Severe Hypoglycemia: A Critical Guide for Persons with Diabetes and Their Families Severe hypoglycemia, a condition characterized by dangerously low b...

Severe Hypoglycemia: A Critical Guide for Persons with Diabetes and Their Families

Severe hypoglycemia, a condition characterized by dangerously low blood sugar levels, poses a significant threat to individuals with diabetes. It’s more than just feeling shaky or sweaty; it can lead to seizures, loss of consciousness, and, in rare cases, even be life-threatening. This guide aims to provide a comprehensive understanding of severe hypoglycemia for both individuals living with diabetes and their families, equipping them with the knowledge and tools to recognize, manage, and prevent this serious complication.

What is Severe Hypoglycemia?

Hypoglycemia, in general, occurs when the glucose (sugar) level in your blood drops too low. For people with diabetes, this typically means a blood sugar level below 70 mg/dL. Severe hypoglycemia is characterized by a low blood glucose level that requires assistance from another person to treat because the individual is unable to treat themselves due to confusion, unconsciousness, or seizures.

Why does this happen? In diabetes, the balance between insulin (or other blood sugar-lowering medications), food intake, and physical activity is crucial. When this balance is disrupted, such as by taking too much insulin, skipping meals, or engaging in strenuous exercise without adjusting medication or food intake, hypoglycemia can occur. Severe episodes are far less common than mild or moderate ones, but are often more worrisome for those with diabetes and their caregivers.

Key differences between mild, moderate, and severe hypoglycemia:

| Symptom | Mild Hypoglycemia | Moderate Hypoglycemia | Severe Hypoglycemia | |---|---|---|---| | Blood Sugar Level | Below 70 mg/dL | Below 70 mg/dL | Requiring assistance to treat, usually blood glucose < 55 mg/dL | | Symptoms | Shakiness, sweating, hunger, anxiety, irritability | Confusion, difficulty concentrating, blurred vision, weakness | Loss of consciousness, seizure, coma | | Ability to Self-Treat | Able to treat with fast-acting carbohydrates | Able to treat with fast-acting carbohydrates, but may need prompting | Unable to self-treat; requires assistance from another person |

Who is at Risk?

Anyone with diabetes who takes insulin or certain oral medications (sulfonylureas and glinides) is at risk for developing hypoglycemia. However, some individuals face a higher risk than others:

People with Type 1 Diabetes: Because they are entirely dependent on injected insulin, the risk of hypoglycemia is often more prominent.
People with a Long History of Diabetes: Those with long-standing diabetes may have reduced awareness of hypoglycemic symptoms (hypoglycemia unawareness).
Elderly Individuals: The elderly may have impaired kidney or liver function, which can affect how medications are metabolized, increasing the risk of hypoglycemia. They may also live alone and have less access to help.
Individuals with Hypoglycemia Unawareness: This condition develops when frequent hypoglycemic episodes dull the body’s warning signs, making it harder to recognize when blood sugar is dropping too low.
People with Cognitive Impairment: Difficulty understanding or remembering medication regimens can significantly raise the risk.
Individuals with Erratic Eating Schedules: Skipping meals or irregular eating patterns can disrupt blood sugar levels.

Recognizing the Signs and Symptoms

Early recognition of hypoglycemia is critical to preventing a severe episode. Symptoms can vary from person to person, but common warning signs include:

Shakiness
Sweating
Hunger
Dizziness or Lightheadedness
Rapid Heartbeat
Anxiety or Irritability
Confusion
Blurred Vision
Weakness
Headache

As hypoglycemia progresses to a severe stage, symptoms can include:

Loss of Consciousness
Seizures
Inability to Swallow or Drink
Unresponsiveness

Important note: It's essential for family members and caregivers to be aware of these symptoms and know how to respond quickly. Time is of the essence in preventing serious complications.

