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

Severe hypoglycemia, also known as severe low blood sugar, is a dangerous complication of diabetes that can occur when blood glucose levels drop too low, often below 70 mg/dL (3.9 mmol/L). While mild to moderate hypoglycemia can usually be managed with quick-acting carbohydrates, severe hypoglycemia requires immediate intervention, often from another person. This guide outlines the essential steps to take during a severe hypoglycemic episode to protect yourself and those around you. What Is A Normal Blood Sugar Level The Definitive Answer

Understanding and preparing for severe hypoglycemia is critical for individuals with diabetes and their families. By knowing the symptoms, treatment options, and preventive measures, you can confidently manage this potentially life-threatening situation.

Recognizing Severe Hypoglycemia: Key Symptoms

The first step in managing severe hypoglycemia is recognizing the symptoms. These can vary from person to person, but often include:

Loss of Consciousness: This is perhaps the most alarming symptom, indicating that the brain isn't receiving enough glucose.
Seizures: Low blood sugar can disrupt normal brain function, leading to seizures.
Inability to Eat or Drink: Someone experiencing severe hypoglycemia may be confused or uncoordinated and unable to safely consume food or liquids.
Marked Confusion or Disorientation: Significant changes in mental state are a red flag.
Unresponsiveness: The person may not respond to questions or commands.

It’s essential to communicate these symptoms clearly to family, friends, and colleagues. Educating them about hypoglycemia can empower them to act swiftly and appropriately.

Immediate Actions: Steps to Take During a Severe Hypoglycemic Episode

When faced with severe hypoglycemia, immediate action is crucial. Here’s a step-by-step guide:

Do Not Administer Food or Liquids If the Person is Unconscious: Forcing someone to eat or drink when they are unable to swallow poses a choking hazard. Type 1 Vs Type 2 Diabetes Key Differences In Causes And Treatment
Administer Glucagon (if available):
- What is Glucagon?: Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream, quickly raising blood sugar levels. It's often available as an injectable medication or a nasal spray.
- How to Administer Glucagon: Follow these steps:
  - Injectable Glucagon:
    - Locate the glucagon kit.
    - Follow the kit's instructions. Typically, this involves mixing the powder with the liquid provided in the kit.
    - Inject the solution into the thigh, arm, or buttock. The injection can be given through clothing if necessary.
  - Nasal Glucagon:
    - Follow the provided instructions for the specific nasal glucagon product.
    - Administer the spray into one nostril.
Call Emergency Services (911 or your local emergency number): Even if glucagon is administered, it’s critical to call for professional medical help. Severe hypoglycemia can have underlying causes that require further investigation and treatment. Make sure to inform the emergency responders that the person is diabetic and has been given glucagon.
Monitor the Person's Condition: Stay with the person until emergency services arrive. Monitor their breathing and be prepared to provide basic first aid if necessary.
Post-Emergency Care: Once the individual regains consciousness and can swallow safely, offer them a source of quick-acting carbohydrates, such as fruit juice or glucose tablets, followed by a longer-acting carbohydrate, like a sandwich or crackers, to prevent recurrence.

| Action | Rationale | | ------------------------------ | ---------------------------------------------------------------------------------------- | | Do not give food if unconscious | Prevents choking | | Administer Glucagon | Stimulates liver to release stored glucose, raising blood sugar. | | Call Emergency Services | Ensures professional medical evaluation and treatment of underlying causes. | | Monitor Condition | Ensures patient's safety until help arrives; be prepared for basic first aid. | | Give quick-acting carbs after recovery | Replenishes blood sugar quickly and prevents another episode. |

Preparing for Hypoglycemia: A Proactive Approach

Prevention is key to minimizing the risk of severe hypoglycemic episodes. Here's how to prepare:

Education: Educate yourself, your family, and your close contacts about diabetes and the symptoms of hypoglycemia. Make sure they know where your glucagon kit is located and how to use it. Regularly review the signs of low blood sugar. Your Complete Guide To Understanding The Normal Blood Sugar Range
Wear a Medical Alert ID: A medical ID bracelet or necklace can inform first responders and others about your diabetes, even if you're unable to communicate.
Regular Blood Glucose Monitoring: Consistent monitoring helps you identify patterns and trends, allowing you to adjust your insulin dosage, diet, or exercise routine as needed.
Work with Your Healthcare Team: Regularly consult your endocrinologist or diabetes educator to optimize your diabetes management plan. Discuss any instances of hypoglycemia and explore strategies to prevent them.
Keep Emergency Supplies Accessible: Ensure you have a glucagon kit readily available at home, work, and when traveling. Check the expiration date regularly. Also, keep fast-acting glucose sources (glucose tablets, juice) accessible.

