What Is Severe Hypoglycemia and How Do You Treat It?

Severe hypoglycemia, often referred to as low blood sugar, is a dangerous condition that occurs when the glucose level in your blood drops to a point where you require assistance from someone else to recover. It’s more than just feeling a little shaky or sweaty; it can lead to serious complications, including seizures, loss of consciousness, and even death if left untreated. This article delves into the causes, symptoms, treatment, and prevention strategies for severe hypoglycemia, ensuring you have a comprehensive understanding of this potentially life-threatening condition.

Understanding Hypoglycemia

To grasp the severity of severe hypoglycemia, it's important to first understand hypoglycemia itself. Glucose is your body's primary source of energy, derived from the food you eat. Insulin, a hormone produced by the pancreas, helps glucose enter your cells to be used for energy. When blood glucose levels drop too low (typically below 70 mg/dL or 3.9 mmol/L, but the exact threshold can vary), hypoglycemia sets in. Master Your Blood Sugar A Beginner S Guide To Diabetes Control

Key Differences: Mild vs. Severe Hypoglycemia

While mild hypoglycemia may cause symptoms like shakiness, sweating, and irritability, these can usually be managed by consuming a quick source of carbohydrates, such as juice or glucose tablets. Severe hypoglycemia, on the other hand, is characterized by a blood sugar level so low that you are unable to treat it yourself. This often involves altered mental status, such as confusion, disorientation, or even unconsciousness. You need the help of someone else to raise your blood sugar levels.

| Feature | Mild Hypoglycemia | Severe Hypoglycemia | |--------------------|-------------------------------------------------------|-----------------------------------------------------------------------| | Blood Sugar Level | Typically below 70 mg/dL (3.9 mmol/L) | Dangerously low, requires external assistance to correct | | Symptoms | Shakiness, sweating, irritability, hunger | Confusion, disorientation, loss of consciousness, seizures | | Treatment | Consuming quick-acting carbohydrates (juice, glucose tabs) | Requires glucagon injection or intravenous glucose administered by others | | Self-Treatment | Possible | Impossible |

Causes of Severe Hypoglycemia

Severe hypoglycemia can occur for several reasons, primarily in people with diabetes who are using insulin or certain oral medications to manage their blood sugar levels. However, non-diabetic individuals can also experience severe hypoglycemia in rare cases.

Common Causes in People with Diabetes

• Excess Insulin: Taking too much insulin relative to food intake or activity level is one of the most common causes.
• Skipped or Delayed Meals: Failing to eat enough carbohydrates or delaying meals can lead to a drop in blood sugar.
• Intense Exercise: Strenuous physical activity can deplete glucose stores faster than anticipated, particularly if insulin dosage isn't adjusted accordingly.
• Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, especially when consumed without food.
• Kidney or Liver Problems: These organs play a vital role in glucose metabolism. Dysfunction can affect blood sugar regulation.
• Certain Medications: Some oral diabetes medications (e.g., sulfonylureas) can cause hypoglycemia.
• Infection/Illness: Illness can affect how your body uses insulin and glucose, leading to unpredictable blood sugar levels.

Causes in People Without Diabetes

• Insulinoma: A rare tumor of the pancreas that produces excess insulin.
• Reactive Hypoglycemia: Occurs a few hours after eating, possibly due to the body releasing too much insulin in response to a carbohydrate-rich meal.
• Hormone Deficiencies: Deficiencies in hormones like cortisol or growth hormone can impact blood sugar regulation.
• Severe Illness: Conditions like severe liver disease or sepsis can lead to hypoglycemia.
• Certain Medications: Some medications, such as quinine (used to treat malaria), can occasionally cause hypoglycemia.

Example:

• A person with type 1 diabetes takes their usual morning dose of insulin but then misses breakfast due to a meeting. As the insulin starts working, their blood sugar levels plummet, leading to confusion and disorientation, requiring a glucagon injection from a colleague.

Recognizing the Symptoms of Severe Hypoglycemia

Identifying the signs of severe hypoglycemia is crucial for prompt treatment. The symptoms can vary from person to person, but some common indicators include:

Physical Symptoms

• Loss of Consciousness: One of the most alarming signs.
• Seizures: Uncontrolled muscle spasms due to low brain glucose.
• Weakness and Dizziness: Profound feelings of instability.
• Sweating and Pallor: Cold, clammy skin and a pale complexion.
• Rapid Heartbeat: The body's attempt to compensate for low glucose levels.

Mental Symptoms

• Confusion: Difficulty thinking clearly.
• Disorientation: Not knowing where you are or the current time.
• Difficulty Speaking: Slurred speech or inability to find the right words.
• Irritability and Agitation: Uncharacteristic mood changes.
• Unusual Behavior: Actions that are out of character.

It's important to note that sometimes people who frequently experience hypoglycemia can develop hypoglycemia unawareness. This means they no longer experience the early warning signs of low blood sugar, making them more vulnerable to severe episodes. Regular monitoring of blood glucose levels is especially critical for these individuals.

How to Treat Severe Hypoglycemia

Severe hypoglycemia requires immediate intervention. Since the affected person is usually unable to treat themselves, someone else must step in. The primary goal is to raise blood sugar levels quickly and safely. Fasting Blood Glucose What Your Morning Numbers Are Telling You

Step-by-Step Treatment Guide

1. Check for Responsiveness: Try to rouse the person. If they are unresponsive, call for emergency medical help immediately (e.g., dial 911 in the US or your local emergency number).