How to Respond to Severe Hypoglycemia

The immediate response to severe hypoglycemia is critical. Here's a step-by-step guide for caregivers and family members:

Check for Responsiveness: Gently try to wake the person and see if they respond.
Do Not Give Food or Drink if Unconscious: This can be dangerous and lead to choking.
Administer Glucagon (if available): Glucagon is a hormone that raises blood sugar levels. It is available as an injection or a nasal spray.
- Glucagon Injection:
  - Locate the glucagon emergency kit.
  - Follow the instructions provided in the kit. Generally, this involves mixing the glucagon powder with the liquid provided and injecting it into the thigh, arm, or buttock.
  - The dose for adults is typically 1 mg. For children, the dose is usually lower and depends on their weight. Consult with a healthcare professional to determine the appropriate dose for children.
  - After administering the injection, turn the person onto their side to prevent choking in case of vomiting.
- Nasal Glucagon:
  - Remove the device from its packaging.
  - Follow the instructions provided. Generally, this involves inserting the nozzle into one nostril and pressing the plunger to deliver the dose.
  - Nasal glucagon does not require mixing or injection and is absorbed through the nasal lining.
Call Emergency Services (911): Even if glucagon is administered and the person regains consciousness, it's crucial to call for emergency medical assistance. Severe hypoglycemia can have underlying causes that need to be addressed. Mention "severe hypoglycemia" and any other relevant medical conditions to the dispatcher.
Related reading: The Ultimate Guide To Your First At Home Blood Sugar Test
Monitor Breathing: Ensure the person is breathing normally. If breathing stops, initiate CPR if you are trained to do so.
Once Conscious, Provide Fast-Acting Carbohydrates: Once the person is fully awake and able to swallow, give them a fast-acting carbohydrate source, such as:
- Glucose Tablets: Follow the instructions on the packaging (usually 3-4 tablets).
- Fruit Juice (4 ounces): Orange juice, apple juice, or grape juice.
- Regular Soda (not diet): 4 ounces.
- Honey or Corn Syrup (1 tablespoon): Spread on the gums if necessary.
Related reading: Is Your Blood Sugar Level Causing Fatigue The Hidden Link
Follow Up with a Longer-Acting Carbohydrate: After the fast-acting carbohydrate, provide a longer-acting carbohydrate and protein snack, such as crackers with peanut butter or cheese, to help stabilize blood sugar levels.
Contact the Person's Healthcare Provider: Inform their doctor about the episode so they can review the person's diabetes management plan.

Important Considerations for Glucagon:

Always check the expiration date: Expired glucagon may not be effective.
Practice administration: Familiarize yourself with how to use the glucagon kit before an emergency occurs.
Teach others: Ensure that other family members, friends, and coworkers know how to administer glucagon.
Common side effects: Nausea and vomiting are common after glucagon administration.

Prevention Strategies: A Proactive Approach

Prevention is key to minimizing the risk of severe hypoglycemic episodes. Here are several strategies that individuals with diabetes and their families can implement:

Regular Blood Glucose Monitoring: Frequent blood glucose checks provide valuable data to understand how various factors (food, activity, medication) affect blood sugar levels. Continuous Glucose Monitors (CGMs) can be especially helpful in detecting trends and alerting to potential lows.
Adherence to Medication Regimen: Take diabetes medications exactly as prescribed by a healthcare provider. Do not skip doses or adjust medications without consulting a doctor.
Meal Planning and Timing: Eat regular meals and snacks to maintain consistent blood sugar levels. Avoid skipping meals, especially when taking insulin or sulfonylureas. Understanding the glycemic index and load of foods can also be beneficial.
Carbohydrate Counting: Learn how to count carbohydrates accurately to match insulin doses to food intake, especially if using insulin pumps or multiple daily injections.
Adjusting Insulin Doses with Exercise: Physical activity can lower blood sugar levels. Adjust insulin doses or increase carbohydrate intake before, during, or after exercise as needed. Monitor blood sugar levels more frequently when engaging in physical activity.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream. If you choose to drink alcohol, do so in moderation and always with food. Monitor blood glucose levels carefully.
Educating Family and Friends: Ensure that family members, friends, and caregivers are aware of the signs and symptoms of hypoglycemia and know how to administer glucagon.
Wearing a Medical Alert Identification: A medical alert bracelet or necklace can provide crucial information to emergency responders in case of a severe hypoglycemic episode, especially if the person is unable to communicate.
Regular Medical Check-ups: Regular visits with an endocrinologist or diabetes educator can help optimize diabetes management and address any concerns or challenges.
Hypoglycemia Awareness Training: Consider attending a diabetes education program or workshop that focuses on hypoglycemia awareness and management.

