Severe Hypoglycemia: Recognizing the Emergency Signs and What to Do Fast

Severe hypoglycemia, or critically low blood sugar, is a dangerous condition that requires immediate attention. Understanding the signs and knowing how to respond quickly can be life-saving, especially for individuals with diabetes who are at higher risk. This article provides a detailed guide to recognizing severe hypoglycemia and outlines the critical steps to take in an emergency.

Understanding Hypoglycemia: The Basics

Hypoglycemia occurs when the level of glucose (sugar) in the blood drops too low, typically below 70 mg/dL (3.9 mmol/L). While mild to moderate hypoglycemia can often be managed with quick carbohydrate intake, severe hypoglycemia is a medical emergency that may result in unconsciousness, seizures, and, if left untreated, even death.

Who is at Risk?

The most common group at risk includes individuals with diabetes, particularly those who:

• Take insulin or certain oral diabetes medications (sulfonylureas and glinides)
• Skip meals or eat irregularly
• Engage in intense physical activity without adjusting medication or food intake
• Drink alcohol, especially on an empty stomach
• Have kidney or liver problems
• Have certain hormone deficiencies

However, non-diabetic individuals can also experience hypoglycemia due to rare conditions such as insulinomas (tumors that produce insulin), reactive hypoglycemia (occurs after eating), or certain medications. What Your Blood Glucose Bg Levels Are Telling You About Your Health

Blood Glucose Levels: A Quick Guide

| Blood Glucose Level (mg/dL) | Condition | Symptoms | | :---------------------------: | :---------------: | :-------------------------------------------------------------------------------------------------------------------------: | | 70-100 (mg/dL) | Normal | None | | 55-70 (mg/dL) | Mild Hypoglycemia | Shakiness, sweating, anxiety, hunger, tingling lips, blurred vision | | Below 55 (mg/dL) | Moderate Hypoglycemia | Confusion, difficulty concentrating, slurred speech, irritability, weakness, coordination problems | | Requires Assistance | Severe Hypoglycemia | Loss of consciousness, seizures, inability to swallow, coma, potentially life-threatening |

Recognizing the Emergency Signs of Severe Hypoglycemia

It’s crucial to distinguish between mild and severe hypoglycemia. Severe episodes can lead to serious complications, therefore, recognizing the signs is paramount. The hallmark of severe hypoglycemia is the individual's inability to self-treat due to altered mental status. Here are key signs to watch for:

Primary Indicators

1. Loss of Consciousness: The person is unresponsive and cannot be roused.
2. Seizures: Uncontrolled jerking movements.
3. Inability to Swallow or Follow Instructions: The person may be awake but too confused or disoriented to respond to simple commands or swallow food or drink.

Secondary Indicators

While the primary indicators warrant immediate action, recognizing these earlier signs can help prevent the situation from escalating:

1. Profound Confusion or Disorientation: Severe mental fog that makes it difficult for the person to understand or answer questions.
2. Slurred Speech: Similar to being heavily intoxicated.
3. Unusual or Aggressive Behavior: Sudden changes in personality, often appearing combative or irrational.
4. Severe Weakness or Incoordination: Staggering, stumbling, or an inability to stand or walk without assistance.
5. Sweating Profusely (despite feeling cold): Cool, clammy skin accompanied by excessive sweating, even in a cold environment.

Important Note: Sometimes, the person experiencing severe hypoglycemia may not recognize their own symptoms, making it even more crucial for others to be vigilant.

What to Do Fast When You Suspect Severe Hypoglycemia

Immediate action is crucial when severe hypoglycemia is suspected. Here's a step-by-step guide to handling the emergency:

Step 1: Do Not Attempt to Give Food or Drink if the Person is Unconscious or Having Seizures

Attempting to give food or liquids to someone who is unconscious or convulsing could lead to choking.

Step 2: Administer Glucagon (If Available)

Glucagon is a hormone that raises blood sugar levels rapidly and is available as an emergency injection or nasal spray. If the person is known to have diabetes and has a glucagon kit, administer it immediately.

How to Administer Glucagon Injection:

1. Locate the glucagon emergency kit: Typically stored with other diabetes supplies.
2. Follow the kit's instructions precisely: Different kits may have slightly varying methods. However, generally, you'll need to mix the glucagon powder with the provided liquid.
3. Inject the solution: Usually into the thigh, arm, or buttock.
4. Turn the person on their side after the injection in case of vomiting.

How to Administer Glucagon Nasal Spray:

1. Locate the glucagon nasal spray dispenser.
2. Follow the instructions. Insert the nozzle into one nostril and press the plunger to deliver the dose.
3. No need to inhale or prime the device. The medication is absorbed through the nasal lining.
4. Turn the person on their side after the injection in case of vomiting.

Note: Even after administering glucagon, you must still call for emergency medical assistance.

Step 3: Call for Emergency Medical Assistance Immediately

Dial your local emergency number (911 in the US, 112 in Europe, 000 in Australia) immediately. Provide the dispatcher with the following information: Glucose Blood Sugar And A1C Understanding The Key Terms In Diabetes

• "I am with someone who is having a severe hypoglycemic reaction."
• The person’s age, gender, and known medical conditions (if known).
• What you observed (loss of consciousness, seizures, etc.).
• Any interventions you have taken (e.g., "I have administered glucagon").
• Your exact location.

