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

Severe hypoglycemia, also known as low blood sugar, is a critical and potentially life-threatening condition that can occur in individuals with diabetes, particularly those taking insulin or certain oral medications. Recognizing the symptoms and knowing how to respond quickly and effectively are crucial skills for anyone managing diabetes, as well as their family and friends. This guide provides comprehensive information on understanding, preventing, and treating severe hypoglycemia. Dietitian Approved Snacks That Won T Cause A Blood Sugar Spike

Understanding Severe Hypoglycemia

Hypoglycemia is defined as a blood glucose level below 70 mg/dL (3.9 mmol/L). Severe hypoglycemia is characterized by a blood glucose level low enough that the individual requires assistance from another person to recover. This usually manifests as confusion, loss of consciousness, seizures, or coma.

Why Hypoglycemia Occurs:

• Excess Insulin: Taking too much insulin in relation to food intake or activity levels.
• Missed or Delayed Meals: Not eating enough carbohydrates, or skipping meals, can lead to a drop in blood sugar.
• Increased Physical Activity: Strenuous exercise can deplete glucose stores, especially without proper carbohydrate intake.
• Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose, particularly if consumed without food.
• Certain Medications: Some oral diabetes medications (sulfonylureas) are more likely to cause hypoglycemia.
• Kidney or Liver Problems: Impaired kidney or liver function can affect how the body processes insulin and glucose.
• Hormonal Deficiencies: Conditions affecting the adrenal or pituitary glands can disrupt glucose regulation.

Real-World Examples:

• A person with Type 1 diabetes injects their usual dose of insulin but then gets stuck in a meeting and misses their scheduled lunch.
• Someone with Type 2 diabetes takes their prescribed sulfonylurea medication but then engages in an unexpectedly strenuous hike without adjusting their food intake.

Key Metrics and Data:

Studies show that individuals with Type 1 diabetes experience an average of two episodes of symptomatic hypoglycemia per week, and one episode of severe hypoglycemia per year. The risk is also significant in those with advanced Type 2 diabetes on insulin therapy. (Source: Diabetes Care, American Diabetes Association).

Recognizing the Signs and Symptoms of Severe Hypoglycemia

Early recognition of hypoglycemia is crucial to prevent it from progressing to a severe state. Symptoms can vary from person to person, but typically include: What A High A1C Blood Sugar Reading Really Means For Your Health

Mild to Moderate Hypoglycemia Symptoms:

• Shakiness or trembling
• Sweating
• Rapid heartbeat or palpitations
• Anxiety or nervousness
• Hunger
• Dizziness or lightheadedness
• Blurred vision
• Headache
• Confusion or difficulty concentrating
• Irritability or mood changes

Severe Hypoglycemia Symptoms (Requiring Assistance):

• Disorientation or confusion
• Inability to speak clearly
• Loss of coordination
• Seizures
• Loss of consciousness
• Coma

The Danger of Hypoglycemia Unawareness:

Some individuals with diabetes, especially those who have had diabetes for a long time, 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.

Strategies to Identify and Respond to Hypoglycemia Unawareness:

• Frequent Blood Glucose Monitoring: Regularly check blood sugar levels, especially before meals, before bed, and after exercise. Continuous Glucose Monitoring (CGM) systems can be extremely beneficial in detecting trends and preventing severe drops.
• Set Higher Blood Glucose Targets: Consult with your healthcare provider about adjusting your target blood glucose range to minimize the frequency of hypoglycemic episodes.
• Hypoglycemia Awareness Training: Participate in programs designed to help restore awareness of hypoglycemia symptoms.
• Patient education: It is important to have family and friends to be aware of how to help the patient who has diabetes.

Case Study:

Consider a 65-year-old man with Type 2 diabetes and a history of cardiovascular disease who experienced frequent nocturnal hypoglycemia. He initially dismissed his symptoms (night sweats and morning headaches), but after a severe episode of confusion at breakfast, his doctor recommended a CGM and adjusted his medication regimen. This intervention helped restore his hypoglycemia awareness and prevented further severe events.

Immediate Steps to Take During a Severe Hypoglycemic Episode

When someone experiences severe hypoglycemia, prompt and appropriate action is vital. Here's a step-by-step guide:

1. Assess the Situation and Call for Help:

• Check for responsiveness: Try to wake the person. If they are unconscious or having seizures, immediately call emergency services (911 in the US, or your local emergency number).
• Explain the situation: Clearly state that the person has diabetes and is experiencing severe hypoglycemia. Provide your location and any other relevant information to the emergency responders.

2. Administer Glucagon (if available):

• Glucagon Kit: Glucagon is a hormone that raises blood sugar levels. If you have a glucagon emergency kit and know how to use it, administer it immediately. Important: It’s crucial that family members and close contacts are trained on how to administer glucagon.
• Preparation: Glucagon usually comes in a powdered form that needs to be mixed with a liquid before injection. Follow the instructions on the kit carefully.
• Administration: Glucagon can be injected into the thigh, arm, or buttock.
• What to expect: After glucagon administration, the person should regain consciousness within 5-15 minutes. If they don't, call emergency services again.
• If the patient recovers: Once conscious and able to swallow, give them a fast-acting source of glucose, such as fruit juice or glucose tablets.

