What to Do for Severe Hypoglycemia: An Emergency Guide

17 Sep 2025 By Arpitha K. Ketty, M.D.

What to Do for Severe Hypoglycemia: An Emergency Guide

Severe hypoglycemia, or low blood sugar, is a dangerous condition that requires immediate intervention. It occurs when your blood glucose levels drop too low, preventing your brain and body from functioning correctly. For individuals with diabetes, particularly those using insulin or certain oral medications, understanding how to recognize and manage severe hypoglycemia is crucial. This guide provides step-by-step instructions on how to respond effectively in an emergency situation, ensuring the safety of yourself or someone you're assisting. The goal is to equip you with the knowledge and confidence to act quickly and appropriately until professional medical help arrives.

Understanding the Urgency

Severe hypoglycemia is more than just feeling a bit shaky. It can lead to seizures, loss of consciousness, brain damage, and, in rare cases, even death. The brain relies on glucose for energy, and when levels are critically low, its functions become impaired. This is why a rapid response is essential. Being prepared and knowing the correct steps can be life-saving. Remember, early and correct intervention is key to preventing serious complications.

Recognizing the Signs and Symptoms of Severe Hypoglycemia

The ability to recognize the signs and symptoms of severe hypoglycemia is the first critical step in managing the emergency. While mild to moderate hypoglycemia presents with symptoms like shakiness, sweating, and hunger, severe hypoglycemia manifests in more alarming ways. Recognizing these signs can help you act swiftly and prevent potentially devastating outcomes.

Key Symptoms of Severe Hypoglycemia:

Confusion or Disorientation: The person may seem lost, unable to answer simple questions, or behave irrationally.
Loss of Consciousness: This is a critical sign. The individual may pass out and be unresponsive.
Seizures: Involuntary muscle contractions or convulsions can occur due to the brain's lack of glucose.
Inability to Swallow or Cooperate: The person might be conscious but unable to take oral medication or food.
Slurred Speech: Similar to intoxication, their speech might be difficult to understand.

Real-Life Example:

Imagine you are at a family gathering, and your diabetic uncle suddenly starts acting confused and disoriented. He is sweating profusely and seems unable to respond to your questions appropriately. This could be a sign of severe hypoglycemia, demanding immediate action.

Knowing these symptoms allows you to differentiate between a mild hypoglycemic episode and a severe one, ensuring that you escalate your response accordingly. Remember, time is of the essence. How To Create A Diabetic Diet Plan For Better Blood Glucose Control

Step-by-Step Guide: Responding to Severe Hypoglycemia

When faced with a situation of severe hypoglycemia, a clear and methodical approach is essential. Following these steps can provide the best possible outcome until professional medical help can be secured. Prioritize safety, act swiftly, and remain calm.

Step 1: Assess the Situation and Check for Responsiveness

Before anything else, ensure that the environment is safe. Check if the person is conscious and responsive. Try to rouse them by gently shaking their shoulder and speaking loudly.

If the person is responsive but confused: Proceed to check their blood glucose if possible (Step 2).
If the person is unresponsive: Do not attempt to give them anything by mouth (Step 4).

Step 2: Check Blood Glucose Levels (If Possible)

If the individual has a glucose meter and you know how to use it, check their blood sugar levels immediately. This will confirm whether hypoglycemia is indeed the issue. However, if you cannot check blood sugar quickly or are unsure how to use the meter, proceed directly to Step 4.

Target Blood Glucose Levels: Generally, levels below 70 mg/dL (3.9 mmol/L) are considered low, but severe hypoglycemia usually presents with significantly lower readings or when a meter reading is unavailable.

Step 3: If Conscious and Able to Swallow, Administer Quick-Acting Glucose

If the person is conscious, able to swallow, and you have confirmed low blood sugar, provide a quick source of glucose.

Examples of Quick-Acting Glucose Sources:
- Glucose gel or tablets (follow package instructions)
- 4 ounces (120 ml) of regular soda (not diet)
- 1 tablespoon of honey or syrup
- Hard candies (approximately 3-4 pieces, but avoid if there is a risk of choking)
Wait 15 Minutes: After administering the glucose, wait 15 minutes and recheck blood sugar levels. If levels are still low, repeat the treatment.
Follow Up with a Longer-Acting Carbohydrate: Once blood sugar levels start to rise, give a longer-acting carbohydrate source like a slice of bread or a few crackers to stabilize blood sugar.

