Severe Hypoglycemia: Emergency Steps Every Person with Diabetes Should Know

Severe hypoglycemia, or dangerously low blood sugar, is a critical emergency that can occur in individuals with diabetes, particularly those who use insulin or certain oral medications. It's essential for every person with diabetes, along with their family and friends, to recognize the signs, understand the risks, and know the emergency steps to take. This article provides a comprehensive guide to help you navigate severe hypoglycemic events effectively.

Understanding Severe Hypoglycemia

Hypoglycemia happens when your blood glucose levels drop too low, typically below 70 mg/dL. While mild hypoglycemia can be managed with a quick snack, severe hypoglycemia is a different beast altogether. It occurs when your blood sugar drops to a point where you become unable to treat it yourself and require assistance from someone else. This can manifest as confusion, seizures, or even unconsciousness.

| Feature | Mild Hypoglycemia | Severe Hypoglycemia | |----------------------|-----------------------------------------|------------------------------------------------------| | Blood Sugar Level | Below 70 mg/dL but usually above 55 mg/dL | Level at which the individual requires assistance | | Symptoms | Shakiness, sweating, hunger, irritability | Confusion, seizures, loss of consciousness | | Treatment | Consuming 15-20g of fast-acting carbs | Requires glucagon injection or intravenous glucose | | Self-Treatment | Possible | Not possible |

Why is it so dangerous? Your brain relies on glucose as its primary energy source. When blood sugar plummets, brain function is severely impaired. Prolonged or untreated severe hypoglycemia can lead to brain damage, coma, and, in rare cases, death.

Recognizing the Symptoms: Early Warning Signs

Early detection is crucial. Knowing the symptoms of hypoglycemia allows you to intervene before it escalates to a severe episode. Common symptoms include:

Shakiness: Uncontrollable tremors or trembling.
Sweating: Sudden, unexplained perspiration.
Dizziness: Feeling lightheaded or unsteady.
Hunger: An intense craving for food.
Irritability: Becoming easily agitated or frustrated.
Confusion: Difficulty concentrating or thinking clearly.
Rapid Heartbeat: A noticeably faster pulse.
Blurred Vision: Temporary impairment of eyesight.

These symptoms can vary from person to person and may not always be present in every episode. If you experience any of these, especially if you have diabetes, check your blood sugar immediately. How To Lower Your A1C A Step By Step Plan For Persons With Diabetes

Emergency Steps: What to Do When Someone is Unconscious or Unable to Swallow

When a person with diabetes experiences severe hypoglycemia and is unconscious, seizing, or unable to swallow, immediate action is required. Here’s a step-by-step guide: What Happens When Blood Sugar Is Too Low A Guide To Hypoglycemia

Do NOT attempt to give food or liquid orally. This poses a significant choking hazard.
Administer Glucagon.
- What is Glucagon? Glucagon is a hormone that raises blood sugar levels by stimulating the liver to release stored glucose. It’s available as an injectable medication.
- How to Administer Glucagon:
  - Locate the glucagon emergency kit. Ensure that someone in the house has had training for this process before you need them!
  - Follow the kit's instructions carefully. Typically, you'll mix the glucagon powder with the provided liquid.
  - Inject the glucagon into the person's thigh or arm muscle. The injection site doesn’t have to be exact; the important thing is to get the medication into the body.
  - The dosage usually depends on age and weight (follow the instructions in the kit).
Call Emergency Services (911 or your local emergency number). Even after administering glucagon, it’s vital to seek professional medical help. Explain the situation clearly, mentioning that the person is experiencing severe hypoglycemia and has received a glucagon injection.
Turn the Person on Their Side (Recovery Position). If the person is unconscious, position them on their side to prevent choking should vomiting occur.
Monitor Vital Signs. Keep a close eye on their breathing and pulse until emergency services arrive.
Inform Emergency Responders. Upon their arrival, inform them of the person's diabetes, the fact that they received glucagon, and any other relevant medical information.

Important Notes on Glucagon:

Glucagon is not a substitute for medical care. It’s a temporary measure to raise blood sugar until professional help arrives.
Glucagon may not work immediately. It can take 10-15 minutes for blood sugar to start rising.
Glucagon has side effects. Common side effects include nausea and vomiting.
Glucagon is not effective if the person's glycogen stores are depleted (e.g., after prolonged starvation or excessive exercise).

Glucagon Administration: A Detailed Example

Let's consider a scenario: Sarah, who has Type 1 diabetes, collapses at home. Her husband, John, realizes she’s unresponsive and suspects severe hypoglycemia.

John quickly locates Sarah's glucagon emergency kit.
He reads the instructions carefully and mixes the glucagon powder with the liquid using the syringe provided in the kit.
He injects the glucagon into Sarah’s thigh.
While waiting for the glucagon to take effect, John calls 911, informing them of Sarah’s condition and the fact that she’s received glucagon.
He turns Sarah onto her side to prevent choking.
He monitors Sarah’s breathing and pulse.

After about 12 minutes, Sarah starts to regain consciousness. She's still confused, but her condition is improving. When the paramedics arrive, John provides them with all the necessary medical information. Sarah is then transported to the hospital for further evaluation and treatment.

