Feeling Shaky? How to Quickly Treat an Episode of Severe Hypoglycemia Hypoglycemia, also known as low blood sugar, can be a frightening experience. Es...

Feeling Shaky? How to Quickly Treat an Episode of Severe Hypoglycemia

Hypoglycemia, also known as low blood sugar, can be a frightening experience. Especially when severe, it requires immediate attention to prevent serious complications. This article provides a comprehensive guide on how to quickly and effectively treat an episode of severe hypoglycemia. We’ll cover recognizing the symptoms, understanding the underlying causes, and, most importantly, outlining step-by-step actions you can take to restore your blood sugar levels and prevent future occurrences.

Severe hypoglycemia is defined as a condition where your blood sugar drops so low that you need assistance from another person to treat it. It can lead to confusion, unconsciousness, seizures, and in rare cases, even death. Therefore, understanding how to manage and treat it is crucial for anyone at risk, particularly individuals with diabetes.

Recognizing the Signs and Symptoms of Severe Hypoglycemia

The first step in effectively treating severe hypoglycemia is recognizing the symptoms. Symptoms can vary from person to person, but common indicators include:

Confusion and disorientation: Difficulty thinking clearly or making rational decisions.
Loss of consciousness: Inability to respond to stimuli.
Seizures: Uncontrolled muscle spasms.
Slurred speech: Difficulty speaking clearly.
Extreme weakness or fatigue: Feeling unusually tired and unable to move normally.
Sweating profusely: Excessive perspiration even in a cool environment.
Rapid heartbeat: Increased heart rate, often felt as palpitations.
Tremors or shakiness: Uncontrollable shaking of the hands or body.

It is vital to know your individual symptoms and how they manifest. If you have a history of hypoglycemia, keeping a log of your symptoms can help you identify early warning signs and take preventive measures.

| Symptom | Description | Severity | | ------------------------- | ------------------------------------------------------------------ | --------- | | Confusion | Difficulty thinking clearly, disorientation | Moderate | | Loss of consciousness | Unresponsiveness to external stimuli | Severe | | Seizures | Uncontrolled muscle spasms | Severe | | Slurred speech | Difficulty speaking clearly | Moderate | | Extreme weakness/fatigue | Overwhelming tiredness, inability to move | Moderate | | Profuse sweating | Excessive perspiration, unrelated to temperature | Mild to Moderate | | Rapid heartbeat | Noticeably increased heart rate, palpitations | Mild to Moderate | | Tremors/shakiness | Uncontrollable shaking, usually of hands and body | Mild to Moderate |

Immediate Actions to Take During a Severe Hypoglycemic Episode

When someone exhibits signs of severe hypoglycemia, prompt and decisive action is required. Here's a step-by-step guide:

Check Blood Sugar (If Possible and Safe): If the person is conscious and able to cooperate, check their blood sugar levels using a glucose meter. However, never attempt to check blood sugar if the person is unconscious or seizing, as this could lead to injury.
Related reading: Managing Type 1 Diabetes A Daily Guide To Stable Glucose Levels
Administer Glucagon (If Available): Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It is typically prescribed for individuals at risk of severe hypoglycemia.
- How to Administer Glucagon:
  - Locate the glucagon kit and follow the included instructions.
  - Generally, you will need to mix the glucagon powder with the provided diluent.
  - Inject the solution into the thigh, upper arm, or abdomen. The person doesn't need to be lying down.
  - Important: After administering glucagon, the person may vomit. Turn them on their side to prevent choking.
- If Glucagon Is Not Available: Call for Emergency Medical Services (EMS) immediately. Explain that the person is experiencing a severe hypoglycemic episode and needs urgent medical attention. Provide your location and any relevant medical history you are aware of.
- Do NOT Attempt to Give Food or Drink to an Unconscious Person: This could cause choking. The priority is to administer glucagon or call for emergency assistance.
- Monitor and Observe: After administering glucagon or while waiting for EMS, monitor the person closely. Note any changes in their condition, such as breathing rate, level of consciousness, and skin color. This information will be crucial for medical professionals.
- Post-Episode Care: After the episode subsides and the person regains consciousness, provide them with a source of fast-acting carbohydrates, such as fruit juice or glucose tablets, followed by a longer-acting source of energy like a sandwich or crackers with peanut butter. Monitor their blood sugar levels regularly for the next few hours to ensure they remain stable.