Step 4: If Unconscious or Unable to Swallow, Administer Glucagon

Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It is a crucial emergency treatment for severe hypoglycemia when the person cannot take glucose orally.

How to Administer Glucagon:
- Locate the Glucagon Kit: These kits typically contain a syringe with sterile water and a vial of powdered glucagon.
- Prepare the Injection: Follow the instructions in the kit carefully. Typically, you'll need to inject the sterile water into the vial of glucagon, gently roll (do not shake) to mix, and then draw the solution back into the syringe.
- Administer the Injection: Inject the glucagon into the thigh or arm muscle as instructed in the kit.
- Dosage: Usually, adults and children over 25 kg (55 lbs) receive 1 mg of glucagon, while children under 25 kg receive 0.5 mg. Check the specific product instructions.
If you're uncomfortable giving the injection, do your best. It’s better to attempt the injection than to do nothing.
Important Note: Once glucagon is administered, the person may take 5-15 minutes to regain consciousness.

Step 5: Call for Emergency Medical Assistance

Regardless of whether the person regains consciousness after glucose or glucagon administration, call emergency services (911 in the US) immediately. Even if the person appears to recover fully, it’s crucial to have them evaluated by medical professionals to determine the underlying cause of the hypoglycemic episode and prevent future occurrences. The Beginner S Guide To The Diabetic Diet And Healthy Eating

Provide Detailed Information: When calling emergency services, give them as much information as possible, including:
- That the person is experiencing severe hypoglycemia
- Whether they are conscious or unconscious
- What steps you have taken so far (glucose or glucagon administration)
- Any known medical conditions (such as diabetes)
- The person's current condition and vital signs (if known)
Remain Calm and Follow Instructions: Stay on the line with the emergency operator and follow their instructions until help arrives.

Step 6: Monitor and Document

While waiting for medical assistance, continue to monitor the person's condition. Note the time that glucose or glucagon was administered and any changes in their responsiveness or symptoms. This information will be valuable for the arriving medical team.

Quick Reference Table:

| Action | Conscious & Able to Swallow | Unconscious or Unable to Swallow | | :------------------------------------------- | :---------------------------------------------------------------------------------------------------------------------------------------------- | :----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | 1. Assess & Check Responsiveness | Try to rouse by speaking loudly. | Check for breathing and pulse. | | 2. Check Blood Glucose (If Possible) | Confirm hypoglycemia. | Skip if unable to do quickly. | | 3. Administer Quick-Acting Glucose | Give glucose gel, soda, honey, or candies. Wait 15 mins and recheck. Follow with longer-acting carbs. | Do not give anything by mouth. Choking hazard. | | 4. Administer Glucagon | Not needed if responding to oral glucose. | Locate kit, prepare injection, and administer into thigh or arm. | | 5. Call Emergency Services (911) | Do immediately after giving glucose and monitoring, or if condition worsens. | Do immediately after administering glucagon. | | 6. Monitor and Document | Record time of glucose administration, blood sugar levels, and any changes in condition. | Record time of glucagon administration and any changes in condition. |

By following these steps, you can effectively manage a severe hypoglycemic episode, providing critical support until professional medical assistance arrives. Remember, preparation and knowledge are your best allies in these situations.

Preventing Future Episodes of Severe Hypoglycemia

While knowing how to respond to severe hypoglycemia is crucial, preventing future occurrences is even more important. Understanding the causes and adopting proactive strategies can significantly reduce the risk of experiencing these dangerous episodes. Prevention involves a combination of education, careful monitoring, and lifestyle adjustments.

