Severe Hypoglycemia: Emergency Signs and What to Do

17 Sep 2025 By Ana L. Creo, M.D.

Severe Hypoglycemia: Emergency Signs and What to Do

Severe hypoglycemia, or low blood sugar, is a dangerous condition that requires immediate action. For individuals with diabetes, understanding the signs and knowing how to respond can be life-saving. This article dives deep into the emergency signs of severe hypoglycemia and provides a step-by-step guide on what to do in such situations. Recognizing the symptoms early and taking swift action can prevent serious complications.

What is Severe Hypoglycemia?

Hypoglycemia occurs when blood glucose levels drop too low, typically below 70 mg/dL (3.9 mmol/L). In severe cases, blood sugar levels plummet so drastically that the person may lose consciousness, have seizures, or be unable to help themselves. Managing Severe Hypoglycemia A Guide For Patients And Caregivers

Defining Severe Hypoglycemia

Blood Sugar Level: Generally, a reading below 50 mg/dL is considered severe.
Symptoms: Loss of consciousness, seizures, confusion, or inability to swallow.
Need for Assistance: Requires assistance from another person to recover.

This is distinctly different from mild or moderate hypoglycemia, where the individual can typically self-treat by consuming fast-acting carbohydrates.

Causes of Severe Hypoglycemia

Understanding the causes can help prevent future occurrences:

Excess Insulin: Taking too much insulin or other diabetes medications.
Missed Meals: Skipping meals or eating too little.
Increased Activity: Exercising more than usual without adjusting medication or food intake.
Alcohol Consumption: Especially without food, can interfere with the liver's ability to release glucose.
Kidney or Liver Problems: Impaired organ function can affect glucose metabolism.
Drug Interactions: Certain medications can interact with diabetes drugs, leading to hypoglycemia.

Emergency Signs of Severe Hypoglycemia

Recognizing the symptoms of severe hypoglycemia is critical for timely intervention. The signs can vary from person to person but often include:

Physical Symptoms

Loss of Consciousness: The individual is unresponsive and cannot be roused.
Seizures: Uncontrolled muscle spasms or convulsions.
Difficulty Breathing: Shallow or labored breathing.
Rapid Heartbeat: Palpitations or a racing pulse.
Sweating: Profuse sweating, even in a cool environment.
Pale Skin: Skin appears clammy and pale.
Muscle Weakness: Severe weakness making it impossible to stand or move.

Neurological Symptoms

Confusion: Disorientation or inability to think clearly.
Slurred Speech: Difficulty speaking clearly.
Vision Changes: Blurred or double vision.
Unresponsiveness: Unable to follow simple commands or answer questions.
Coma: Complete loss of consciousness.

Behavioral Symptoms

Irritability: Sudden and unexplained irritability or aggression.
Anxiety: Intense feelings of fear or panic.

Here’s a table summarizing the key emergency signs:

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

If you suspect someone is experiencing severe hypoglycemia, follow these critical steps:

1. Assess the Situation

Check for Responsiveness: Try to wake the person by calling their name or gently shaking them.
Look for Medical Identification: Check for a medical ID bracelet, necklace, or card that indicates they have diabetes. This can provide valuable information.

2. Do Not Give Food or Drink if Unconscious

Risk of Choking: Giving food or drink to an unconscious person can cause choking or aspiration into the lungs.
Focus on Safe Treatment: Administering glucagon is the safest and most effective first step.

3. Administer Glucagon

Glucagon Kit: Glucagon is a hormone that raises blood sugar levels quickly. It's available as an injectable medication.
How to Administer:
1. Prepare the Glucagon: Follow the instructions in the glucagon kit. Typically, this involves mixing the powdered glucagon with a liquid solution.
2. Inject the Glucagon: Inject the glucagon into the person’s thigh or arm.
3. Turn the Person on Their Side: After administering glucagon, turn the person on their side in the recovery position to prevent choking if they vomit.
If No Glucagon Available: If glucagon is not available, call emergency services immediately.