Prevention Strategies: Avoiding Severe Hypoglycemic Episodes

Prevention is always better than cure. Here are some strategies to minimize the risk of severe hypoglycemia:

Regular Blood Glucose Monitoring: Check blood sugar levels regularly, especially before meals, before bed, and before, during, and after exercise. This will help you identify trends and make adjustments to your insulin or medication dosage as needed.
Consistent Meal Schedules: Avoid skipping meals or drastically changing your eating habits. Irregular meal schedules can make it harder to manage blood sugar levels.
Proper Insulin or Medication Dosing: Work closely with your healthcare provider to determine the correct dosage of insulin or oral medications. Never adjust your dosage without consulting your doctor.
Carbohydrate Counting: Learn how to accurately count carbohydrates in your meals. This will help you match your insulin dosage to your carbohydrate intake.
Exercise Precautions: Discuss your exercise plans with your healthcare provider. You may need to adjust your insulin dosage or carbohydrate intake before, during, and after exercise to prevent hypoglycemia.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose, increasing the risk of hypoglycemia. If you consume alcohol, do so in moderation and always with food.
Continuous Glucose Monitoring (CGM): A CGM device can continuously track your blood sugar levels and alert you to highs and lows, often before symptoms even develop. This provides a proactive way to manage your diabetes.
Educate Family and Friends: Make sure your family, friends, and coworkers know how to recognize the symptoms of hypoglycemia and how to administer glucagon.
Wear a Medical Alert ID: A medical alert bracelet or necklace can inform first responders that you have diabetes in case of an emergency.
Keep a Supply of Fast-Acting Carbohydrates on Hand: Always have a readily available source of fast-acting carbohydrates, such as glucose tablets, juice, or hard candies, to treat mild hypoglycemia.

Real-World Example: Adjusting Insulin Based on CGM Data

John, who uses a CGM, notices a consistent pattern of low blood sugar in the late afternoon. He downloads the data from his CGM and discusses the trend with his endocrinologist. The doctor recommends a slight reduction in his basal insulin dose during that time. After making the adjustment, John’s blood sugar levels stabilize, and he experiences fewer hypoglycemic episodes. Is Your Morning Blood Glucose Consistently High Here S What To Do

Why Continuous Education is Key

Diabetes management is a continuous learning process. Healthcare guidelines, medications, and technologies evolve. To stay informed, consider the following:

Regular Appointments with Your Healthcare Team: Discuss any concerns or questions you have about your diabetes management with your doctor, certified diabetes educator, or other healthcare professionals.
Diabetes Education Programs: Participate in diabetes education programs to learn more about self-management skills.
Support Groups: Join a diabetes support group to connect with others who have diabetes. Sharing experiences and tips can be invaluable.
Reliable Online Resources: Utilize reputable online resources, such as the American Diabetes Association (ADA) and the Juvenile Diabetes Research Foundation (JDRF), to stay up-to-date on the latest diabetes research and recommendations.
Review Medication Labels: Always double-check your medication labels and follow the instructions carefully. If you have any questions, ask your pharmacist.

Common Mistakes to Avoid

Even with the best preparation, mistakes can happen. Here are some common errors to avoid:

Hesitating to Administer Glucagon: Time is of the essence in severe hypoglycemia. Don't hesitate to administer glucagon if someone is unconscious or unable to swallow.
Assuming Someone is Intoxicated: Mistaking hypoglycemia for intoxication can delay treatment. Always consider the possibility of low blood sugar in someone with diabetes.
Treating with Diet Soda: Diet soda contains no carbohydrates and will not raise blood sugar levels.
Ignoring Mild Hypoglycemia: Failing to treat mild hypoglycemia promptly can lead to a severe episode.
Overcorrecting Hypoglycemia: Consuming too many carbohydrates can cause a rapid spike in blood sugar levels. Follow the 15-15 rule (consume 15 grams of carbohydrates, wait 15 minutes, and recheck your blood sugar).
Not Replacing Glucagon Kits: Glucagon has an expiration date. It is critical to ensure your kit hasn't expired!
Not Practicing Glucagon Administration: When administering, make sure to simulate injecting the needle (without actually injecting!) so you are comfortable with the syringe/needle operation.
Not seeking help immediately after: Some sources suggest that a trip to the hospital isn't always necessary after glucagon administration, but it's far better to get the blood sugar checked, to be safe!

The Importance of a Diabetes Action Plan

Every person with diabetes should have a comprehensive diabetes action plan. This plan should include:

Target Blood Sugar Ranges: Your personal blood sugar goals.
Medication List: A list of all medications you take, including dosages and timing.
Hypoglycemia Treatment Protocol: Specific instructions on how to treat mild and severe hypoglycemia.
Emergency Contact Information: Contact information for your healthcare provider and emergency contacts.
Glucagon Location: Where your glucagon kit is stored.
When to Call 911: Clear guidelines on when to seek emergency medical help.

Share this plan with your family, friends, and coworkers so they know how to assist you in case of an emergency.

Resources to Boost Your Knowledge

To further enhance your understanding and preparedness, consider exploring the following resources:

American Diabetes Association (ADA): The ADA website (www.diabetes.org) offers a wealth of information on all aspects of diabetes management, including hypoglycemia.
Juvenile Diabetes Research Foundation (JDRF): JDRF (www.jdrf.org) focuses on finding a cure for type 1 diabetes and provides valuable resources for individuals with type 1 diabetes and their families.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): NIDDK (www.niddk.nih.gov) conducts research on diabetes and other related conditions and provides information for both healthcare professionals and the general public.
Your Healthcare Provider: Your doctor, certified diabetes educator, and other healthcare professionals are your best resources for personalized advice and guidance.

Conclusion

Severe hypoglycemia is a serious complication of diabetes that demands immediate action. By understanding the risks, recognizing the symptoms, knowing how to administer glucagon, and implementing preventive strategies, individuals with diabetes and their loved ones can be well-prepared to handle these emergencies effectively. Remember, knowledge and preparedness are your strongest allies in navigating the challenges of diabetes. Don't hesitate to seek education, support, and guidance from your healthcare team and trusted resources. With proactive management and a well-defined action plan, you can minimize the risk of severe hypoglycemia and live a healthy, fulfilling life with diabetes.