Hypoglycemia (Severe): A Lifesaving Guide for Persons with Diabetes

30 Aug 2025

Hypoglycemia (Severe): A Lifesaving Guide for Persons with Diabetes Hypoglycemia, or low blood sugar, is a common complication for individuals managin...

Hypoglycemia (Severe): A Lifesaving Guide for Persons with Diabetes

Hypoglycemia, or low blood sugar, is a common complication for individuals managing diabetes, particularly those using insulin or certain oral medications. While mild hypoglycemia can often be managed with quick-acting carbohydrates, severe hypoglycemia is a medical emergency requiring immediate intervention. This guide provides critical information on recognizing, treating, and preventing severe hypoglycemia to help save lives and improve the well-being of individuals with diabetes.

Why is Severe Hypoglycemia a Serious Concern?

Severe hypoglycemia occurs when blood glucose levels drop to a point where the individual is unable to treat themselves due to confusion, disorientation, loss of consciousness, seizures, or coma. This condition can lead to:

Related reading: Manage Blood Sugar Spikes After Meals A Step By Step Plan

  • Brain Damage: The brain relies heavily on glucose for energy; prolonged low blood sugar can cause irreversible neurological damage.
  • Cardiovascular Events: Severe hypoglycemia can trigger heart arrhythmias, angina, or even heart attacks, especially in individuals with pre-existing heart conditions.
  • Injuries: Loss of consciousness can result in falls, accidents, and other physical injuries.
  • Death: In extreme cases, untreated severe hypoglycemia can be fatal.
  • Increased Fear and Anxiety: Experiencing severe hypoglycemia can create fear, anxiety, and a reluctance to maintain optimal glycemic control.
  • Decreased Quality of Life: The constant threat of severe hypoglycemia can negatively impact an individual's quality of life, limiting their activities and social interactions.

Recognizing the Signs and Symptoms of Severe Hypoglycemia

Recognizing the warning signs of hypoglycemia is crucial for preventing a severe episode. However, it’s equally important to recognize that symptoms can vary significantly from person to person, and sometimes, there may be no warning signs at all (a condition known as hypoglycemia unawareness).

Common Symptoms That May Precede Severe Hypoglycemia:

  • Mild to Moderate Hypoglycemia Symptoms (which, if left untreated, can lead to severe hypoglycemia):
    • Shakiness
    • Sweating
    • Dizziness or lightheadedness
    • Hunger
    • Irritability or anxiety
    • Confusion or difficulty concentrating
    • Rapid heartbeat
    • Blurred vision
    • Weakness
    • Headache
  • Symptoms of Severe Hypoglycemia
    • Inability to wake up
    • Seizures
    • Loss of consciousness
    • Erratic or combative behavior
    • Slurred speech
    • Unresponsiveness to verbal stimuli

Hypoglycemia Unawareness:

Some individuals with diabetes, especially those with frequent hypoglycemic episodes or long-standing diabetes, may develop hypoglycemia unawareness. This means they no longer experience the early warning signs of low blood sugar, significantly increasing their risk of severe hypoglycemia.

What to Do If You Suspect Someone is Experiencing Severe Hypoglycemia:

If you suspect someone is experiencing severe hypoglycemia, take the following steps:

  1. Check for a Medical ID: Look for a medical ID bracelet, necklace, or card that indicates the person has diabetes.
  2. Do Not Give Food or Drink: If the person is unconscious or unable to swallow, do not attempt to give them food or drink, as this could cause choking.
  3. Administer Glucagon: If glucagon is available and you know how to administer it, inject it into the person's thigh or arm (see instructions below).
  4. Call Emergency Services (911): Even after administering glucagon, call emergency services immediately. It is crucial to seek professional medical attention.
  5. Provide Information: When emergency services arrive, provide them with any information you have about the person's diabetes and the steps you have taken.

How to Treat Severe Hypoglycemia: The Role of Glucagon

Glucagon is a hormone that raises blood sugar levels by stimulating the liver to release stored glucose into the bloodstream. It is a prescription medication available in injectable and nasal spray forms, specifically designed to treat severe hypoglycemia. Every individual with diabetes at risk of severe hypoglycemia should have a glucagon kit readily available, and their family, friends, and caregivers should be trained on how to use it.

Types of Glucagon Available:

  • Injectable Glucagon: This is the traditional form, requiring reconstitution (mixing the powder with a liquid). Brands include GlucaGen and generic options.
  • Nasal Glucagon (Baqsimi): This is a pre-mixed, ready-to-use nasal spray. It is easier to administer than injectable glucagon and does not require reconstitution.
  • Pre-filled Syringe and Auto-Injector (Gvoke): This is a ready-to-use injectable glucagon formulation. It comes in a pre-filled syringe or an auto-injector pen, making it easier to administer.