Understanding Glucagon: Types, Administration, and Storage

Glucagon is a life-saving medication designed to quickly raise blood sugar levels in cases of severe hypoglycemia. It's crucial to understand the different types available and how to use them effectively.

Types of Glucagon:

Injectable Glucagon: This is the traditional form of glucagon that requires mixing a powder with a liquid before injecting it into the muscle.
Nasal Glucagon: This is a newer formulation that's administered as a nasal spray, offering a more convenient option as it does not require mixing or injection. An example is Baqsimi.

Administering Glucagon:

Injectable Glucagon:
- Remove the cap from the glucagon syringe and the vial.
- Wipe the rubber stopper of the vial with an alcohol swab.
- Insert the needle of the syringe into the vial.
- Inject all the liquid from the syringe into the vial.
- Gently swirl the vial to mix the solution until it is clear.
- Withdraw the solution back into the syringe.
- Clean the injection site (thigh, arm, or buttock) with an alcohol swab.
- Pinch the skin and inject the glucagon into the muscle.
- Remove the needle and apply pressure to the injection site.
Nasal Glucagon:
- Remove the device from its packaging.
- Hold the device between your fingers and thumb.
- Insert the nozzle into one nostril.
- Press the plunger firmly to release the dose.

Storing Glucagon:

Store glucagon according to the manufacturer’s instructions, typically at room temperature and away from direct sunlight and heat.
Check the expiration date regularly, and replace it before it expires.
Keep it in an easily accessible location known to family members or close contacts.

Debunking Myths About Severe Hypoglycemia

There are several misconceptions about severe hypoglycemia that can hinder effective management. Here are a few myths debunked:

Myth: Giving Insulin Will Help Stabilize Blood Sugar During Hypoglycemia.
- Reality: Insulin lowers blood sugar; administering it during hypoglycemia can be life-threatening.
Myth: Fruit Juice Alone is Always Sufficient to Treat Severe Hypoglycemia.
- Reality: While fruit juice can raise blood sugar, it may not be enough in cases of severe hypoglycemia. Glucagon is usually necessary to provide a more rapid and significant increase in blood sugar levels.
Myth: Severe Hypoglycemia Only Happens to People Taking Insulin.
- Reality: While it is more common in insulin users, individuals taking certain oral diabetes medications (sulfonylureas) are also at risk.
Myth: Once Someone Recovers from Severe Hypoglycemia, They Don't Need Medical Attention.
- Reality: It's crucial to seek medical evaluation to identify the underlying cause and prevent future episodes.

The Psychological Impact of Severe Hypoglycemia: Addressing Fear and Anxiety

Experiencing a severe hypoglycemic episode can be traumatizing and can lead to significant anxiety and fear. Addressing the psychological impact is an integral part of overall diabetes management.

Acknowledge Your Feelings: Recognize and validate your emotions. It’s normal to feel anxious, scared, or frustrated after a severe low blood sugar event.
Seek Professional Support: Consider talking to a therapist or counselor specializing in diabetes. They can provide coping strategies and help you process your experience.
Join a Support Group: Connecting with others who have experienced similar events can provide a sense of community and reduce feelings of isolation.
Work with Your Healthcare Team: Collaborate with your doctor, diabetes educator, or psychologist to develop a plan for managing your diabetes effectively and addressing any psychological concerns.
Focus on Prevention: Taking proactive steps to prevent hypoglycemia can help reduce anxiety. This includes regular blood glucose monitoring, adjusting your medication as needed, and maintaining a healthy lifestyle.

Real-Life Scenarios: What to Do in Different Situations

Different situations call for different responses during a severe hypoglycemic episode. Here are a few scenarios and the recommended actions:

At Home: Ensure your family members know where the glucagon kit is and how to administer it. Keep emergency contact information readily available.
At Work: Inform colleagues about your diabetes and what to do if you experience severe hypoglycemia. Keep glucagon and quick-acting carbohydrates in an easily accessible location.
Traveling: Carry your glucagon kit and diabetes supplies with you at all times. Wear a medical alert ID, and inform travel companions about your condition and emergency procedures.
During Exercise: Monitor your blood glucose levels frequently before, during, and after exercise. Adjust your insulin dosage or carbohydrate intake as needed to prevent hypoglycemia. Always carry a source of fast-acting carbohydrates with you.

Conclusion: Empowering Yourself and Others

Severe hypoglycemia is a serious but manageable condition. By understanding the symptoms, immediate actions, preventive measures, and psychological impact, individuals with diabetes can confidently navigate these challenges. Education, preparation, and collaboration with healthcare professionals are key to preventing and managing severe low blood sugar effectively. Remember to educate your loved ones and carry appropriate medical identification at all times. Through knowledge and proactive steps, you can empower yourself and those around you to respond appropriately and ensure your safety.