Crucial Note: Even if the person appears to recover after receiving glucagon or simple carbohydrates, always seek medical evaluation. There may be underlying issues that need addressing.

Understanding the Causes and Risk Factors

Understanding the factors that contribute to hypoglycemia can help prevent future episodes. Common causes include:

Excessive Insulin Dosage: Taking too much insulin can cause blood sugar to drop too low. This is a primary concern for individuals with Type 1 diabetes and those with Type 2 diabetes who use insulin.
Skipping Meals or Eating Inadequately: Insufficient carbohydrate intake can lead to hypoglycemia, especially when taking insulin or certain oral diabetes medications.
Increased Physical Activity: Exercise increases glucose utilization, and if you don't adjust your medication or food intake accordingly, your blood sugar can plummet.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release stored glucose, particularly when consumed on an empty stomach.
Certain Medications: Some medications, such as sulfonylureas (a type of diabetes medication) can increase the risk of hypoglycemia.
Kidney or Liver Disease: These conditions can impair glucose regulation.

Risk factors for severe hypoglycemia include:

History of Frequent Hypoglycemic Episodes: Individuals who experience hypoglycemia frequently are more likely to have severe episodes.
Impaired Awareness of Hypoglycemia: Some people lose the ability to recognize the early warning signs of low blood sugar.
Cognitive Impairment: Individuals with cognitive impairment may struggle to manage their diabetes effectively.
Elderly Adults: Older adults are more vulnerable to hypoglycemia due to age-related changes in metabolism and kidney function.

| Cause | Explanation | Preventive Measure | | ----------------------------------- | -------------------------------------------------------------------------- | --------------------------------------------------------------------------------- | | Excessive Insulin Dosage | Taking too much insulin relative to food intake or activity levels | Work with your healthcare provider to adjust your insulin dosage appropriately | | Skipping Meals or Eating Inadequately | Not consuming enough carbohydrates to match insulin dosage | Plan regular meals and snacks; ensure adequate carbohydrate intake with meals | | Increased Physical Activity | Increased glucose utilization during exercise | Monitor blood sugar before, during, and after exercise; adjust insulin or snacks as needed | | Alcohol Consumption | Alcohol interferes with liver's glucose release, especially on empty stomach | Consume alcohol in moderation, with food; avoid alcohol on an empty stomach | | Certain Medications | Sulfonylureas and other medications that lower blood sugar | Discuss medication adjustments with your doctor |

Preventing Future Hypoglycemic Episodes

Preventing severe hypoglycemia requires a multifaceted approach, including:

Regular Blood Sugar Monitoring: Use a glucose meter to check your blood sugar levels frequently, especially before meals, before and after exercise, and before bedtime. Continuous Glucose Monitoring (CGM) systems can provide real-time blood sugar data and alerts for low blood sugar trends.
Consistent Meal Timing: Eat regular meals and snacks, and avoid skipping meals. If you take insulin, coordinate your meals with your insulin injections.
Medication Management: Work closely with your healthcare provider to adjust your medication dosages as needed, especially when changing your diet or activity levels.
Educate Family and Friends: Teach your family, friends, and coworkers about the signs and symptoms of hypoglycemia and how to administer glucagon. Make sure they know where your glucagon kit is located.
Carry a Medical Alert ID: Wear a medical alert bracelet or necklace that identifies you as someone with diabetes and provides instructions on how to help you in an emergency.
Hypoglycemia Awareness Training: Participate in diabetes education programs to improve your understanding of hypoglycemia and how to manage it effectively.
Plan Ahead for Exercise: Monitor your blood sugar before, during, and after exercise, and adjust your insulin or food intake as needed.
Avoid Excessive Alcohol Consumption: Consume alcohol in moderation, with food, and avoid drinking on an empty stomach.