Step 4: Monitor the Person Closely

Continue to monitor the person’s breathing and pulse while waiting for medical assistance. Be prepared to provide additional information to the paramedics when they arrive. If the person regains consciousness before emergency services arrive, you can offer them a fast-acting carbohydrate source.

Step 5: What to Do After Glucagon Administration?

After the person regains consciousness, they will need to eat a long-acting source of carbohydrates to stabilize their blood sugar. This might include:

• A sandwich with protein filling (such as peanut butter or cheese)
• A granola bar
• A piece of fruit with nuts

Preventing Severe Hypoglycemia: Proactive Strategies

Prevention is key when it comes to severe hypoglycemia. Individuals with diabetes can take several proactive steps to minimize their risk:

1. Regular Blood Glucose Monitoring

Consistent blood glucose monitoring is essential. Those on insulin should check their blood sugar multiple times a day, particularly before meals, before bedtime, and before and after exercise. Continuous glucose monitors (CGMs) can also be invaluable in providing real-time glucose readings and alerts for impending lows.

2. Meal Planning and Timing

Eating regular meals and snacks can help prevent blood sugar from dropping too low. Work with a registered dietitian or certified diabetes educator to develop a meal plan that balances carbohydrates, proteins, and fats appropriately.

3. Medication Management

Adhere to prescribed medication dosages and schedules. Discuss any medication changes or adjustments with your healthcare provider. Be especially cautious when starting new medications that could interact with your diabetes medications.

4. Exercise Precautions

Physical activity lowers blood sugar. Before exercising, check your blood glucose and have a carbohydrate snack if needed. Monitor blood sugar levels during and after exercise and adjust insulin doses accordingly. Always carry a source of fast-acting carbohydrates during exercise.

5. Alcohol Consumption

Alcohol can interfere with the liver's ability to release glucose, increasing the risk of hypoglycemia, especially when consumed on an empty stomach. Drink alcohol in moderation and always with food. Monitor blood sugar closely when drinking alcohol.

6. Educate Family, Friends, and Colleagues

Inform your family, friends, and coworkers about diabetes, hypoglycemia, and how to recognize and treat severe hypoglycemia. Make sure they know where your glucagon kit is stored and how to use it. Consider wearing a medical identification bracelet or necklace to alert first responders to your condition.

7. Work with a Healthcare Team

Regular check-ups with a healthcare team, including an endocrinologist, certified diabetes educator, and registered dietitian, can provide personalized guidance on managing diabetes and preventing complications like hypoglycemia.

Glucagon: A Lifesaving Medication

Glucagon is a synthetic hormone that stimulates the liver to release stored glucose into the bloodstream, rapidly raising blood sugar levels. It is a critical tool for treating severe hypoglycemia in individuals with diabetes.

Who Should Have Glucagon?

• Anyone with diabetes who is at risk of severe hypoglycemia (especially those on insulin or sulfonylureas).
• Parents or caregivers of children with type 1 diabetes.
• Partners, family members, or close friends of individuals with diabetes.

Types of Glucagon Kits:

1. Traditional Glucagon Injection Kit: Contains a vial of powdered glucagon and a syringe with sterile water.
2. Glucagon Nasal Spray: A pre-filled, ready-to-use nasal spray formulation.

Important Considerations:

• Storage: Store glucagon kits at room temperature and check the expiration date regularly.
• Training: Get hands-on training from a healthcare provider on how to administer glucagon.
• Rebound Hypoglycemia: After glucagon administration, blood sugar levels may drop again. Provide a long-acting carbohydrate snack as soon as the person is able to swallow.

Debunking Common Myths About Hypoglycemia

1. Myth: Only people with diabetes get hypoglycemia.

   • Fact: While diabetes is the most common cause, non-diabetic individuals can also experience hypoglycemia due to various conditions.

2. Myth: If someone is unconscious from hypoglycemia, just put some honey in their mouth.

   • Fact: This is dangerous and could cause choking. Never attempt to give food or drink to an unconscious person.

3. Myth: Glucagon always works immediately.

   • Fact: Glucagon effectiveness depends on liver glycogen stores. It may take longer to work, or not work at all, if the person has depleted glycogen stores (e.g., after prolonged fasting or intense exercise).

4. Myth: Once blood sugar is back to normal, the person is fine.

   • Fact: Blood sugar levels can drop again. Monitor closely and provide a long-acting carbohydrate snack to stabilize blood sugar.

Conclusion

Severe hypoglycemia is a potentially life-threatening condition that demands swift recognition and action. By understanding the emergency signs, knowing how to administer glucagon, and calling for immediate medical assistance, you can make a critical difference in the outcome. Moreover, proactive strategies, such as regular blood glucose monitoring, meal planning, and medication management, can significantly reduce the risk of severe hypoglycemic episodes. Education and preparedness are vital for both individuals with diabetes and those who care for them. Staying informed and prepared is the best defense against the dangers of severe hypoglycemia. Diabetic Friendly Foods That Won T Spike Your Blood Sugar Levels