What to Do During a Hypoglycemia Emergency: A Step-by-Step Guide

18 Sep 2025 By Rozalina G. McCoy, M.D., M.S.

What to Do During a Hypoglycemia Emergency: A Step-by-Step Guide

Hypoglycemia, often called low blood sugar, occurs when the level of glucose in your blood drops below normal. This can happen for various reasons, most commonly as a side effect of diabetes treatment, but also due to other factors such as skipping meals, excessive exercise, or certain medical conditions. A hypoglycemia emergency can be frightening, but knowing how to respond can make all the difference. This step-by-step guide will help you understand what to do if you or someone you know experiences a severe hypoglycemic episode.

Understanding the Risks and Symptoms

It’s critical to recognize the symptoms of hypoglycemia early, as they can worsen quickly if left untreated. Mild symptoms might include:

Shakiness
Sweating
Dizziness or lightheadedness
Hunger
Irritability or confusion
Rapid heartbeat
Blurred vision
Headache

As blood sugar levels continue to drop, more severe symptoms can emerge, indicating a hypoglycemia emergency:

Loss of coordination
Difficulty speaking
Confusion or disorientation
Seizures
Loss of consciousness

Recognizing these symptoms is the first critical step in managing a hypoglycemic emergency effectively.

Step-by-Step Actions for a Hypoglycemia Emergency

When someone experiences a severe hypoglycemic episode, quick action is paramount. Here’s a structured approach:

Step 1: Assess the Situation

Quickly evaluate the individual's state. Are they conscious? Can they swallow? Look for any medical identification, such as a MedicAlert bracelet or diabetes ID card. This can provide crucial information about their condition and any existing health problems.

Step 2: If the Person is Conscious and Able to Swallow

Give them a fast-acting source of glucose. The goal is to quickly raise their blood sugar level. Good options include:

Glucose Tablets or Gel: Follow the instructions on the package. Typically, this involves taking 3-4 glucose tablets or a tube of glucose gel.
Juice or Regular Soda: Give about 4 ounces (120 ml) of fruit juice or regular (non-diet) soda. These provide a quick sugar boost.
Hard Candies: Offer a few hard candies that can be chewed quickly, like jelly beans or lifesavers.
Honey or Sugar: One tablespoon (15 ml) of honey or table sugar can also be used.

Important: Avoid giving fatty foods, like chocolate or peanut butter, as the fat content can slow down the absorption of glucose.

Step 3: Wait 15 Minutes and Recheck Blood Sugar

After providing the glucose source, wait 15 minutes and then check the person's blood sugar level using a glucose meter if available. If blood sugar remains low (typically below 70 mg/dL or 3.9 mmol/L), administer another dose of fast-acting glucose.

Step 4: If the Person Improves, Provide a Longer-Acting Carbohydrate

Once the person’s blood sugar starts to rise and they are feeling better, offer a snack that combines carbohydrates and protein to help stabilize their blood sugar level. Examples include:

Crackers with peanut butter or cheese
A piece of fruit with a handful of nuts
A small sandwich

Step 5: When to Call for Emergency Medical Assistance (911)**

If the person is unconscious, unable to swallow, or doesn’t improve after two rounds of glucose administration, call emergency services (911 in the United States) immediately. Do not attempt to force food or liquid into an unconscious person’s mouth, as this could cause choking.

Step 6: Administering Glucagon (If Available)

Glucagon is a hormone that can quickly raise blood sugar levels. It is often prescribed to individuals at risk of severe hypoglycemia, and their family members or caregivers are trained on how to administer it.

For a conscious person who cannot swallow: If the person is conscious but unable to swallow, you might be able to administer a nasal glucagon spray if it is available and you are trained. Follow the instructions on the product packaging.
For an unconscious person: If the person is unconscious, administer glucagon via intramuscular injection, if you are trained to do so. Follow these steps: Living With Diabetes How To Achieve Better Blood Sugar Balance
1. Locate the Glucagon Kit: Ensure you have a prescribed glucagon kit. Check the expiration date.
2. Prepare the Injection: Mix the glucagon according to the kit’s instructions.
3. Administer the Injection: Inject the glucagon into the thigh or upper arm.
4. Call Emergency Services: Even after administering glucagon, call emergency services immediately. The person needs medical evaluation.
5. Monitor: Watch the person closely. They should regain consciousness within 15-20 minutes. If not, follow emergency dispatch instructions.
6. Document: Note the time of the glucagon injection for emergency responders.

Note: Glucagon may cause nausea and vomiting. Once the person regains consciousness, turn them on their side to prevent choking. The 10 Best Foods To Help Stabilize Blood Sugar All Day

Preventative Measures and Education

Prevention is always better than cure. Educating yourself and others about hypoglycemia is crucial, particularly if you or someone you know has diabetes.

1. Understanding Risk Factors

Be aware of factors that increase the risk of hypoglycemia:

Skipping meals or eating irregularly
Taking too much insulin or diabetes medication
Exercising more intensely or for a longer duration than usual
Consuming alcohol, especially on an empty stomach
Kidney or liver disease

2. Regular Blood Sugar Monitoring

If you have diabetes, regularly monitor your blood sugar levels as directed by your healthcare provider. Keep a log of your readings and share it with your doctor. This will help in adjusting your medication and meal plan as needed.