How to Administer Glucagon:

  • Injectable Glucagon:
    1. Locate the glucagon kit and follow the manufacturer's instructions for reconstitution (mixing the powder with the liquid).
    2. Inject the glucagon into the person's thigh or arm muscle.
    3. Turn the person onto their side in case of vomiting.
  • Nasal Glucagon (Baqsimi):
    1. Remove the device from its packaging.
    2. Insert the tip of the nozzle into one nostril and press the plunger firmly.
    3. There is no need to inhale.
    4. Turn the person onto their side in case of vomiting.
  • Pre-filled Syringe and Auto-Injector (Gvoke):
    1. Remove the cap and press the auto-injector firmly against the thigh. Hold for the duration specified in the product instructions.
    2. Turn the person onto their side in case of vomiting.
    3. Remove syringe and discard.

Important Considerations When Using Glucagon:

  • Expiration Date: Always check the expiration date of the glucagon kit. Expired glucagon may not be effective.
  • Storage: Store glucagon at room temperature, away from direct sunlight and extreme temperatures.
  • Side Effects: Common side effects of glucagon include nausea and vomiting.
  • Follow-Up: After administering glucagon, the individual should be taken to the hospital for further evaluation. Glucagon's effects are temporary, and additional treatment may be necessary.
  • Education: Regular review of glucagon administration techniques is vital for caregivers. Do not rely on memory from the last time you learned.

Preventing Severe Hypoglycemia: Proactive Strategies

Prevention is the best approach to managing severe hypoglycemia. By implementing proactive strategies, individuals with diabetes can significantly reduce their risk of experiencing this life-threatening event.

Key Prevention Strategies:

  1. Regular Blood Glucose Monitoring:

    • Monitor blood glucose levels frequently, especially before meals, after meals, before bedtime, and before and after exercise.
    • Consider using a continuous glucose monitor (CGM) to track glucose levels in real-time and receive alerts when glucose levels are trending too high or too low.

    • Careful Medication Management:

    • Work closely with your healthcare provider to adjust insulin or medication dosages based on blood glucose levels, diet, and activity levels.

    • Avoid skipping meals or delaying eating, as this can lead to hypoglycemia, especially when taking insulin or certain oral medications.
    • Be aware of how different medications, including those not related to diabetes, can affect blood glucose levels.

    • Related reading: The Complete Guide To Glucose And Its Role In Your Health

      Consistent Meal Planning:

    • Eat regular, balanced meals and snacks to maintain stable blood glucose levels.

    • Carbohydrate counting can help manage insulin dosages more accurately.

    • Exercise Precautions:

    • Monitor blood glucose levels before, during, and after exercise, as physical activity can lower blood glucose.

    • Adjust insulin or medication dosages and consume extra carbohydrates before or during exercise, as needed.
    • Carry a fast-acting carbohydrate source, such as glucose tablets or juice, during exercise.

    • Alcohol Consumption:

    • Consume alcohol in moderation and always with food.

    • Alcohol can interfere with the liver's ability to release glucose, increasing the risk of hypoglycemia, especially when consumed on an empty stomach.
    • Monitor blood glucose levels closely after consuming alcohol.

    • Educate Family and Friends:

    • Teach family members, friends, and caregivers how to recognize the signs and symptoms of hypoglycemia and how to administer glucagon.

    • Ensure they know where to find the glucagon kit and how to contact emergency services.

    • Related reading: A1C Test Vs Cgm Which Is Better For Monitoring Your Glucose

      Medical Alert Identification:

    • Wear a medical ID bracelet or necklace indicating you have diabetes.

    • This will alert first responders to your condition in case of an emergency.

    • Regular Healthcare Provider Visits:

    • Schedule regular check-ups with your healthcare provider to discuss blood glucose management, medication adjustments, and any concerns you may have.

    • Adjustments for Illness:

    • When sick, monitor blood sugar more often.

    • Illness can greatly affect blood sugar control, requiring adjustments to medication or insulin, diet, and other habits.

    • Utilizing Technology:

    • CGMs: Continuous glucose monitors offer real-time glucose readings and alert the user to impending highs and lows. This allows for pre-emptive action to be taken.

    • Insulin Pumps with Suspension Features: Some insulin pumps can automatically suspend insulin delivery when blood glucose drops to a pre-set level, reducing the risk of hypoglycemia.

    • Address Hypoglycemia Unawareness:

    • SMBG: Regular self-monitoring of blood glucose, even when feeling well, can help detect patterns and trends that lead to hypoglycemia.

