuming they are simply tired or inebriated could delay much-needed treatment, thereby jeopardizing their health. Therefore, it's crucial to take these signs seriously and immediately check blood sugar levels.

Step-by-Step Actions: What to Do in an Emergency

When encountering someone experiencing severe hypoglycemia, quick and informed action is paramount. Follow these steps:

1. Check for Responsiveness:

Before anything else, assess the person's level of consciousness. Try to rouse them by speaking loudly or gently shaking them. If they are unresponsive or unconscious, proceed to step 3 and call for emergency assistance immediately.

2. If Conscious, Check Blood Sugar:

If the person is conscious and able to respond, check their blood sugar using a glucometer if available. A reading below 70 mg/dL generally indicates hypoglycemia. Keep in mind, however, that even without a meter, if the symptoms strongly suggest hypoglycemia, it’s better to act promptly. Understanding Type 2 Diabetes Your Guide To Glucose Levels And Insulin

Example: Mary finds her diabetic husband, John, confused and unsteady. Although she does not have a blood sugar monitor handy, she recognizes these symptoms from his past hypoglycemic episodes and prepares to administer glucagon.

3. Administer Glucagon (If Available and Trained):

Glucagon is a hormone that helps raise blood sugar levels quickly. It’s typically prescribed to individuals at risk of severe hypoglycemia, often those with diabetes using insulin. If you are trained and have access to a glucagon kit:

Locate the Glucagon Kit: Most kits contain a syringe and a vial of glucagon powder.
Prepare the Injection: Mix the glucagon according to the instructions in the kit (typically, you'll need to inject the liquid into the powder vial, mix gently, and then draw the mixture back into the syringe).
Administer the Injection: Inject the glucagon into the thigh or arm muscle as instructed.
Call Emergency Services: Even after administering glucagon, call emergency services immediately (911 in the United States) and inform them that you have administered glucagon and that the person is hypoglycemic.

Here's a breakdown in a table format:

4. If No Glucagon is Available and Person is Conscious:

If glucagon is not available and the person is conscious and able to swallow:

Give Fast-Acting Carbohydrates: Provide something containing rapidly absorbable carbohydrates such as:
- Fruit juice (4 ounces)
- Regular (non-diet) soda (4 ounces)
- Glucose tablets (as directed on the package)
- Hard candies (about 3-4 pieces that can be chewed quickly)
Recheck Blood Sugar in 15 Minutes: After giving the carbohydrate source, wait 15 minutes and recheck blood sugar levels (if a meter is available).
Repeat if Necessary: If blood sugar is still low (below 70 mg/dL), give another dose of fast-acting carbohydrates.
Follow with a Snack or Meal: Once blood sugar has returned to a safe range, have the person eat a snack or meal containing both carbohydrates and protein to help stabilize blood sugar levels and prevent another drop. Good choices include:
- Peanut butter crackers
- Cheese and crackers
- A sandwich

Here's another quick reference table:

| Situation | Action | | :----------------------------------------- | :----------------------------------------------------------------------------- | | No Glucagon, Person Conscious | Give fast-acting carbohydrates like juice, soda, or glucose tablets. | | Recheck Blood Sugar After 15 Minutes | Measure blood sugar levels again; if still low, repeat carbohydrate administration. | | Blood Sugar Levels Stabilized | Give a snack or meal containing complex carbohydrates and protein. |

5. When to Call Emergency Services (911):

Always call emergency services immediately in the following situations:

The Person is Unconscious: Do not attempt to give food or liquids to an unconscious person as this could cause choking.
Seizures Occur: Seizures can be life-threatening and require immediate medical attention.
Glucagon is Administered: As mentioned previously, even if glucagon is given, it's essential to call for emergency help to ensure proper monitoring and care.
Symptoms Do Not Improve: If symptoms persist or worsen despite intervention with carbohydrates, seek immediate medical assistance.