Identifying the Causes:

Medication Management:
- Insulin Overdose: Taking too much insulin is a common cause of hypoglycemia. It's crucial to measure insulin doses accurately and coordinate them with food intake.
- Oral Diabetes Medications: Sulfonylureas (e.g., glipizide, glyburide) can also cause hypoglycemia, particularly if meals are skipped or delayed.
- Medication Errors: Inadvertently taking the wrong medication or dosage can lead to severe blood sugar drops. Always double-check medications.
Dietary Factors:
- Skipping Meals: Irregular meal times or skipping meals can lead to hypoglycemia, especially if taking insulin or sulfonylureas.
- Inadequate Carbohydrate Intake: Not eating enough carbohydrates to match insulin dosages can cause blood sugar levels to fall.
- Delayed Meals: Prolonged intervals between meals can also trigger hypoglycemia.
Physical Activity:
- Unplanned Exercise: Strenuous physical activity without adjusting insulin or carbohydrate intake can lower blood sugar.
- Post-Exercise Hypoglycemia: Blood sugar can drop hours after exercise, so it's important to monitor levels and adjust food intake accordingly.
Alcohol Consumption:
- Alcohol Interference: Alcohol can impair the liver's ability to release glucose, increasing the risk of hypoglycemia, particularly when consumed without food.
- Impaired Awareness: Alcohol can also mask the symptoms of hypoglycemia, making it harder to recognize and treat.
Other Factors:
- Kidney Disease: Impaired kidney function can affect insulin metabolism, increasing the risk of hypoglycemia.
- Hormonal Imbalances: Certain hormonal disorders can affect blood sugar regulation.
- Illness: Infections or other illnesses can affect appetite and insulin requirements.

Proactive Strategies for Prevention:

Consistent Meal Timing:
- Regular Meals and Snacks: Eat meals and snacks at consistent times each day to maintain stable blood sugar levels.
- Avoid Skipping Meals: Never skip meals, especially when taking insulin or sulfonylureas.
Medication Management:
- Accurate Insulin Dosing: Use the correct insulin dosage as prescribed by your healthcare provider.
- Regular Medication Review: Review all medications regularly with your doctor to ensure they are appropriate and adjusted as needed.
- Awareness of Medication Effects: Understand how your diabetes medications affect blood sugar levels.
Blood Glucose Monitoring:
- Frequent Monitoring: Check blood glucose levels regularly, especially before meals, before bed, and before and after exercise.
- Continuous Glucose Monitoring (CGM): Consider using a CGM system, which continuously tracks blood glucose levels and alerts you to potential highs and lows.
Exercise Planning:
- Monitor Blood Sugar During Exercise: Check blood sugar levels before, during, and after physical activity.
- Adjust Insulin or Carbohydrate Intake: Adjust insulin dosages or carbohydrate intake as needed to prevent hypoglycemia during and after exercise.
Alcohol Consumption:
- Consume Alcohol with Food: If consuming alcohol, do so in moderation and always with food.
- Monitor Blood Sugar After Drinking: Check blood sugar levels regularly after drinking alcohol, as the effects can last for several hours.
Diabetes Education:
- Attend Diabetes Education Programs: Participate in diabetes education programs to learn more about managing blood sugar levels and preventing complications.
- Family and Caregiver Education: Educate family members and caregivers about recognizing and treating hypoglycemia.
Carry Identification:
- Medical Alert Bracelet or Card: Wear a medical alert bracelet or carry a card indicating that you have diabetes and are at risk for hypoglycemia.
- Emergency Contact Information: Include emergency contact information in case of an emergency.
Emergency Preparedness:
- Keep Glucose Supplies Handy: Always carry a quick source of glucose, such as glucose tablets or gel.
- Glucagon Kit: Keep a glucagon kit readily available and ensure that family members and caregivers know how to use it.
- Develop a Hypoglycemia Action Plan: Work with your healthcare provider to develop a personalized hypoglycemia action plan that outlines steps to take in case of low blood sugar.

By adopting these preventive strategies, individuals with diabetes can significantly reduce their risk of experiencing severe hypoglycemia and maintain better control of their blood sugar levels. Regularly communicating with your healthcare team and staying informed are key to long-term diabetes management.