4. Call Emergency Services (911)

Immediate Assistance: Even if you administer glucagon, it’s essential to call for professional medical help.
Provide Information: Tell the emergency responders about the situation, that the person is unconscious, and that you suspect severe hypoglycemia.
Ongoing Monitoring: Follow any instructions given by the emergency dispatcher.

5. Monitor the Person

Check for Improvement: Watch for signs that the glucagon is working, such as the person regaining consciousness or becoming more responsive.
Provide Support: Stay with the person until medical help arrives, offering reassurance and comfort.

6. After Recovery

Medical Evaluation: Ensure the person sees a healthcare provider as soon as possible to evaluate the cause of the severe hypoglycemia and adjust their treatment plan.
Education: Review diabetes management strategies with the person, including medication timing, meal planning, and blood sugar monitoring.

Here is a simplified checklist for quick reference:

Preventative Measures to Avoid Severe Hypoglycemia

Prevention is always better than cure. People with diabetes can take several steps to minimize the risk of severe hypoglycemia:

1. Regular Blood Sugar Monitoring

Frequency: Check blood sugar levels regularly, as directed by your healthcare provider.
Tracking Trends: Keep a log of blood sugar readings to identify patterns and potential problem areas.
Continuous Glucose Monitoring (CGM): Consider using a CGM system, which provides real-time glucose readings and alerts you to highs and lows.

2. Medication Management

Proper Dosage: Ensure you are taking the correct dosage of insulin or other diabetes medications.
Timing: Administer medications at the right time, as prescribed by your healthcare provider.
Coordination with Meals: Coordinate insulin doses with meal timing and carbohydrate intake.

3. Meal Planning

Balanced Diet: Eat regular, balanced meals and snacks that include carbohydrates, protein, and healthy fats.
Consistent Timing: Maintain a consistent meal schedule to avoid large fluctuations in blood sugar.
Carbohydrate Counting: Learn to count carbohydrates to match insulin doses to food intake.

4. Exercise Precautions

Monitor Glucose During Exercise: Check blood sugar levels before, during, and after exercise.
Adjust Insulin or Food: Adjust insulin doses or consume extra carbohydrates before exercise to prevent hypoglycemia.
Carry a Snack: Always carry a fast-acting carbohydrate snack, such as glucose tablets or fruit juice, in case blood sugar drops too low during exercise.

5. Alcohol Consumption

Eat While Drinking: Always consume alcohol with food to prevent blood sugar from dropping.
Monitor Blood Sugar: Check blood sugar levels more frequently when drinking alcohol.
Limit Intake: Avoid excessive alcohol consumption, as it can impair the liver's ability to release glucose.

6. Educate Family and Friends

Recognize Symptoms: Teach family members, friends, and coworkers how to recognize the signs of hypoglycemia.
Glucagon Administration: Show them how to administer glucagon in case of an emergency.
Emergency Plan: Develop an emergency plan that includes who to call and what steps to take.

7. Regular Medical Check-ups

Healthcare Provider: See your healthcare provider regularly to review your diabetes management plan and make any necessary adjustments.
Medication Review: Periodically review your medications to ensure they are still appropriate and effective.

A summary of these preventive measures:

| Measure | Description | Benefit | | :---------------------------- | :----------------------------------------------------------------------------- | :------------------------------------------------------------------ | | Regular Blood Sugar Monitoring | Check levels frequently and use CGM if possible. | Allows for timely adjustments in medication or diet. | | Medication Management | Ensure proper dosage and timing of diabetes medications. | Prevents fluctuations in blood sugar levels. | | Balanced Meal Planning | Eat regular, balanced meals and snacks with consistent timing. | Maintains stable glucose levels throughout the day. | | Exercise Precautions | Monitor glucose during exercise and adjust insulin or food intake. | Prevents exercise-induced hypoglycemia. | | Cautious Alcohol Consumption | Consume alcohol with food, monitor blood sugar, and limit intake. | Reduces the risk of alcohol-related hypoglycemia. | | Education of Others | Teach family and friends how to recognize symptoms and administer glucagon. | Ensures rapid response in case of emergency. | | Regular Medical Check-ups | See a healthcare provider regularly for plan review and medication adjustments. | Ensures an optimized and effective management plan. |

