What to Do During a Severe Hypoglycemia Event: A Guide for Persons with Diabetes

Severe hypoglycemia, also known as severe low blood sugar, is a dangerous and potentially life-threatening condition that requires immediate attention. It's characterized by a blood glucose level that's so low that the individual needs assistance from another person to recover. For people with diabetes, especially those who take insulin or certain oral medications, understanding how to recognize, manage, and prevent severe hypoglycemic episodes is crucial. This guide provides a comprehensive overview of what to do during a severe hypoglycemia event, offering actionable steps for both the person experiencing the low and those assisting them.

Why Immediate Action is Critical

Severe hypoglycemia can lead to seizures, loss of consciousness, coma, and in rare cases, even death. Quick and effective intervention is essential to restore blood glucose levels and prevent serious complications. Recognizing the signs early and acting decisively can make all the difference. The Surprising Factors Affecting Your Blood Sugar You Might Not Know

Recognizing the Signs and Symptoms

Being able to identify the warning signs of hypoglycemia, especially as they progress to severe levels, is vital. Symptoms vary from person to person, and some individuals may experience "hypoglycemia unawareness," meaning they don't feel the early warning signs. Here’s a breakdown of the potential symptoms:

Early Symptoms:

Shakiness or Trembling: A feeling of instability or uncontrollable shaking.
Sweating: Unexplained perspiration, even when not physically active.
Rapid Heartbeat: An increased heart rate or palpitations.
Anxiety or Nervousness: Feeling unusually worried, agitated, or uneasy.
Irritability: Becoming easily annoyed or angered.
Hunger: An intense craving for food, particularly sweets.
Dizziness or Lightheadedness: Feeling faint or unsteady.
Blurred Vision: Difficulty focusing or seeing clearly.

As Hypoglycemia Worsens, Symptoms May Include:

Confusion: Difficulty thinking clearly or understanding instructions.
Difficulty Concentrating: Problems focusing or paying attention.
Slurred Speech: Speaking incoherently or with difficulty.
Weakness: Feeling physically feeble or lacking strength.
Coordination Problems: Difficulty with movement or balance.
Seizures: Uncontrolled muscle contractions.
Loss of Consciousness: Becoming unresponsive or passing out.

Important Note: If someone with diabetes exhibits these symptoms, especially confusion, slurred speech, or loss of consciousness, assume it is hypoglycemia and treat it accordingly, even if you don't have a blood glucose meter. It’s safer to treat a suspected low than to delay treatment. The Ultimate Daily Checklist For Effective Blood Sugar Management

Steps to Take During a Severe Hypoglycemia Event

The treatment for severe hypoglycemia focuses on rapidly raising blood glucose levels to a safe range. Here’s a detailed guide for both the individual experiencing the low and the person assisting them.

For the Person Experiencing Hypoglycemia (If Conscious and Able to Swallow):

Check Blood Glucose (if possible): If you have a blood glucose meter, test your blood sugar immediately. This will confirm the hypoglycemia and guide treatment.
Consume Rapidly Absorbing Carbohydrates:
- Glucose Tablets or Gel: These are the preferred choice because they are absorbed quickly. Follow the instructions on the product label (typically 3-4 tablets or a packet of gel).
- Liquid Carbohydrates: Examples include 4 ounces (120 ml) of juice or regular (non-diet) soda.
- Other Options: If glucose tablets or liquids aren’t available, you can use honey, corn syrup, or a small amount of table sugar (about 1 tablespoon).
Re-check Blood Glucose: Wait 15 minutes, then re-check your blood glucose level. If it's still below 70 mg/dL (3.9 mmol/L), repeat step 2.
Eat a Longer-Acting Carbohydrate: Once your blood glucose is above 70 mg/dL (3.9 mmol/L), consume a snack containing both carbohydrates and protein, such as crackers with peanut butter, a cheese sandwich, or a piece of fruit with nuts. This will help stabilize your blood sugar and prevent another drop.