3. Meal Planning and Timing

Work with a registered dietitian or diabetes educator to develop a meal plan that suits your needs. Eat regular meals and snacks, and avoid skipping meals. Understand how different foods affect your blood sugar levels.

4. Adjusting Medication and Insulin Doses

Follow your doctor’s instructions carefully regarding your medication and insulin doses. If you experience frequent hypoglycemic episodes, discuss it with your doctor, as they may need to adjust your medication. The Subtle Signs Of Low Blood Sugar Hypoglycemia You Shouldn T Miss

5. Wearing Medical Identification

Wear a medical identification bracelet or necklace stating that you have diabetes and what to do in case of a hypoglycemia emergency. Carry a diabetes ID card in your wallet.

6. Educating Family and Friends

Educate your family members, friends, and coworkers about the signs and symptoms of hypoglycemia and what to do if you experience a severe episode. Show them how to administer glucagon.

7. Keeping a Hypoglycemia Kit Handy

Keep a hypoglycemia kit containing glucose tablets, glucagon, and a quick reference guide in an easily accessible location, such as your home, car, or workplace.

8. Checking Before and After Exercise

If you have diabetes, check your blood sugar levels before, during, and after exercise. Adjust your insulin or carbohydrate intake as needed to prevent hypoglycemia.

9. Avoiding Alcohol on an Empty Stomach

If you consume alcohol, do so in moderation and always with food. Alcohol can lower blood sugar levels, especially when consumed on an empty stomach.

10. Continuous Glucose Monitoring (CGM)

Consider using a continuous glucose monitor (CGM). CGMs are devices that continuously track your blood sugar levels and can alert you when your blood sugar is dropping too low.

Special Considerations

Certain populations or situations require extra vigilance and modified approaches when dealing with hypoglycemia.

Hypoglycemia in Children

Managing hypoglycemia in children requires special attention. Children may have difficulty recognizing the symptoms of low blood sugar, and they may be unable to communicate their needs effectively. Parents and caregivers should be vigilant in monitoring their child’s blood sugar levels and recognizing the signs of hypoglycemia. Adjust glucose administration according to the child's age and weight, and consult a pediatrician or pediatric endocrinologist for guidance.

Hypoglycemia in the Elderly

Elderly individuals are more vulnerable to hypoglycemia due to factors such as decreased kidney function, impaired cognitive function, and polypharmacy (taking multiple medications). They may also have difficulty recognizing the symptoms of low blood sugar. Close monitoring, medication review, and simplification of treatment regimens are essential.

Nocturnal Hypoglycemia

Nocturnal hypoglycemia, or low blood sugar that occurs during sleep, can be particularly dangerous, as it can go unnoticed. Signs of nocturnal hypoglycemia include nightmares, sweating, or headaches upon waking. To prevent nocturnal hypoglycemia, ensure that you have an adequate bedtime snack and avoid taking long-acting insulin too close to bedtime. Consider using a CGM with alarms to alert you to low blood sugar levels during the night.

Reactive Hypoglycemia

Reactive hypoglycemia, also known as postprandial hypoglycemia, occurs within a few hours after eating a meal. It is typically caused by an overproduction of insulin in response to carbohydrate intake. To manage reactive hypoglycemia, eat small, frequent meals, avoid sugary foods and drinks, and choose complex carbohydrates and fiber-rich foods.

Hypoglycemia Unawareness

Some people with diabetes may develop hypoglycemia unawareness, a condition in which they no longer experience the warning symptoms of low blood sugar. This can be particularly dangerous, as they may not recognize when their blood sugar is dropping too low until it reaches a critical level. Regular blood sugar monitoring, frequent communication with healthcare providers, and the use of a CGM may help to improve hypoglycemia awareness.

Additional Resources and Support

Living with diabetes and managing hypoglycemia can be challenging. Fortunately, there are numerous resources and support networks available to help.

Diabetes Education Programs

Enroll in a diabetes education program to learn more about managing your condition and preventing hypoglycemia. These programs are typically led by certified diabetes educators (CDEs) who can provide personalized guidance and support.

Online Communities and Forums

Join online communities and forums for people with diabetes to connect with others, share experiences, and exchange tips and advice.

Support Groups

Attend local support groups for people with diabetes to meet others who understand what you are going through and to receive emotional support.

Healthcare Providers

Maintain regular contact with your healthcare providers, including your primary care physician, endocrinologist, and diabetes educator. Keep them informed about your blood sugar levels, medication, and any challenges you are experiencing.

Diabetes Organizations

Consult with diabetes organizations such as the American Diabetes Association (ADA) and the Juvenile Diabetes Research Foundation (JDRF) for resources, education, and support.

Continuous Learning

Stay up-to-date with the latest research and advancements in diabetes care and hypoglycemia management by attending conferences, reading reputable sources, and participating in educational events.

By being prepared, understanding the warning signs, knowing how to act, and taking preventative measures, you can effectively manage a hypoglycemia emergency and safeguard your health and the health of those around you.