Important Considerations:

Educate Family and Friends: If you are at risk of severe hypoglycemia, make sure your family, friends, and colleagues know how to recognize the signs and what to do in an emergency. Keep a glucagon kit readily accessible, and make sure they know how to use it.
Medical Identification: Wear a medical identification bracelet or necklace stating that you have diabetes and any other relevant medical information. This can provide vital information to first responders.

By taking these steps, you can effectively respond to an emergency involving severe hypoglycemia, ensuring the best possible outcome for the affected individual.

Preventing Future Episodes of Severe Hypoglycemia

Prevention is critical in managing the risk of severe hypoglycemia, particularly for individuals with diabetes. Here are key strategies:

1. Consistent Monitoring of Blood Glucose Levels:

Regularly check blood glucose levels, as advised by your healthcare provider. Consistent monitoring provides insights into how diet, exercise, and medications impact your blood sugar. This helps you make informed adjustments to your diabetes management plan.

Practical Advice: Use a blood glucose meter or a continuous glucose monitor (CGM) to monitor levels regularly, particularly before meals, after meals, and at bedtime.

2. Adherence to Prescribed Medication Regimen:

Take all medications exactly as prescribed by your healthcare provider. Never skip doses or adjust dosages without medical advice, as this can lead to imbalances in blood sugar levels.

Example: If you are on insulin, ensure you administer the correct dose at the correct time. Missing a dose or injecting too much can dramatically affect blood sugar levels.

3. Proper Meal Planning and Timing:

Eating regular, balanced meals at consistent times is crucial. Avoid skipping meals or prolonged periods without food, as this can lead to a drop in blood sugar.

Dietary Recommendations: Include a mix of carbohydrates, proteins, and healthy fats in each meal. This combination helps to stabilize blood sugar levels.

4. Coordinating Exercise with Diet and Medication:

Physical activity can lower blood sugar levels, so it's essential to coordinate exercise with your diet and medication. Before engaging in physical activity:

Check Blood Sugar: Ensure blood sugar is at a safe level before beginning exercise.
Have a Snack: If blood sugar is low, consume a small snack containing carbohydrates before starting.
Monitor During Exercise: Check blood sugar periodically during prolonged exercise.
Adjust Insulin: Consult with your healthcare provider to adjust insulin dosages as necessary.

5. Avoiding Excessive Alcohol Consumption:

Alcohol can interfere with the liver's ability to release glucose into the bloodstream, leading to hypoglycemia, especially when consumed without food.

Guidelines: If you choose to drink alcohol, do so in moderation and always with food. Monitor blood sugar levels closely when consuming alcohol.

6. Regular Consultation with Healthcare Providers:

Regular check-ups with your healthcare provider are vital for managing diabetes effectively. Your healthcare provider can assess your treatment plan, adjust medications, and provide personalized advice based on your individual needs and health status. How To Lower Your Fasting Blood Glucose 7 Tips For Better Mornings

7. Educating Family Members and Caregivers:

Ensure that family members, caregivers, and close contacts are educated about diabetes, the signs of hypoglycemia, and how to respond in an emergency. This includes teaching them how to administer glucagon and when to call for emergency assistance. Unexpected Factors Affecting Your Blood Sugar And A1C

Additional Tips for Prevention:

Carry a Source of Fast-Acting Carbohydrates: Always carry a source of fast-acting carbohydrates, such as glucose tablets or fruit juice, in case blood sugar levels drop too low.
Wear Medical Identification: Wear a medical identification bracelet or necklace to alert others to your condition in case of an emergency.
Review Medications Regularly: Regularly review all medications with your healthcare provider, as some medications can increase the risk of hypoglycemia.

By implementing these preventive measures, you can significantly reduce the risk of severe hypoglycemia and maintain better control over your blood sugar levels. Regular monitoring, adherence to medication regimens, and proactive communication with your healthcare team are essential for managing your diabetes and preventing potentially life-threatening hypoglycemic episodes.