For the Person Assisting Someone Experiencing Severe Hypoglycemia (Especially if Unconscious or Unable to Swallow):

Administer Glucagon:
- What is Glucagon? Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It is available as an injectable medication or a nasal spray. Every person with diabetes at risk of severe hypoglycemia should have a glucagon kit readily available, and family members or caregivers should be trained on how to use it.
- Injectable Glucagon:
  - Follow the instructions included with the glucagon kit. Typically, you'll need to mix the powdered glucagon with the liquid provided.
  - Inject the solution into the thigh, arm, or buttocks. You can inject through clothing if necessary.
  - Do not attempt to inject glucagon into someone who is able to swallow or is actively seizing. Doing so carries the risk of choking or aspiration.
- Nasal Glucagon:
  - Follow the instructions included with the nasal glucagon product.
  - Administer the nasal spray into one nostril. No need to inhale or prime the device.
Call for Emergency Medical Assistance (911 or Your Local Emergency Number): After administering glucagon, immediately call for emergency medical assistance. Even if the person regains consciousness, professional medical evaluation is still necessary to ensure they are stable and to identify the cause of the hypoglycemia.
Position the Person Safely: If the person is unconscious, place them on their side in the recovery position to prevent choking if they vomit.
Monitor Breathing: Ensure the person is breathing. If they are not breathing, begin CPR if you are trained to do so.
Do Not Give Food or Drink: Never attempt to give food or drink to an unconscious person due to the risk of choking.

Important Considerations When Administering Glucagon:

Time to Effect: Glucagon typically takes 10-15 minutes to raise blood glucose levels.
Side Effects: Common side effects of glucagon include nausea and vomiting. Be prepared to manage these symptoms.
Glucagon is Not a Substitute for Medical Care: Even if glucagon is effective in raising blood glucose levels, the underlying cause of the hypoglycemia needs to be addressed. Always seek professional medical attention after a severe hypoglycemic episode.
Expiration Date: Check the expiration date on your glucagon kit regularly and replace it before it expires.
Storage: Store glucagon according to the manufacturer's instructions, typically at room temperature and away from direct sunlight and heat.

Post-Event Care

After a severe hypoglycemia event, it’s crucial to take steps to prevent future episodes.

Medical Evaluation: Schedule an appointment with the person’s healthcare provider as soon as possible. The doctor will review their diabetes management plan, medication dosages, and lifestyle factors to identify potential causes of the hypoglycemia and make necessary adjustments.
Diabetes Education: Consider attending a diabetes education program or meeting with a certified diabetes educator (CDE). They can provide personalized guidance on blood glucose monitoring, insulin administration, meal planning, and managing exercise to minimize the risk of hypoglycemia.
Continuous Glucose Monitoring (CGM): If the person experiences frequent or severe hypoglycemia, a CGM may be beneficial. CGMs continuously track blood glucose levels and can alert the user to impending lows, allowing them to take proactive steps to prevent severe episodes. Newer CGM systems can also directly alert caregivers during dangerous drops in glucose levels.
Medication Review: Ensure that the person understands their medications, dosages, and potential side effects. They should know how to adjust their insulin or other diabetes medications based on blood glucose levels and meal intake, under the guidance of their healthcare provider.
Meal Planning: Work with a registered dietitian or certified diabetes educator to develop a meal plan that includes consistent meal times, appropriate carbohydrate intake, and balanced meals. Avoid skipping meals or drastically reducing carbohydrate intake, as this can increase the risk of hypoglycemia.
Exercise Precautions: Hypoglycemia can occur during or after exercise. Educate the person on how to monitor their blood glucose levels before, during, and after physical activity, and how to adjust their insulin or carbohydrate intake accordingly. Carry a readily available source of carbohydrate, such as glucose tablets or a sports drink, during exercise.
Hypoglycemia Unawareness: If the person experiences hypoglycemia unawareness, work with their healthcare provider to address this issue. Strategies may include temporarily raising the target blood glucose range to allow the person to regain awareness of hypoglycemia symptoms, or using a CGM with alarms to alert them to impending lows.

