What to Do During a Hypoglycemia Emergency: A Guide for Families

18 Sep 2025 By Craig R. Jenkins, D.O.

What to Do During a Hypoglycemia Emergency: A Guide for Families

Hypoglycemia, or low blood sugar, is a common and potentially dangerous complication for individuals with diabetes, particularly those using insulin or certain oral medications. Understanding how to recognize and manage a hypoglycemic emergency is crucial for families and caregivers. This guide provides essential information on identifying the signs of hypoglycemia, what steps to take during an emergency, and how to prevent future episodes.

Why This Matters: Hypoglycemia can lead to confusion, seizures, loss of consciousness, and, in rare cases, be life-threatening. Being prepared and knowing how to act quickly and effectively can make a significant difference in the outcome. Are Blood Sugar Support Supplements Worth It A Science Backed Look

Recognizing the Signs of Hypoglycemia

Hypoglycemia occurs when the blood glucose level drops below a certain threshold, generally considered to be 70 mg/dL (3.9 mmol/L). However, symptoms can vary from person to person, and some individuals may experience symptoms at slightly higher blood sugar levels. Being familiar with the specific signs and symptoms in your loved one is paramount.

Common symptoms of mild to moderate hypoglycemia include:

Shakiness or tremors
Sweating
Rapid heartbeat
Anxiety or nervousness
Irritability or mood changes
Confusion
Dizziness or lightheadedness
Blurred vision
Hunger
Headache
Weakness or fatigue

Severe hypoglycemia presents with more serious symptoms that require immediate intervention: How Your Fasting Blood Sugar Impacts Your Overall Health

Inability to concentrate or follow simple commands
Seizures
Loss of consciousness
Unresponsiveness

Important Considerations:

Nocturnal Hypoglycemia: Hypoglycemia can occur during sleep. Signs might include nightmares, sweating, or waking up with a headache or feeling unusually tired or confused.
Hypoglycemia Unawareness: Some individuals with long-term diabetes may develop hypoglycemia unawareness, meaning they no longer experience the warning signs of low blood sugar. Regular blood glucose monitoring is especially important in these cases.

Steps to Take During a Hypoglycemic Emergency

When a person shows signs of hypoglycemia, prompt action is essential. The following steps outline how to handle a hypoglycemic emergency:

Step 1: Check Blood Sugar (If Possible and Safe)

If the person is conscious and able to cooperate, check their blood sugar level using a blood glucose meter. This confirms hypoglycemia and provides a baseline reading.
Safety First: Do not attempt to check blood sugar if the person is combative, seizing, or unable to cooperate.

Step 2: Administer Fast-Acting Carbohydrates (For Conscious Individuals)

If the blood sugar is below 70 mg/dL (3.9 mmol/L) or if symptoms of hypoglycemia are present even without a meter reading, administer a fast-acting carbohydrate. The goal is to raise the blood sugar level quickly.

Acceptable fast-acting carbohydrate options include:

Glucose tablets: Follow the instructions on the package, usually 3-4 tablets (15-20 grams of carbohydrates).
Glucose gel: Administer one tube of glucose gel.
Fruit juice: 4 ounces (120 ml) of regular (not diet) fruit juice.
Regular soda: 4 ounces (120 ml) of regular (not diet) soda.
Hard candies: 5-6 hard candies that can be chewed quickly.
Honey or sugar: 1 tablespoon (15 ml) of honey or sugar.

The 15-15 Rule: This is a widely recommended guideline.

Give 15 grams of fast-acting carbohydrates.
Wait 15 minutes.
Recheck blood sugar.
If blood sugar is still below 70 mg/dL (3.9 mmol/L), repeat steps 1-3.

Step 3: Monitor and Recheck Blood Sugar

After administering fast-acting carbohydrates, wait 15 minutes and recheck the blood sugar level.
If the blood sugar has risen above 70 mg/dL (3.9 mmol/L) and the person feels better, proceed to Step 4.
If the blood sugar remains low, repeat the administration of fast-acting carbohydrates and recheck in another 15 minutes.

Step 4: Provide a Longer-Acting Carbohydrate and Protein

Once the blood sugar is back in a safe range, it is crucial to provide a longer-acting carbohydrate source along with protein to help stabilize blood sugar levels and prevent a recurrence of hypoglycemia.

Good options include:

Crackers with peanut butter
Cheese and crackers
A piece of fruit with a handful of nuts
A small sandwich

Step 5: When to Seek Emergency Medical Attention

Unconsciousness: If the person is unconscious or unable to swallow, do not attempt to give them anything by mouth.
Seizures: If the person is having a seizure.
Failure to Respond: If the person does not respond to initial treatment with fast-acting carbohydrates.
Glucagon Not Available or Ineffective: If glucagon is not available or if it is administered but the person does not regain consciousness within 15 minutes.

Call emergency services (911 in the US) immediately if any of these situations occur.

Glucagon: The Emergency Treatment for Severe Hypoglycemia

What is Glucagon? Glucagon is a hormone that raises blood sugar levels by stimulating the liver to release stored glucose. It is available as a prescription medication in injectable and nasal spray forms and is essential for treating severe hypoglycemia when the person is unable to take carbohydrates orally.

