How to Handle a Severe Hypoglycemia Emergency: A Step-by-Step Guide Severe hypoglycemia, or dangerously low blood sugar, is a critical condition that ...

How to Handle a Severe Hypoglycemia Emergency: A Step-by-Step Guide

Severe hypoglycemia, or dangerously low blood sugar, is a critical condition that requires immediate action. It primarily affects individuals with diabetes who are using insulin or certain oral medications that increase insulin production. Recognizing the symptoms and knowing how to respond quickly can be life-saving. This guide provides a detailed, step-by-step approach to handling a severe hypoglycemia emergency.

What is Severe Hypoglycemia and Why is it an Emergency?

Hypoglycemia occurs when the level of glucose (sugar) in your blood drops too low. While mild hypoglycemia can often be managed with food or sugary drinks, severe hypoglycemia is a different beast altogether.

Severe hypoglycemia is characterized by a blood glucose level so low that the individual is unable to treat themselves and requires assistance from another person. This can lead to:

Loss of consciousness: The brain needs glucose to function properly, and a lack of glucose can cause unconsciousness.
Seizures: Severe hypoglycemia can disrupt normal brain activity, leading to seizures.
Coma: Prolonged and untreated severe hypoglycemia can result in a diabetic coma, a life-threatening condition.
Brain damage: In extreme cases, prolonged hypoglycemia can cause permanent brain damage.

Therefore, severe hypoglycemia is a genuine medical emergency requiring prompt and effective intervention.

Step 1: Recognize the Symptoms of Severe Hypoglycemia

Being able to recognize the symptoms of severe hypoglycemia is crucial to a rapid response. The signs and symptoms can vary from person to person, and some people may not experience any noticeable symptoms before losing consciousness. That said, common indicators include:

Confusion or Disorientation: Difficulty thinking clearly, confusion, or inability to follow instructions.
Unconsciousness: This is the most alarming sign.
Seizures: Uncontrolled muscle spasms and jerking.
Weakness or Incoordination: Difficulty standing or walking.
Sweating and Clammy Skin: Profuse sweating despite not being hot.
Pale Skin: Loss of color in the face and skin.
Blurred Vision or Double Vision: Visual disturbances.
Irritability or Aggression: Sudden changes in mood or behavior.

It's essential for individuals with diabetes and their families/caregivers to discuss and understand the specific symptoms that the individual typically experiences when their blood sugar drops too low.

Step 2: Do Not Attempt to Give Food or Drink if the Person is Unconscious

This is paramount! Attempting to force food or liquid into the mouth of an unconscious person poses a significant choking hazard.

Step 3: Administer Glucagon

Glucagon is a hormone that raises blood glucose levels. It's a critical medication for treating severe hypoglycemia.

Locate the Glucagon Kit: Individuals at risk for severe hypoglycemia should always have a glucagon emergency kit readily available at home, work, and school. Their family members, caregivers, and close friends should know where it's located.
Prepare the Glucagon Injection: Follow the specific instructions included in the glucagon kit, as preparation methods may vary depending on the brand. Generally, this involves mixing the powdered glucagon with the diluent (liquid) in the syringe.
Administer the Injection: The injection can be given intramuscularly (into a muscle) in the upper arm, thigh, or buttock. Injecting through clothing is acceptable if necessary.
Dosage:
- Adults and Children weighing more than 25 kg (55 lbs): Typically 1 mg of glucagon.
- Children weighing less than 25 kg (55 lbs): Typically 0.5 mg of glucagon.
Important Note: Glucagon works by stimulating the liver to release stored glucose. It may not be effective if the liver's glycogen stores are depleted, such as in cases of prolonged hypoglycemia or in individuals with liver disease.

Always consult the glucagon kit's instructions for accurate dosage and administration information. If you're unsure, err on the side of caution and administer the dose you think is correct while waiting for emergency services to arrive.

Step 4: Call for Emergency Medical Assistance Immediately (e.g., 911)

While glucagon can help raise blood sugar, it's not a substitute for professional medical care. Call emergency services immediately after administering glucagon. Even if the person regains consciousness, they still need to be evaluated by medical professionals. Explain that you've administered glucagon for severe hypoglycemia.