Prevention Strategies

The best approach to severe hypoglycemia is prevention. By taking proactive steps to manage diabetes effectively, individuals can significantly reduce their risk of experiencing severe low blood sugar. How Does An A1C Blood Sugar Test Work And Why Is It Important

Key Prevention Tips

Regular Blood Glucose Monitoring: Frequent blood glucose checks are essential for tracking trends and making informed decisions about medication dosages, meal intake, and physical activity.
Consistent Meal Schedule: Eating meals and snacks at regular intervals helps maintain stable blood glucose levels. Avoid skipping meals or drastically changing meal times.
Proper Medication Management: Take medications as prescribed by your healthcare provider and understand how they affect your blood glucose levels.
Diabetes Education: Attend diabetes education programs and meet with a certified diabetes educator (CDE) to learn about diabetes management techniques.
Carry a Medical ID: Wear a medical ID bracelet or necklace that identifies you as having diabetes and lists any medications you take. This will alert emergency responders to your condition if you are unable to communicate.
Educate Family and Friends: Educate your family, friends, and coworkers about diabetes and how to recognize and treat hypoglycemia. Show them how to administer glucagon and where your glucagon kit is stored.
CGM Use: Consider a continuous glucose monitor (CGM) to track glucose trends in real-time and be alerted to dangerous lows.

Addressing Specific Scenarios

Different situations may require specific adjustments to your hypoglycemia management plan.

Hypoglycemia During Sleep

Nocturnal hypoglycemia (low blood sugar during sleep) can be dangerous because you may not be aware of the symptoms until it’s severe.

Symptoms: Night sweats, nightmares, morning headaches, and fatigue upon waking can be indicators of nocturnal hypoglycemia.
Prevention: Check your blood glucose level before bedtime and eat a snack containing both carbohydrates and protein if your blood glucose is low or trending downward. Consider using a CGM with alarms to alert you to low blood glucose levels during the night.
Action: If you suspect nocturnal hypoglycemia, check your blood glucose level immediately upon waking and treat it if it’s low. Discuss the episodes with your healthcare provider.

Hypoglycemia and Exercise

Physical activity can lower blood glucose levels, especially if you take insulin or certain oral medications.

Prevention: Check your blood glucose level before, during, and after exercise. Adjust your insulin dosage or carbohydrate intake as needed, based on your blood glucose levels and the intensity and duration of your activity. Carry a readily available source of carbohydrate, such as glucose tablets or a sports drink, during exercise.
Action: If you experience symptoms of hypoglycemia during exercise, stop exercising and treat it immediately.

Alcohol and Hypoglycemia

Alcohol can interfere with the liver's ability to release glucose, increasing the risk of hypoglycemia, especially if consumed without food.

Prevention: If you drink alcohol, do so in moderation and always with food. Check your blood glucose level before and after drinking alcohol. Avoid drinking on an empty stomach.
Action: Be aware that the symptoms of hypoglycemia can be similar to the effects of alcohol intoxication. If you suspect hypoglycemia, check your blood glucose level and treat it accordingly. Educate your friends and family about the risk of hypoglycemia with alcohol consumption.

Technology and Hypoglycemia Management

Advancements in technology have significantly improved the management of hypoglycemia.

Continuous Glucose Monitors (CGMs): CGMs provide real-time glucose readings and can alert you to impending lows, allowing you to take proactive steps to prevent hypoglycemia. Some CGMs can transmit data to smartphones and allow remote monitoring by caregivers.
Insulin Pumps with Glucose Sensors: Some insulin pumps are integrated with glucose sensors, allowing them to automatically adjust insulin delivery based on glucose levels. These systems, known as "artificial pancreas" or "closed-loop" systems, can help prevent both hypoglycemia and hyperglycemia.
Smartphone Apps: Various smartphone apps are available to help you track your blood glucose levels, medication dosages, meal intake, and physical activity. Some apps can also provide reminders to check your blood glucose or take your medications.

Conclusion

Severe hypoglycemia is a serious complication of diabetes that requires immediate attention. By understanding the signs and symptoms, knowing how to treat it effectively, and implementing preventive strategies, people with diabetes can significantly reduce their risk of experiencing severe low blood sugar. Always work closely with your healthcare provider to develop a personalized diabetes management plan that addresses your specific needs and helps you achieve optimal blood glucose control. Remember, preparation, education, and proactive management are key to staying safe and healthy while living with diabetes.