Who Needs Glucagon? People with diabetes, particularly those on insulin or sulfonylureas, should have a glucagon kit readily available. Families, caregivers, and close contacts should be trained on how to administer glucagon.

How to Administer Glucagon (Injectable)

Check Expiration Date: Ensure the glucagon kit has not expired.
Prepare the Injection: Follow the instructions included in the glucagon kit. Typically, this involves mixing the glucagon powder with the diluent.
Administer the Injection: Inject the glucagon into the muscle (e.g., thigh, arm, or buttock).
Call for Help: After administering glucagon, immediately call emergency services (911 in the US) or transport the person to the nearest hospital.
Recovery Position: Once the person regains consciousness, turn them on their side to prevent choking if they vomit.
Provide Food: Once the person is fully awake and able to swallow, give them a long-acting carbohydrate snack with protein.

How to Administer Glucagon (Nasal Spray)

Check Expiration Date: Ensure the glucagon nasal spray has not expired.
Administer the Spray: Insert the nozzle into one nostril and press the plunger to deliver the dose. There is no need to inhale.
Call for Help: After administering glucagon, immediately call emergency services (911 in the US) or transport the person to the nearest hospital.
Recovery Position: Once the person regains consciousness, turn them on their side to prevent choking if they vomit.
Provide Food: Once the person is fully awake and able to swallow, give them a long-acting carbohydrate snack with protein.

Important Notes:

Glucagon may cause nausea and vomiting.
It may take 10-15 minutes for glucagon to raise blood sugar levels.
Even after glucagon is administered, it is still essential to seek medical attention.

Preventing Hypoglycemia: Strategies for Families

Prevention is always better than cure. Here are some strategies families can implement to minimize the risk of hypoglycemic episodes:

Regular Blood Glucose Monitoring

Consistent Monitoring: Encourage regular blood glucose monitoring, especially before meals, before bedtime, and after exercise.
Continuous Glucose Monitors (CGMs): Consider using a CGM, which provides real-time glucose readings and alerts for high and low blood sugar levels.

Medication Management

Accurate Dosing: Ensure insulin and oral medications are administered at the correct dose and time.
Medication Review: Regularly review medications with the healthcare provider to adjust dosages as needed.
Communication: Communicate any changes in medication, diet, or activity level to the healthcare provider.

Meal Planning and Timing

Balanced Meals: Plan balanced meals that include carbohydrates, protein, and healthy fats.
Consistent Timing: Eat meals and snacks at consistent times each day.
Carbohydrate Counting: Learn carbohydrate counting to better manage insulin dosages based on food intake.

Exercise Considerations

Monitor Blood Sugar: Check blood sugar before, during, and after exercise.
Adjust Insulin: Adjust insulin dosages as needed based on exercise intensity and duration.
Carry Snacks: Always carry a fast-acting carbohydrate snack during exercise.

Education and Awareness

Educate Family Members: Ensure all family members and caregivers are educated about hypoglycemia, its signs and symptoms, and how to respond in an emergency.
Medical ID: Wear a medical ID bracelet or necklace indicating diabetes and insulin use.
Emergency Plan: Develop a written hypoglycemia emergency plan and share it with family members, caregivers, and school or workplace personnel.

Dealing with Special Situations

| Situation | Action | | :------------------------- | :--------------------------------------------------------------------------------------------------------------------------------------------------------- | | Traveling | Pack extra supplies (insulin, glucose meter, test strips, glucagon), carry a medical ID, and plan for meal timing and exercise. | | Illness | Monitor blood sugar more frequently, continue taking insulin (unless otherwise directed by the healthcare provider), and drink plenty of fluids. | | Alcohol Consumption | Alcohol can lower blood sugar levels. Consume alcohol in moderation, with food, and monitor blood sugar closely. | | Stress | Stress can affect blood sugar levels. Practice stress management techniques such as exercise, meditation, or deep breathing. |

The Role of Technology

Continuous Glucose Monitoring (CGM): CGMs are revolutionizing diabetes management. These devices track glucose levels in real-time, providing alerts when levels are trending high or low. CGMs help individuals and their families anticipate and prevent hypoglycemic episodes.

Insulin Pumps: Insulin pumps deliver a continuous, controlled dose of insulin, mimicking the way a healthy pancreas works. They can be programmed to adjust insulin delivery based on blood glucose levels, reducing the risk of hypoglycemia.

Smart Apps: Several smartphone apps are available that help individuals track blood glucose levels, insulin dosages, carbohydrate intake, and exercise. These apps provide valuable data and insights to improve diabetes management.

Example Emergency Plan

It is good practice to create an emergency plan and communicate with other members of the family, friends and people nearby. Here is a table outlining an example emergency plan:

By understanding the symptoms, having a clear emergency plan, and adopting preventative strategies, families can effectively manage hypoglycemia and ensure the safety and well-being of their loved ones with diabetes. This proactive approach can help prevent serious complications and improve their overall quality of life. Your Daily Checklist For Effortless Blood Sugar Management