The Importance of Educating Caregivers and Family

Education is a powerful tool in managing and preventing severe hypoglycemia. Caregivers, family members, and close friends should be well-informed about diabetes and how to respond during an emergency. This includes: The Ultimate Checklist For Control Of Blood Glucose Levels

Recognizing Hypoglycemia

Signs and Symptoms: Make sure they are familiar with the symptoms of mild, moderate, and severe hypoglycemia.
Early Detection: Encourage them to be vigilant in observing any changes in the person's behavior or physical condition.

Glucagon Administration

Hands-On Training: Provide hands-on training on how to administer glucagon.
Practice: Practice using a glucagon training kit so they feel comfortable and confident in an emergency.
Easy Access: Ensure the glucagon kit is easily accessible and that they know where it is stored.

Emergency Protocol

Contact Information: Provide them with a list of emergency contacts, including healthcare providers, emergency services, and trusted family members or friends.
Step-by-Step Guide: Create a written step-by-step guide on what to do in case of severe hypoglycemia.
Reassurance: Emphasize the importance of staying calm and following the protocol to ensure the best possible outcome.

Ongoing Support

Regular Updates: Keep them informed about any changes in your diabetes management plan.
Open Communication: Encourage open communication about any concerns or questions they may have.
Positive Reinforcement: Provide positive reinforcement and encouragement for their efforts in helping you manage your diabetes.

Technological Advances in Hypoglycemia Management

Technological advancements have significantly improved the management and prevention of hypoglycemia. These tools can help individuals with diabetes and their caregivers better monitor and control blood sugar levels: A Beginner S Guide To Managing Blood Sugar Levels With Diet And Exercise

Continuous Glucose Monitoring (CGM)

Real-Time Monitoring: CGMs provide real-time glucose readings and track trends over time.
Alerts: CGMs can alert users when their blood sugar is dropping too low or rising too high.
Data Analysis: CGMs allow for easy data analysis, helping users identify patterns and adjust their treatment plans accordingly.
Example: The Dexcom G6 and Abbott Freestyle Libre are popular CGM systems.

Insulin Pumps

Precise Insulin Delivery: Insulin pumps deliver insulin in a controlled and precise manner, mimicking the way the pancreas works.
Customizable Basal Rates: Pumps allow for customizable basal rates, which can be adjusted based on individual needs and activity levels.
Bolus Options: Pumps offer bolus options for meal coverage, making it easier to manage blood sugar after eating.
Example: The Medtronic MiniMed and Tandem t:slim are commonly used insulin pumps.

Artificial Pancreas Systems

Automated Insulin Delivery: Artificial pancreas systems, also known as closed-loop systems, automatically adjust insulin delivery based on real-time glucose readings.
Improved Glucose Control: These systems can significantly improve glucose control and reduce the risk of hypoglycemia.
Example: The Medtronic 780G and Tandem Control-IQ are examples of artificial pancreas systems.

Smart Insulin Pens

Digital Tracking: Smart insulin pens track insulin doses and timing, making it easier to manage medication.
Data Logging: Pens can log data and share it with healthcare providers for better monitoring and adjustments.
Example: The InPen is a smart insulin pen that helps track insulin doses and provides dose reminders.

These technological advances provide valuable tools for managing diabetes and preventing severe hypoglycemia, allowing individuals to lead healthier and more active lives. By understanding the emergency signs of severe hypoglycemia and knowing what to do, you can play a crucial role in saving a life. Preparation, education, and swift action are key to managing this potentially life-threatening condition.