What to Do About Severe Hypoglycemia: A Guide for Persons with Diabetes

Severe hypoglycemia, or severely low blood sugar, is a dangerous and potentially life-threatening complication of diabetes. It occurs when blood glucose levels drop too low for the brain and other organs to function properly. This guide is designed to provide persons with diabetes, their families, and caregivers with the information they need to recognize, prevent, and treat severe hypoglycemia effectively. Understanding how to act quickly and decisively can significantly improve outcomes and prevent serious harm.

Understanding the Significance of Severe Hypoglycemia

Hypoglycemia, in general, is defined as a blood glucose level below 70 mg/dL. Severe hypoglycemia is categorized by the necessity for assistance from another person to administer treatment because the individual is unable to do so themselves due to confusion, loss of consciousness, seizures, or other neurological impairments. This condition requires prompt attention as the brain relies heavily on glucose for energy, and a severe deficiency can lead to cognitive impairment, coma, and in extreme cases, death. The Ultimate Guide To Reading A Blood Sugar Test At Home

Here's why understanding severe hypoglycemia is crucial:

Risk of Cognitive Impairment: Prolonged periods of low blood sugar can damage brain cells.
Emergency Situations: Severe episodes often require emergency medical intervention.
Impact on Daily Life: Fear of severe hypoglycemia can lead to anxiety and affect diabetes management.
Increased Healthcare Costs: Hospitalizations due to severe hypoglycemia contribute to higher healthcare expenses.

To contextualize the severity, consider this data:

Effective education and preparation are key to mitigating these risks.

Recognizing the Symptoms of Severe Hypoglycemia

The ability to recognize the signs and symptoms of hypoglycemia is crucial for timely intervention. Symptoms can vary from person to person, and may develop rapidly. It’s important to note that over time, some individuals may experience hypoglycemia unawareness, where they no longer perceive the early warning signs.

Common Symptoms Include:

Early Symptoms:
- Shakiness
- Sweating
- Anxiety
- Rapid heartbeat
- Hunger
- Blurred vision
- Headache
- Irritability
Severe Symptoms:
- Confusion
- Difficulty concentrating
- Slurred speech
- Loss of coordination
- Seizures
- Loss of consciousness

For a quick reference, consider this table:

If you suspect severe hypoglycemia, immediate action is necessary.

Immediate Actions to Take During a Severe Hypoglycemic Episode

When someone experiences severe hypoglycemia, the primary goal is to raise their blood sugar levels as quickly and safely as possible. Since the individual is often unable to self-treat due to their condition, assistance from someone else is crucial. Hidden Factors Affecting Your Blood Sugar That You May Not Know

Step-by-Step Guide:

Assess the Situation:
- Confirm that the person is showing symptoms of severe hypoglycemia (confusion, unconsciousness, seizure).
- Check their blood glucose level if a meter is available and you know how to use it quickly. Do not delay treatment while waiting for the result.
Administer Glucagon:
- What is Glucagon? Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream, raising blood sugar levels.
- How to Administer: Glucagon is typically administered via intramuscular (IM) injection or intranasally (through the nose). Follow the specific instructions provided with the glucagon kit.
- Who Can Administer? Family members, caregivers, school nurses, and first responders can be trained to administer glucagon.
- Injection Steps (IM):
  1. Locate the injection site (thigh, upper arm, or buttock).
  2. Clean the injection site with an alcohol swab (if available, but don’t delay if not).
  3. Inject the glucagon according to the kit's instructions (usually involves mixing the powder with the liquid).
  4. Hold the needle in place briefly after injection.
  5. Remove the needle and dispose of it properly.
- Nasal Spray Steps:
  1. Remove the device from the packaging
  2. Insert the nozzle into one nostril and press the plunger to deliver the dose.
Call for Emergency Medical Assistance:
- After administering glucagon, immediately call emergency services (911 in the US, or your local emergency number). Provide them with the patient’s condition, the fact that glucagon has been administered, and any other relevant medical information.
Position the Person Safely:
- If the person is unconscious, place them in the recovery position (on their side) to prevent choking if they vomit.
Monitor and Document:
- Note the time of glucagon administration and the person’s response. This information is crucial for medical professionals.
- If a blood glucose meter is available, check blood sugar levels every 15 minutes until medical help arrives.
Post-Glucagon Care:
- Once the person regains consciousness and is able to swallow, give them a fast-acting carbohydrate source (e.g., juice, glucose tablets) followed by a longer-acting carbohydrate (e.g., crackers, sandwich) to prevent a recurrence of hypoglycemia.
Inform Medical Professionals:
- When emergency services arrive, provide them with all relevant details, including the person’s medical history, diabetes type, medications, and the events leading up to the hypoglycemia episode.

To visualize this process:

| Step | Action | Rationale | | :------------------------------- | :----------------------------------------------------------------------------- | :------------------------------------------------------------------------------------ | | 1. Initial Assessment | Confirm symptoms, check blood glucose (if possible), prioritize quick action. | To quickly identify severe hypoglycemia and prevent delays in treatment. | | 2. Glucagon Administration | Inject glucagon (IM or Nasal Spray) following kit instructions. | To quickly raise blood glucose levels. | | 3. Emergency Call | Call 911 (or local emergency number) immediately. | To ensure professional medical care arrives as soon as possible. | | 4. Safe Positioning | Place unconscious person in the recovery position. | To prevent choking in case of vomiting. | | 5. Monitoring & Documentation | Note time of glucagon, person's response, check blood glucose every 15 mins. | To track the effectiveness of treatment and provide essential information to medics. | | 6. Post-Glucagon Care | Give fast-acting carbs when conscious, followed by longer-acting carbs. | To replenish glucose stores and prevent another hypoglycemic episode. | | 7. Information to Medics | Provide medical history, diabetes type, medications, event details. | To assist medical professionals in providing appropriate and informed further treatment. |

Important Note: Glucagon may not be effective in individuals with depleted glycogen stores (e.g., those who have been fasting for a long time or those with liver disease). In these cases, intravenous glucose administration by medical professionals may be necessary.