3. If Glucagon is Not Available or You're Not Trained:

• Do NOT attempt to give food or drink to an unconscious person. This can cause choking.
• Position the person on their side to prevent choking if they vomit.
• Wait for Emergency Services: Stay with the person until emergency medical personnel arrive and can provide further assistance.

4. Document the Event:

• Record the Time: Note the time the episode occurred, what actions were taken, and the person's response.
• Inform Healthcare Provider: Report the severe hypoglycemic event to the person’s healthcare provider as soon as possible. This will allow for a review of their diabetes management plan.

Table: Glucagon Administration - Key Steps:

| Step | Action | Important Notes | | --------------------------- | ----------------------------------------------------------------- | --------------------------------------------------------------------------------------- | | 1. Check Responsiveness | Try to wake the person; if unresponsive, call emergency services. | Do not delay calling for help if the person is unconscious. | | 2. Prepare Glucagon Kit | Follow the kit instructions for mixing and preparing the injection. | Ensure you are familiar with the kit instructions before an emergency occurs. | | 3. Administer Injection | Inject into the thigh, arm, or buttock. | Glucagon can be administered through clothing if necessary. | | 4. Monitor Response | Wait for the person to regain consciousness. | If no response within 15 minutes, call emergency services again. | | 5. Provide Glucose | Once conscious, give fast-acting glucose. | Follow up with a longer-acting carbohydrate source to prevent a recurrence. | | 6. Document and Report | Record details and inform healthcare provider. | Essential for adjusting the diabetes management plan to prevent future severe episodes. |

Crucial Safety Tips:

• Always carry glucagon: Individuals at risk of severe hypoglycemia should always have a glucagon kit readily available.
• Educate those around you: Make sure family, friends, and colleagues know how to recognize the signs of severe hypoglycemia and how to administer glucagon.
• Review medication regimen: Regularly review your medications and dosages with your healthcare provider, especially if you experience frequent hypoglycemia.
• Consider a Medical ID: Wear a medical ID bracelet or necklace indicating that you have diabetes. This will provide important information to first responders.

Preventing Future Severe Hypoglycemic Episodes

Prevention is key to avoiding severe hypoglycemia. A comprehensive approach to diabetes management can significantly reduce the risk.

1. Continuous Glucose Monitoring (CGM):

• Real-time data: CGM systems continuously track glucose levels and provide real-time data, allowing for proactive adjustments to insulin doses and food intake.
• Alerts: CGM devices can be programmed to alert you when your blood sugar is trending low, giving you time to take action before it becomes severe.
• Predictive Alerts: Some advanced CGM systems can predict impending hypoglycemia based on glucose trends.

2. Regular Blood Glucose Monitoring:

• Frequency: Even with a CGM, regular fingerstick blood glucose checks are still necessary, especially to confirm CGM readings or when experiencing symptoms.
• Timing: Check blood sugar before meals, before bed, after exercise, and when you suspect hypoglycemia.

3. Meal Planning and Timing:

• Consistency: Maintain a consistent meal schedule and avoid skipping meals.
• Carbohydrate counting: Learn how to count carbohydrates to match insulin doses appropriately.
• Snacks: Have snacks readily available, especially before and after exercise.

4. Exercise Management:

• Plan ahead: Check blood sugar before, during, and after exercise.
• Adjust insulin doses: Reduce insulin doses before exercise as needed, based on experience and advice from your healthcare provider.
• Carry quick-acting glucose: Always have a source of fast-acting carbohydrates readily available during physical activity.

5. Medication Management:

• Review Medications: Regularly review your medications with your doctor or diabetes educator.
• Insulin Adjustment: Learn how to adjust insulin doses based on blood sugar readings, food intake, and activity levels.
• Timing Matters: Understanding when your insulin is active is a key component to understanding hypoglycemia.

6. Alcohol Consumption:

• Moderation: If you choose to drink alcohol, do so in moderation and always consume it with food.
• Monitor Closely: Check your blood sugar more frequently when drinking alcohol, as it can increase the risk of hypoglycemia.

7. Education and Support:

• Diabetes Education: Participate in diabetes self-management education programs to learn about all aspects of diabetes care.
• Support Groups: Join a diabetes support group to connect with others and share experiences.
• Healthcare Team: Work closely with your healthcare provider, including your endocrinologist, diabetes educator, and registered dietitian, to develop a personalized diabetes management plan.

8. Stress Management:

• Stress Impact: High stress can significantly alter glucose levels.
• Techniques: Techniques like deep breathing, yoga, and spending time in nature can help mitigate high stress levels.

By consistently implementing these strategies and maintaining open communication with your healthcare team, you can significantly reduce your risk of severe hypoglycemia and live a healthier, more confident life with diabetes. Take Control A Beginner S Guide To Long Term Blood Sugar Management