| Strategy | Description | Benefit | | -------------------------------- | ------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------- | | Regular Blood Sugar Monitoring | Frequent checks using glucose meter or CGM | Early detection of blood sugar trends, proactive adjustments | | Consistent Meal Timing | Eating regular meals and snacks | Prevents fluctuations in blood sugar levels, supports consistent insulin action | | Medication Management | Adjusting medication dosages in coordination with healthcare provider | Ensures proper glucose control, reduces risk of hypoglycemia or hyperglycemia | | Education for Family/Friends | Training others to recognize symptoms and administer glucagon | Enables quick response during an emergency, minimizes harm | | Medical Alert ID | Wearing identification with diabetes information | Provides vital information to first responders in case of emergency | | Hypoglycemia Awareness Training | Participating in diabetes education programs | Improves understanding of hypoglycemia, enhances self-management skills |

The Role of Glucagon: A Life-Saving Medication

Glucagon is a critical medication for individuals at risk of severe hypoglycemia. It is a hormone that stimulates the liver to release stored glucose into the bloodstream, rapidly raising blood sugar levels. Glucagon is available as an injectable medication and, more recently, as a nasal spray.

Who Needs Glucagon? Individuals with Type 1 diabetes and those with Type 2 diabetes who use insulin are typically prescribed glucagon. Your healthcare provider will assess your risk of severe hypoglycemia and determine whether glucagon is necessary.
How to Use Glucagon: Glucagon kits come with detailed instructions. Familiarize yourself with these instructions before an emergency occurs. Practice administering the glucagon injection or nasal spray using a training device (if available).
Important Considerations:
- Glucagon is only effective if there is stored glucose in the liver. If the person has been fasting for an extended period or has depleted their glycogen stores, glucagon may not be as effective.
- After administering glucagon, the person may vomit. Turn them on their side to prevent choking.
- Glucagon is a temporary fix. After the episode subsides, it's essential to seek medical evaluation to determine the underlying cause of the hypoglycemia.

| Feature | Injectable Glucagon | Nasal Glucagon | | ----------------- | ------------------------------------------------------- | ----------------------------------------------------- | | Administration | Injection into thigh, upper arm, or abdomen | Nasal spray into one nostril | | Preparation | Requires mixing powder with diluent | Ready-to-use | | Ease of Use | May require some practice | Simple and easy to administer | | Storage | Store at room temperature, away from direct sunlight | Store at room temperature, away from direct sunlight |

Living with Diabetes and Managing Hypoglycemia: A Long-Term Strategy

Effectively managing hypoglycemia is an ongoing process. By understanding the symptoms, causes, and treatment options, you can empower yourself to take control of your health and prevent severe episodes. Remember these key takeaways:

Know Your Body: Be aware of your individual symptoms of hypoglycemia.
Monitor Your Blood Sugar Regularly: Use a glucose meter or CGM to track your blood sugar levels.
Work Closely with Your Healthcare Team: Collaborate with your doctor, diabetes educator, and other healthcare professionals to develop a personalized diabetes management plan.
Carry a Glucagon Kit: If you are at risk of severe hypoglycemia, make sure you have a glucagon kit readily available and that your family and friends know how to use it.
Educate Yourself: Stay informed about diabetes management and hypoglycemia.

Hypoglycemia can be a daunting challenge, but with proactive management, education, and support, you can minimize your risk of severe episodes and live a healthy, fulfilling life with diabetes.

By implementing the strategies outlined in this article, you can be well-prepared to respond quickly and effectively to an episode of severe hypoglycemia, protecting yourself and those around you. Always consult with your healthcare provider for personalized advice and guidance on managing your diabetes and preventing hypoglycemia.