Table: Preventive Strategies and Their Impact

| Preventive Strategy | Impact | | :------------------------------ | :--------------------------------------------------------------------------------------- | | Consistent Meal Timing | Maintains stable blood sugar levels and prevents fluctuations. | | Accurate Insulin Dosing | Ensures appropriate insulin levels for glucose management. | | Regular Blood Glucose Monitoring| Provides real-time data for proactive adjustments and interventions. | | Exercise Planning | Minimizes the risk of exercise-induced hypoglycemia. | | Safe Alcohol Consumption | Prevents alcohol-related interference with blood sugar regulation. | | Diabetes Education | Empowers individuals with knowledge and skills for effective self-management. | | Medical Identification | Alerts emergency responders to diabetes status and facilitates prompt treatment. | | Emergency Preparedness | Ensures readiness for quick response in case of hypoglycemia. |

The Role of Family, Friends, and Caregivers

The support and education of family, friends, and caregivers play a vital role in managing and preventing severe hypoglycemia, particularly for individuals who may have difficulty recognizing the warning signs themselves. These individuals are often the first responders in an emergency situation, making their knowledge and preparedness crucial.

Educating Loved Ones:

Recognizing Symptoms: Ensure that family members and caregivers are familiar with the symptoms of both mild and severe hypoglycemia. Stress the importance of not dismissing subtle changes in behavior or confusion.
Understanding Diabetes Management: Provide a basic understanding of how diabetes medications, diet, and exercise affect blood sugar levels. This knowledge enables them to better support the individual in maintaining stable glucose levels.
Glucagon Administration: Train family members and caregivers on how to properly administer glucagon. Provide hands-on practice using a training kit to build confidence and competence.

Practical Steps for Caregivers:

Keep Emergency Supplies Accessible: Ensure that quick-acting glucose sources (such as glucose tablets, gel, or juice) and a glucagon kit are readily available in multiple locations, including at home, in the car, and at work or school.
Know the Person’s Diabetes Management Plan: Understand the individual’s medication schedule, meal plans, and exercise routines. This knowledge helps in identifying potential triggers for hypoglycemia.
Communicate Effectively with Healthcare Providers: Participate in medical appointments to better understand the individual’s condition and treatment plan. Advocate for clear instructions and resources.
Monitor Regularly: Help monitor blood glucose levels, especially before meals, before bed, and during or after physical activity. This is particularly important for individuals who have difficulty recognizing hypoglycemic symptoms.
Stay Calm and Act Swiftly: In the event of severe hypoglycemia, remain calm and follow the steps outlined in the emergency guide. Call emergency services immediately, even if the person appears to recover after glucagon administration.
Advocate for Continuous Glucose Monitoring (CGM): Encourage the use of a CGM system, which can provide real-time glucose data and alerts for potential highs and lows. This can be particularly helpful for individuals who have frequent or severe hypoglycemia.
Create a Hypoglycemia Action Plan: Work with the healthcare provider to develop a personalized hypoglycemia action plan that outlines specific steps to take in case of low blood sugar. Share this plan with all caregivers and family members.
Provide Emotional Support: Offer emotional support and encouragement to help manage the psychological impact of living with diabetes. Chronic hypoglycemia can be distressing, and a supportive environment is essential.

Example Scenario:

Consider a situation where an elderly parent with diabetes lives with their adult child. The parent has a history of frequent hypoglycemia and sometimes struggles to recognize the symptoms. The adult child takes the following steps: Why Is My Morning Blood Glucose So High 5 Common Causes

Education: Learns about the parent's medication schedule and potential side effects.
Emergency Preparedness: Keeps a glucagon kit and glucose tablets readily accessible and knows how to administer glucagon.
Communication: Attends medical appointments with the parent to stay informed about their condition.
Monitoring: Helps the parent monitor blood glucose levels, especially before meals and before bed.
Action: In the event of severe hypoglycemia, the child remains calm, administers glucagon, calls emergency services, and provides comfort and support.

Table: Roles and Responsibilities of Caregivers

| Role | Responsibilities | | :---------------------- | :---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Educator | Learn about diabetes, its management, and the specific needs of the individual. | | Emergency Responder | Recognize the symptoms of hypoglycemia, administer quick-acting glucose or glucagon, and call emergency services. | | Supporter | Provide emotional support, encouragement, and practical assistance with daily tasks. | | Advocate | Participate in medical appointments, communicate with healthcare providers, and advocate for the individual’s needs. | | Monitor | Help monitor blood glucose levels, medication adherence, and dietary habits. |

By actively participating in the management of diabetes, family, friends, and caregivers can significantly improve the safety and well-being of individuals at risk of severe hypoglycemia. Their involvement ensures a comprehensive support system that promotes proactive prevention and effective emergency response.