Hypoglycemia Unawareness: Regaining Sensitivity

Hypoglycemia unawareness is a dangerous condition in which individuals no longer experience the early warning signs of low blood sugar. Fortunately, it's often reversible. Strategies to regain hypoglycemia awareness include:

Avoiding Hypoglycemia: Strictly avoiding low blood sugar levels for several weeks can help the body become more sensitive to the symptoms of hypoglycemia. This may require working closely with your diabetes care team to adjust medications and blood sugar targets temporarily.
Continuous Glucose Monitoring (CGM): CGMs can provide real-time blood glucose readings and alerts when blood sugar levels are dropping, helping individuals recognize and treat hypoglycemia early on. Even when sleeping.
Setting Higher Blood Sugar Targets (Temporarily): Your healthcare provider may recommend setting slightly higher blood sugar targets for a period of time to help restore hypoglycemia awareness.
Structured Education Programs: Participating in diabetes education programs can provide valuable information and strategies for managing hypoglycemia unawareness.

The Role of Technology in Managing Hypoglycemia

Advancements in diabetes technology have significantly improved the management of hypoglycemia. These technologies include:

Continuous Glucose Monitors (CGMs): CGMs provide continuous blood glucose readings, trend arrows, and alerts when blood sugar levels are dropping too low or rising too high. Some CGMs can even share data with caregivers or family members.
Insulin Pumps with Predictive Low Glucose Suspend (PLGS): These pumps can automatically suspend insulin delivery when blood sugar levels are predicted to drop too low, helping to prevent hypoglycemia.
Automated Insulin Delivery (AID) Systems (also known as "Closed-Loop" Systems): These systems combine a CGM with an insulin pump to automatically adjust insulin delivery based on real-time blood glucose levels, helping to maintain blood sugar levels within a target range and reduce the risk of hypoglycemia.

While these technologies offer significant benefits, it's important to remember that they require education, training, and proper use to be effective.

Living with Diabetes: Support and Resources

Living with diabetes and managing the risk of severe hypoglycemia can be challenging. Fortunately, there are many support and resources available:

Diabetes Education Programs: These programs provide comprehensive education and support for individuals with diabetes and their families.
Support Groups: Connecting with other people with diabetes can provide emotional support, practical advice, and a sense of community.
Online Forums and Communities: Online forums and communities can provide a convenient way to connect with other people with diabetes, share experiences, and ask questions.
Diabetes Organizations: Organizations such as the American Diabetes Association (ADA) and the Juvenile Diabetes Research Foundation (JDRF) offer a wealth of information, resources, and support programs.
Mental Health Professionals: Dealing with the chronic nature of diabetes can be emotionally taxing. A mental health professional can provide support and help manage stress, anxiety, or depression.
Registered Dietitian (RD): A RD who is a Certified Diabetes Care and Education Specialist can help patients develop and implement an eating plan that takes into account the patient’s preferences, culture and medical needs.
Diabetes Care and Education Specialist (CDCES): A CDCES is a health care professional who has comprehensive knowledge of and experience in diabetes management, prediabetes, and diabetes prevention. They can provide valuable education, tools and support to help manage your diabetes.

The Importance of Ongoing Education

Diabetes management is an ongoing process, and it's essential to stay informed about the latest advancements in diabetes care and technology. Attend diabetes education programs, read reputable diabetes-related publications, and consult with your healthcare team regularly to ensure that you are using the most effective strategies to manage your diabetes and prevent hypoglycemia.

By understanding the risks, recognizing the symptoms, and implementing effective prevention strategies, individuals with diabetes and their families can significantly reduce the risk of severe hypoglycemic episodes and improve their overall quality of life. Remember, proactive management, education, and support are the cornerstones of successful diabetes care.