Recognizing Severe Hypoglycemia: A Life-Saving Guide for Persons with Diabetes Severe hypoglycemia, or critically low blood sugar, is a frightening bu...

Recognizing Severe Hypoglycemia: A Life-Saving Guide for Persons with Diabetes

Severe hypoglycemia, or critically low blood sugar, is a frightening but manageable complication for individuals with diabetes. It's crucial to be prepared, both for yourself and for loved ones, so that you can respond quickly and effectively to protect against potentially life-threatening consequences. This guide will walk you through recognizing severe hypoglycemia, understanding its risk factors, and implementing life-saving strategies.

What is Severe Hypoglycemia?

Hypoglycemia refers to a state where blood glucose levels drop too low. For people with diabetes, this often means a blood sugar reading below 70 mg/dL (3.9 mmol/L), but thresholds may vary depending on individual targets. Severe hypoglycemia is defined as a low blood sugar event that requires assistance from another person to treat because the individual is unable to treat themselves. This inability to self-treat can result from confusion, seizures, or loss of consciousness. It is essential to highlight that even if the person can eventually recover and self-treat, the initial need for assistance classifies it as severe.

| Severity | Blood Sugar Level (mg/dL) | Symptoms | Treatment | |-----------------------|-----------------------------|---------------------------------------------------------------------------|----------------------------------------------------------------------------------------| | Mild to Moderate | Below 70 (3.9 mmol/L) | Shakiness, sweating, hunger, dizziness, anxiety | 15-20 grams of fast-acting carbohydrates | | Severe | Variable, requiring assistance | Confusion, inability to follow commands, seizure, unconsciousness | Glucagon injection or intravenous glucose by a trained professional |

Why is it important to recognize and treat severe hypoglycemia? Unattended severe hypoglycemia can lead to:

Seizures: Extremely low blood sugar can disrupt normal brain function.
Loss of Consciousness: The brain needs glucose to function. If the sugar levels get too low, the brain can shut down, leading to loss of consciousness.
Brain Damage: Prolonged and untreated severe hypoglycemia can cause permanent brain damage.
Death: In the most extreme cases, severe hypoglycemia can be fatal.

Recognizing the Signs and Symptoms

One of the first steps in managing severe hypoglycemia is recognizing the warning signs. While symptoms can vary from person to person, here are some common indicators:

Early Warning Signs

These symptoms often occur at milder stages of hypoglycemia, but paying attention to them can prevent a severe episode:

Shakiness or Trembling: Uncontrollable shaking or trembling is a common physical symptom.
Sweating: Excessive sweating, even in a cool environment.
Dizziness or Lightheadedness: Feeling unsteady or faint.
Hunger: An intense, sudden hunger, even if you've recently eaten.
Irritability or Anxiety: Feeling unusually agitated or anxious.
Confusion or Difficulty Concentrating: Mental fog or an inability to focus.
Rapid Heartbeat: A noticeable increase in heart rate.

Symptoms Indicating Severe Hypoglycemia

These symptoms signify a critical drop in blood sugar and require immediate intervention:

Inability to Eat or Drink: The person is unable to swallow or keep down food or drink.
Confusion or Disorientation: Significant mental confusion, disorientation, or inability to follow simple commands.
Seizures: Uncontrolled muscle spasms or convulsions.
Loss of Consciousness: Unresponsiveness or inability to be awakened.
Unusual Behavior: Erratic or aggressive behavior that is out of character.
Slurred Speech: Difficulty speaking clearly.

It is important to remember that some individuals may not experience the usual warning signs of hypoglycemia (known as hypoglycemia unawareness). This is particularly common in those who have frequent episodes of low blood sugar, have had diabetes for a long time, or are taking certain medications. In these cases, regular blood glucose monitoring is even more vital.

Risk Factors and Prevention Strategies

Knowing the risk factors can help you prevent severe hypoglycemia:

Risk Factors for Severe Hypoglycemia:

Intensive Insulin Therapy: Tight glucose control with insulin increases the risk of hypoglycemia.
Delayed or Missed Meals: Skipping meals or delaying food intake can cause blood sugar to drop.
Unplanned Exercise: Exercise, particularly strenuous activity, can lower blood sugar levels.
Alcohol Consumption: Alcohol can impair the liver's ability to release glucose, leading to hypoglycemia, especially when combined with diabetes medications.
Kidney Disease: Impaired kidney function can affect insulin clearance.
Autonomic Neuropathy: Nerve damage that affects the body’s ability to sense low blood sugar.
Hypoglycemia Unawareness: Not being able to feel the early warning signs of low blood sugar.
Medication Interactions: Certain medications can interact with diabetes drugs and increase the risk of hypoglycemia.
Variable Insulin Absorption: Variations in the rate at which insulin is absorbed from the injection site.