2. Administer Glucagon (If Available):

   • What is Glucagon? Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It's often prescribed to people with diabetes who are at risk of severe hypoglycemia.
   • How to Administer: Glucagon is typically given as an injection into the thigh, arm, or buttock. Follow the instructions provided with the glucagon kit.
   • Dosage: The usual adult dose is 1 mg. The dose for children depends on their weight and age; consult the product instructions or a healthcare professional.
   • What to Expect: After the glucagon injection, it may take 10-15 minutes for the person to regain consciousness. Even if they wake up, it’s essential to seek medical attention.
   • Important Note: Glucagon may cause nausea and vomiting. Turn the person on their side to prevent choking.

   • If Glucagon Isn’t Available or You're Unsure How to Use It:

   • Call for Emergency Help Immediately: Don't delay seeking professional medical assistance. Paramedics can administer intravenous glucose, which works more rapidly than glucagon.

     
   • Do NOT Give Food or Drink to an Unconscious Person: This could cause choking.

   • After Recovery:

     
   • 

     Once the person is conscious and able to swallow, give them a fast-acting source of glucose, such as fruit juice, glucose tablets, or regular soda (not diet soda).

   • Follow up with a longer-acting source of carbohydrates, such as crackers with peanut butter or a sandwich, to help stabilize blood sugar levels.
   • Monitor their blood sugar levels regularly in the following hours.
   • Seek Medical Evaluation: Even if the person recovers fully, it's essential to consult a doctor or diabetes educator to determine the cause of the severe hypoglycemia and adjust their treatment plan to prevent future episodes.

Practical Example:

• You find a colleague slumped over their desk, unresponsive. You know they have diabetes because you've seen them checking their blood sugar before. You immediately call 911. While waiting for the ambulance, you locate their glucagon kit, carefully follow the instructions, and administer the injection into their thigh. After about 12 minutes, they start to regain consciousness. Once they are fully awake and alert, you give them a juice box and a handful of crackers.

Prevention Strategies for Severe Hypoglycemia

Prevention is always better than cure. People at risk of severe hypoglycemia should take proactive steps to minimize their risk.

Key Prevention Tips

• Regular Blood Sugar Monitoring: Check blood sugar levels frequently, especially before meals, after exercise, and before bedtime. Continuous glucose monitors (CGMs) can be particularly helpful in detecting trends and alerting you to potential lows.
• Medication Management: Work closely with your healthcare provider to adjust your insulin or oral medication dosages based on your food intake, activity level, and overall health.
• Meal Planning: Eat regular meals and snacks, and don't skip meals. Ensure each meal contains a balance of carbohydrates, protein, and fats.
• Carbohydrate Counting: Learn how to estimate the carbohydrate content of your meals to match your insulin dosage accurately.

• Exercise Precautions:

  • Check your blood sugar before, during, and after exercise.
  • Adjust your insulin dose or carbohydrate intake as needed.
  • Carry a source of fast-acting carbohydrates with you during physical activity.

  • Alcohol Awareness:

  • Consume alcohol in moderation and always with food.

  • Monitor your blood sugar levels more frequently when drinking alcohol.
  • Be aware that alcohol can affect your blood sugar for several hours after consumption.
  • Educate Family and Friends: Teach your loved ones how to recognize the symptoms of hypoglycemia and how to administer glucagon. Make sure they know where your glucagon kit is stored.
  • Wear Medical Identification: Wear a medical ID bracelet or necklace that identifies you as having diabetes and indicates that you are at risk of hypoglycemia. This can be invaluable in an emergency situation.
  • Keep a Hypoglycemia Journal: Track your blood sugar levels, medication dosages, food intake, and physical activity. This can help you identify patterns and triggers for hypoglycemia.
  • Regular Medical Check-ups: Attend regular appointments with your doctor or diabetes educator to review your treatment plan and address any concerns.
  • Consider a Continuous Glucose Monitor (CGM): CGMs automatically track blood glucose levels throughout the day and night, alerting users to potential highs and lows. This can be particularly beneficial for individuals with hypoglycemia unawareness or frequent low blood sugars.
  • Adjust Insulin Delivery with an Insulin Pump: Insulin pumps can be programmed to deliver basal insulin (a continuous background dose) and bolus insulin (doses taken before meals). This allows for more precise insulin delivery, which can help to prevent hypoglycemia.

Example Scenario:

• A person with type 1 diabetes uses a CGM that alerts them when their blood sugar is dropping rapidly. They check their blood sugar, confirm it's low, and immediately consume glucose tablets. The CGM continues to monitor their blood sugar, ensuring it returns to a safe range and preventing a severe hypoglycemic episode.

When to Seek Professional Medical Advice

While it's essential to manage mild hypoglycemia on your own, certain situations warrant immediate medical attention:

• Severe Hypoglycemia Requiring Glucagon or Assistance: Always seek medical evaluation after a severe episode, even if you recover fully.
• Recurrent Hypoglycemia: Frequent low blood sugar episodes can indicate an underlying problem that needs to be addressed.
• Hypoglycemia Unawareness: If you no longer experience the early warning signs of low blood sugar, consult your doctor to adjust your treatment plan.
• Unexplained Hypoglycemia: If you experience hypoglycemia without any obvious triggers, it's important to rule out any underlying medical conditions.
• Symptoms of Hypoglycemia Even with Normal Blood Sugar Readings: Consult a doctor to investigate potential causes for these symptoms.

Conclusion

Severe hypoglycemia is a serious condition that can have life-threatening consequences if not treated promptly. By understanding the causes, recognizing the symptoms, knowing how to administer glucagon, and implementing preventative measures, you can significantly reduce your risk of severe low blood sugar episodes. Always work closely with your healthcare team to develop a personalized diabetes management plan that meets your individual needs. Remember, proactive management and education are key to staying safe and healthy. A1C Vs Daily Glucose Levels What Your Doctor Really Looks At