Preventing Severe Hypoglycemia: Proactive Strategies

Prevention is always better than cure. Implementing proactive strategies to manage blood sugar levels effectively can significantly reduce the risk of severe hypoglycemic episodes.

Key Preventive Measures:

Regular Blood Glucose Monitoring:
- Check blood glucose levels regularly as recommended by your healthcare provider. This is especially important before meals, before exercise, and at bedtime.
- Continuous Glucose Monitoring (CGM) systems can be particularly useful for tracking glucose trends and alerting you to potential lows.
Medication Management:
- Understand the action of your diabetes medications (especially insulin and sulfonylureas) and how they affect your blood glucose levels.
- Never skip meals or significantly delay them after taking your medications.
- Adjust medication dosages as needed, under the guidance of your healthcare provider, based on your activity level, diet, and other factors.
Meal Planning and Timing:
- Eat consistent meals and snacks, and avoid long periods without food.
- Ensure that your meals contain a balance of carbohydrates, protein, and fat.
- If you are engaging in physical activity, consume extra carbohydrates beforehand, and monitor your blood glucose levels during and after exercise.
Alcohol Consumption:
- Be aware that alcohol can impair the liver’s ability to release glucose, increasing the risk of hypoglycemia.
- If you choose to drink alcohol, do so in moderation and always consume it with food.
- Monitor your blood glucose levels carefully after drinking alcohol.
Education and Awareness:
- Educate yourself and your family/caregivers about the signs and symptoms of hypoglycemia and how to treat it.
- Ensure that family members, friends, and coworkers know where your glucagon kit is stored and how to administer it.
- Consider wearing a medical identification bracelet or necklace indicating that you have diabetes.
Communication with Healthcare Team:
- Regularly discuss your diabetes management plan with your healthcare team.
- Report any episodes of hypoglycemia, even mild ones, to your healthcare provider so that they can make necessary adjustments to your treatment plan.
Advanced Technology:
- Hybrid closed-loop systems ("artificial pancreas"): These systems automate insulin delivery based on continuous glucose monitoring data, reducing the risk of both hypoglycemia and hyperglycemia.

Here's a preventive action plan:

By integrating these preventive strategies into your diabetes management routine, you can significantly decrease the likelihood of experiencing severe hypoglycemia.

Training and Resources for Severe Hypoglycemia Management

Effectively managing severe hypoglycemia requires education, preparation, and access to resources.

Essential Training:

Glucagon Administration Training:
- Family members, caregivers, school nurses, and close friends should be trained on how to administer glucagon (both injection and nasal spray) by a healthcare professional.
- Practice using a training kit to become familiar with the administration process.
Hypoglycemia Awareness Training:
- Learn to recognize the early symptoms of hypoglycemia so you can take action before it becomes severe.
- Understand the factors that can contribute to hypoglycemia (e.g., missed meals, excessive exercise, alcohol consumption).
Emergency Response Training:
- Know how to call for emergency medical assistance and provide essential information to first responders.
- Be familiar with basic first aid procedures for someone who is unconscious or having a seizure.

Valuable Resources:

American Diabetes Association (ADA): Provides comprehensive information on diabetes management, including hypoglycemia. (www.diabetes.org)
Juvenile Diabetes Research Foundation (JDRF): Offers resources and support for individuals with type 1 diabetes and their families. (www.jdrf.org)
Endocrine Society: Provides educational materials and clinical guidelines for endocrinologists and other healthcare professionals. (www.endocrine.org)
Local Diabetes Education Programs: Hospitals and clinics often offer diabetes education programs taught by certified diabetes educators (CDEs).
Online Support Groups and Forums: Connect with other individuals with diabetes to share experiences, tips, and support.
Pharmacist Consultations: Pharmacists can provide valuable information about diabetes medications and potential side effects, including hypoglycemia.

To facilitate learning and preparedness:

| Training/Resource | Target Audience | Key Benefit | | :------------------------ | :------------------------------------------------------------------- | :--------------------------------------------------------------------------------------- | | Glucagon Training | Family, caregivers, school nurses | Enables quick and effective response during severe hypoglycemia episodes | | Hypoglycemia Awareness | Individuals with diabetes, family | Improves early recognition of symptoms, leading to timely intervention | | Emergency Response | Individuals with diabetes, family, friends | Prepares for managing severe episodes until professional medical help arrives | | ADA, JDRF, Endocrine Soc. | Individuals with diabetes, healthcare providers | Provides reliable information on all aspects of diabetes management | | Local Education Programs | Individuals with diabetes | Offers personalized education and support from certified diabetes educators |

By actively engaging in training programs and utilizing available resources, individuals with diabetes and their support networks can better manage the risk of severe hypoglycemia and respond effectively when it occurs. The combination of knowledge, skills, and preparation is the key to ensuring safety and well-being.