    • Target Higher Glucose Levels: Initially aiming for slightly higher blood glucose targets can help the body regain sensitivity to low blood sugar symptoms. This should be done in consultation with a healthcare provider.
    • Avoid Overcorrection: Overcorrecting high blood sugar can lead to a rapid drop and increase the risk of hypoglycemia.
    • Consider CGM Alarms: Set CGM alarms at a slightly higher level than usual to provide earlier warnings of a potential low.

Long-Term Management After a Severe Hypoglycemic Event

Experiencing severe hypoglycemia can be a traumatic event, both physically and emotionally. It's essential to have a plan for long-term management to prevent future occurrences and address any underlying issues.

Post-Event Action Plan:

  • Review the Event: Work with your healthcare team to analyze the events leading up to the severe hypoglycemic episode. Identify any contributing factors, such as medication errors, missed meals, or unexpected physical activity.
  • Adjust Treatment Plan: Based on the review, make necessary adjustments to your diabetes management plan. This may involve changes to insulin dosages, medication regimens, meal planning, or exercise routines.
  • Re-evaluate Blood Glucose Targets: Your healthcare provider may recommend adjusting your blood glucose targets to reduce the risk of future hypoglycemic events.
  • Address Hypoglycemia Unawareness: If you experienced hypoglycemia unawareness, work with your healthcare team to develop a strategy to regain awareness of low blood sugar symptoms.
  • Mental Health Support: Severe hypoglycemia can lead to anxiety, fear, and post-traumatic stress. Consider seeking support from a mental health professional to address these emotional challenges.
  • Ongoing Education: Continue to educate yourself about diabetes management, including the prevention and treatment of hypoglycemia.
  • Emergency Plan Review: Regularly review and update your emergency plan, ensuring that family, friends, and caregivers are aware of the latest protocols.
  • Technology Review: Work with your healthcare team to see if changes in diabetes technologies can help prevent or reduce the risk of future events. Review CGM settings and discuss insulin pump integrations.

The Importance of Continuous Education and Support

Living with diabetes and managing the risk of severe hypoglycemia requires ongoing education, support, and a proactive approach. Staying informed about the latest advancements in diabetes care, participating in support groups, and working closely with your healthcare team are essential for maintaining optimal health and well-being. By taking these steps, individuals with diabetes can significantly reduce their risk of severe hypoglycemia and live full, active lives. Severe hypoglycemia is a serious complication of diabetes, but with proper education, proactive strategies, and readily available glucagon, individuals with diabetes can successfully manage their condition and prevent life-threatening events. This guide serves as a comprehensive resource for individuals with diabetes, their families, and their caregivers.

Debunking Common Myths about Hypoglycemia and Severe Hypoglycemia

There are many misconceptions about hypoglycemia, especially in relation to severe episodes. Clearing up these myths can improve management and outcomes for people with diabetes.

Myth 1: Only people with Type 1 diabetes experience severe hypoglycemia. * Fact: While more common in Type 1 diabetes due to absolute insulin deficiency and insulin-dependent management, severe hypoglycemia can occur in Type 2 diabetes, particularly when using insulin or certain oral medications (e.g., sulfonylureas).

Myth 2: If someone is hypoglycemic, you should give them any sugary food or drink you can find. * Fact: It's best to administer rapidly absorbed carbohydrates like glucose tablets, juice, or non-diet soda for mild to moderate hypoglycemia. However, if the person is unconscious or having seizures (severe hypoglycemia), never try to force food or drink into their mouth, as this can cause choking. Glucagon is the appropriate treatment in these instances, followed by a call to emergency services.

Myth 3: Glucagon always works immediately. * Fact: Glucagon typically begins to raise blood sugar within 10-15 minutes, but it may not work if the liver's glycogen stores are depleted (e.g., due to excessive alcohol consumption, starvation, or liver disease). It's vital to call for emergency medical assistance even after glucagon administration.

Myth 4: Once blood sugar is back to normal after a hypoglycemic episode, the danger is over. * Fact: Even after blood sugar levels are normalized, there can be lingering effects, and blood sugar levels can drop again. It's essential to continue monitoring blood glucose levels and have a snack containing both carbohydrates and protein to help stabilize levels. The underlying cause should be investigated with your healthcare provider to prevent future episodes.

Myth 5: You don’t need to call emergency services after glucagon is given and the person recovers.

  • Fact: Although glucagon can restore blood sugar to normal, emergency medical services should still be contacted after the injection has taken place. The underlying cause of the hypoglycemic event can only be investigated and further stabilized by trained medical professionals.

Myth 6: If someone appears drunk, they are just drunk.

  • Fact: Symptoms of hypoglycemia can mimic intoxication (slurred speech, confusion, incoordination). Always rule out hypoglycemia, especially if the person has diabetes or is wearing a medical alert.