Prevention Strategies:

Regular Blood Glucose Monitoring: Check blood sugar levels frequently, especially before meals, before and after exercise, and at bedtime. Use a continuous glucose monitor (CGM) if recommended by your healthcare provider.
Related reading: Why Is My Morning Blood Glucose So High A Guide To The Dawn Phenomenon
Example: If your CGM consistently shows lows overnight, adjust your basal insulin dose in consultation with your doctor. 2. Consistent Meal Timing: Eat meals and snacks at consistent times each day to avoid prolonged periods without food. 3. Carbohydrate Counting: Learn to accurately estimate the carbohydrate content of meals and snacks to match insulin doses appropriately. 4. Adjust Insulin Doses: Work with your healthcare provider to adjust insulin doses based on blood sugar levels, food intake, and activity levels. 5. Snack Before Exercise: Consume a carbohydrate-rich snack before physical activity, especially if it is prolonged or strenuous.
Example: Eat a small granola bar or a piece of fruit before a long walk. 6. Avoid Excessive Alcohol: If you choose to drink alcohol, do so in moderation and always with food. 7. Diabetes Education: Participate in diabetes education programs to learn more about managing blood sugar levels and preventing hypoglycemia. 8. Wear a Medical Alert: Wear a medical ID bracelet or necklace that identifies you as having diabetes and provides emergency contact information. 9. Inform Friends and Family: Educate your friends, family, and coworkers about diabetes and how to recognize and treat severe hypoglycemia. Make sure they know where your glucagon is stored and how to administer it.
Example: Show family members how to inject glucagon and explain when it should be used.
Related reading: Why Is My Morning Blood Glucose So High 8 Common Causes

By understanding these risk factors and implementing preventative measures, you can significantly reduce your risk of severe hypoglycemic episodes.

How to Treat Severe Hypoglycemia

In situations where someone experiences severe hypoglycemia, prompt and effective treatment is essential. The primary treatment for severe hypoglycemia is the administration of glucagon.

Understanding Glucagon

Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream, rapidly raising blood sugar levels. It is available as an injectable medication and more recently as a nasal spray, which can be administered by someone who is not a healthcare professional. Glucagon is available by prescription.

Steps to Administer Glucagon

Recognize the Need: Glucagon should be administered when the person with diabetes is unable to take oral glucose due to confusion, loss of consciousness, or seizures.
Prepare the Glucagon Kit: Each glucagon kit typically contains a vial of powdered glucagon and a syringe filled with sterile water or saline.
Mix the Solution: Remove the caps from the vial and syringe. Inject the sterile water or saline from the syringe into the vial of glucagon. Gently swirl the vial until the glucagon powder is completely dissolved.
Draw the Solution: Draw the reconstituted glucagon solution back into the syringe.
Administer the Injection: Inject the glucagon into the muscle (e.g., thigh, arm, or buttock). The injection site does not need to be sterilized with alcohol beforehand.
Call for Emergency Assistance: Immediately call emergency services (911 in the US) to ensure further medical assistance is provided.

For nasal glucagon:

Ensure the nostril is clear.
Insert the tip of the applicator into one nostril.
Press the plunger to administer the dose.

Important Considerations

Side Effects: Common side effects of glucagon include nausea and vomiting. Place the person on their side after administration to prevent choking if they vomit.
Response Time: It may take 10-15 minutes for glucagon to raise blood sugar levels. If there is no improvement after 15 minutes, a second dose may be necessary, depending on the specific glucagon product instructions and medical advice.
Follow-Up: Once the person regains consciousness and is able to swallow, give them a fast-acting source of carbohydrates (such as fruit juice, glucose tablets, or regular soda) followed by a longer-acting source (such as crackers and peanut butter) to stabilize blood sugar levels.
Medical Evaluation: Always seek medical evaluation after a severe hypoglycemic event to identify and address the underlying causes.

Demonstrating Glucagon Use

Practical training can be invaluable. Ask your doctor or diabetes educator to demonstrate how to administer glucagon and let you practice with a training kit. Many online resources offer step-by-step instructions and videos as well.

Ongoing Management and Support

Managing diabetes effectively and preventing severe hypoglycemia requires an ongoing commitment to self-care, education, and support. Here are some strategies to help you stay on track:

Regular Check-ups: Schedule regular appointments with your healthcare provider to review your diabetes management plan and make any necessary adjustments.
Continuous Education: Stay informed about the latest advancements in diabetes care and management by attending workshops, seminars, and online courses.
Support Groups: Join a diabetes support group to connect with others who have diabetes, share experiences, and learn from each other.
Mental Health Support: Diabetes can take a toll on mental health. Seek support from a therapist or counselor if you are feeling overwhelmed, stressed, or depressed.
Advocate for Yourself: Be an active participant in your care. Speak up about your concerns and needs, and work collaboratively with your healthcare team to develop a personalized treatment plan.
Keep a Detailed Log: Keep track of blood sugar readings, food intake, physical activity, and medication dosages. This information can help you identify patterns and make informed decisions about your diabetes management.
| Date | Time | Blood Sugar (mg/dL) | Food Intake | Activity | Insulin Dose | Notes | |------------|-------|-----------------------|------------------|-------------------------------------------|--------------|-------------------------------------------| | 2024-01-01 | 7:00 AM | 120 | Breakfast | None | 10 units | Fasting reading, feeling good | | 2024-01-01 | 12:00 PM | 80 | Lunch | Light walk | 5 units | Felt slightly low, had a snack | | 2024-01-01 | 6:00 PM | 150 | Dinner | None | 8 units | Reading before dinner | | 2024-01-01 | 10:00 PM | 100 | Snack | Reading | 0 units | Reading before bed |

Resources for Further Learning:

American Diabetes Association (ADA): Provides comprehensive information on diabetes management, research, and advocacy.
Juvenile Diabetes Research Foundation (JDRF): Focuses on funding research to cure, prevent, and treat type 1 diabetes.
Centers for Disease Control and Prevention (CDC): Offers resources on diabetes prevention, education, and statistics.

By taking these steps, you can empower yourself to manage diabetes effectively and reduce the risk of severe hypoglycemia. Remember, knowledge is power, and with the right tools and support, you can live a healthy and fulfilling life with diabetes. Recognizing severe hypoglycemia and knowing how to respond is a life-saving skill that every person with diabetes and their caregivers should possess. Stay vigilant, stay informed, and prioritize your well-being.