Step 5: Monitor the Person’s Condition

After administering glucagon, closely monitor the person’s breathing and pulse. If they regain consciousness, they may experience nausea and vomiting. Turn them on their side to prevent choking if they vomit.

Note: Glucagon is not a cure for the underlying cause of the hypoglycemia. Further medical evaluation is needed to determine why the episode occurred and prevent future occurrences.

Step 6: Once the Person is Conscious and Able to Swallow, Give Them a Fast-Acting Carbohydrate

If the person regains consciousness and is able to swallow safely, give them a fast-acting carbohydrate source, such as:

Glucose Tablets or Gel: Follow the package instructions for the appropriate dose.
Fruit Juice (4 ounces): Provides a quick sugar boost.
Regular Soda (not diet): Another source of fast-acting carbohydrates.
Honey or Syrup (1 tablespoon): Can be easily absorbed.

After the initial fast-acting carbohydrate, follow up with a longer-acting carbohydrate source, such as:

Crackers with Peanut Butter: Combines carbohydrates and protein for sustained blood sugar levels.
A Sandwich: Provides carbohydrates and protein.
Milk: Contains lactose, a slower-digesting sugar.

This will help prevent the blood sugar from dropping again.

Step 7: Provide Information to Emergency Responders

When emergency medical personnel arrive, provide them with the following information:

That the person is diabetic.
That they experienced severe hypoglycemia.
That you administered glucagon (and the time it was administered).
Any other relevant medical history or medications the person takes.
Their typical symptoms of low blood sugar

This information will help them provide the best possible care.

Preventing Future Episodes of Severe Hypoglycemia

Prevention is always better than cure. There are many strategies for preventing future episodes of severe hypoglycemia:

Regular Blood Glucose Monitoring: Consistently checking blood sugar levels, especially before meals, before bedtime, and after exercise. Using a continuous glucose monitor (CGM) can be extremely helpful for detecting trends and alerting to potential low blood sugars.
Careful Medication Management: Following your doctor's instructions for insulin or other diabetes medications. Understanding how these medications work and how they affect your blood sugar is crucial.
Consistent Meal Timing: Eating meals and snacks at regular intervals to prevent blood sugar from dropping too low.
Carbohydrate Counting: Learning how to estimate the carbohydrate content of foods and adjusting insulin doses accordingly.
Adjusting Insulin for Exercise: Understanding how exercise affects blood sugar and adjusting insulin doses or carbohydrate intake accordingly.
Avoiding Alcohol or Drinking in Moderation: Alcohol can lower blood sugar levels, especially when consumed on an empty stomach. If you drink alcohol, do so in moderation and always with food.
Educating Family and Friends: Ensuring that family members, caregivers, and close friends are trained on how to recognize and treat severe hypoglycemia.
Wearing a Medical Identification: Wearing a medical identification bracelet or necklace that identifies you as having diabetes and provides emergency contact information.
Regularly Reviewing Treatment Plan with Healthcare Provider: Working closely with your doctor or diabetes educator to review your treatment plan and make adjustments as needed.

Importance of Training and Preparation

Effectively managing a severe hypoglycemia emergency requires training and preparedness. Consider the following:

Glucagon Training: Get proper training from your healthcare provider on how to administer glucagon. Practice with a trainer kit (which doesn’t contain medication) until you feel comfortable with the process.
Family and Caregiver Education: Ensure that family members, caregivers, and close friends are also trained on how to recognize and treat severe hypoglycemia.
Emergency Action Plan: Develop a written emergency action plan that outlines the steps to take in the event of severe hypoglycemia. Share this plan with family members, caregivers, and school officials.
Regular Review of Emergency Supplies: Check the expiration dates of glucagon kits and glucose tablets regularly and replace them as needed. Ensure that all emergency supplies are readily accessible.

Severe hypoglycemia is a serious and potentially life-threatening condition, but with proper preparation, knowledge, and a swift response, you can effectively manage the emergency and help the affected individual. It is essential to regularly review your diabetes management plan with your healthcare provider and seek guidance on preventing and treating severe hypoglycemia.