Severe Hypoglycemia: An Emergency Guide for Persons with Diabetes

02 Sep 2025

Severe Hypoglycemia: An Emergency Guide for Persons with Diabetes Hypoglycemia, or low blood sugar, is a common complication for people with diabetes,...

Severe Hypoglycemia: An Emergency Guide for Persons with Diabetes

Hypoglycemia, or low blood sugar, is a common complication for people with diabetes, especially those using insulin or certain oral medications. While mild hypoglycemia can often be managed with quick-acting carbohydrates, severe hypoglycemia is a serious and potentially life-threatening condition requiring immediate intervention. This guide provides crucial information for individuals with diabetes, their families, and caregivers on how to recognize, manage, and prevent severe hypoglycemic episodes. Understanding the signs, symptoms, and steps to take during a severe hypoglycemic event can be life-saving.

Severe hypoglycemia is defined as a condition where blood glucose levels drop so low that the individual becomes mentally or physically incapacitated and requires assistance from another person to recover. This can lead to loss of consciousness, seizures, or even coma if not treated promptly. For individuals with diabetes, being prepared and knowing how to act in these situations is essential. This guide aims to empower individuals with diabetes and their support networks with the knowledge necessary to handle severe hypoglycemic emergencies effectively.

Recognizing the Signs and Symptoms of Severe Hypoglycemia

It is crucial to understand the progression of hypoglycemia and to differentiate between mild, moderate, and severe stages. Recognizing the symptoms early can prevent the condition from escalating.

Mild to Moderate Hypoglycemia:

  • Shakiness
  • Sweating
  • Dizziness
  • Hunger
  • Irritability or anxiety
  • Rapid heartbeat
  • Confusion
  • Difficulty concentrating

Severe Hypoglycemia Symptoms:

  • Inability to eat or drink
  • Unconsciousness
  • Seizures
  • Disorientation or bizarre behavior
  • Loss of coordination
  • Difficulty speaking
  • Coma

The key distinction of severe hypoglycemia is the person's inability to self-treat due to impaired cognitive or physical function. They require assistance from someone else to restore their blood sugar levels. It’s important to note that symptoms can vary from person to person, and some individuals might not experience noticeable warning signs (known as hypoglycemia unawareness). In such cases, regular blood glucose monitoring is particularly important.

Individuals at higher risk for severe hypoglycemia include those with:

  • Long-standing diabetes
  • A history of severe hypoglycemic events
  • Impaired awareness of hypoglycemia
  • Kidney or liver disease
  • Cognitive impairment
  • Those taking medications that increase insulin secretion.

| Symptom Category | Mild/Moderate Hypoglycemia | Severe Hypoglycemia | | --------------------- | ------------------------------------- | -------------------------------------------- | | Cognitive | Confusion, Difficulty concentrating | Disorientation, Inability to think clearly | | Physical | Shakiness, Sweating, Rapid heartbeat | Loss of consciousness, Seizures, Unresponsive | | Behavioral | Irritability, Anxiety | Bizarre behavior, Inability to cooperate |

Emergency Treatment for Severe Hypoglycemia

The primary goal in treating severe hypoglycemia is to quickly raise the person’s blood glucose level to prevent brain damage or other complications. Here's a step-by-step guide on how to administer treatment:

  1. Assess the Situation: Check for responsiveness. If the person is conscious but unable to eat or drink safely, proceed with caution. If unconscious, do NOT attempt to give anything by mouth due to the risk of choking.

  2. Related reading: Severe Hypoglycemia An Emergency Action Plan For Dangerous Lows

    Administer Glucagon (If Available): Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It is available as an injectable medication or a nasal spray.

    • Injectable Glucagon: Mix the glucagon according to the package instructions. Inject it into the muscle (usually the upper arm, thigh, or buttock).
    • Nasal Glucagon: Follow the instructions on the nasal spray device. Administer the dose into one nostril.

    Important Notes about Glucagon:

    • Glucagon will not work if there are depleted glycogen stores in the liver, such as in cases of prolonged starvation or alcohol intoxication.
    • It may take 10-15 minutes for the person to regain consciousness after glucagon administration.
    • Side effects can include nausea and vomiting. Place the person on their side to prevent choking if vomiting occurs.
    • Even if the person regains consciousness, they should still receive a source of fast-acting carbohydrate to replenish glucose levels.
    • Call for Emergency Medical Help (911): Even after administering glucagon, it’s crucial to call for emergency medical services (EMS). The person needs to be evaluated in a hospital setting to ensure their blood sugar levels stabilize and to determine the underlying cause of the hypoglycemic episode.

    • If No Glucagon is Available: If glucagon is not available, and the person is conscious and able to swallow safely, give them a source of fast-acting carbohydrate, such as:

    • Honey or syrup rubbed inside the cheek

    • Glucose gel or liquid
    • Sugar dissolved in water

    This is less ideal than glucagon, but it may help raise blood glucose levels until medical help arrives. 5. Monitor and Support: Continuously monitor the person’s breathing and vital signs. Be prepared to administer CPR if necessary. Once the person regains consciousness, provide reassurance and help them get comfortable. 6. Post-Emergency Care:

    • After regaining consciousness, the person should eat a longer-acting source of carbohydrate and protein (e.g., crackers with peanut butter, cheese and crackers) to prevent a recurrence of hypoglycemia.
    • The cause of the severe hypoglycemia should be investigated. This may involve reviewing medication dosages, meal timing, exercise habits, and other factors.
    • Work with their healthcare provider to adjust their diabetes management plan as needed.

| Action | Description | Rationale | | ----------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------- | | Assess Responsiveness | Check if the person is conscious and able to respond to questions or commands. | Determines the severity of the situation and the appropriate course of action. | | Administer Glucagon | Inject glucagon into the muscle (if injectable form) or administer nasally (if nasal spray). | Raises blood glucose levels by stimulating the release of stored glucose from the liver. | | Call for Emergency Medical Help | Call 911 or your local emergency number. | Ensures prompt medical evaluation and treatment to prevent complications. | | If No Glucagon, Give Fast-Acting Carb | If the person is conscious and able to swallow, provide a source of fast-acting carbohydrate (honey, glucose gel). | Quickly raises blood glucose levels until more definitive treatment can be given. | | Monitor and Support | Continuously monitor vital signs and provide reassurance. Be prepared to administer CPR if necessary. | Ensures the person's safety and well-being until medical help arrives. | | Post-Emergency Care | Give a longer-acting carb/protein snack and consult healthcare provider to identify and correct the cause, adjust diabetes management plan. | Prevent recurrence, provide medical guidance to identify factors causing low blood glucose. |

Preventing Severe Hypoglycemia

Prevention is key to avoiding severe hypoglycemic episodes. Here are several strategies to reduce the risk:

  1. Regular Blood Glucose Monitoring: Check blood glucose levels frequently, especially before meals, before and after exercise, and at bedtime. Continuous Glucose Monitoring (CGM) systems can be particularly helpful for people with hypoglycemia unawareness, as they provide real-time glucose readings and alerts when glucose levels are dropping.

  2. Medication Management:

    • Understand how your diabetes medications work and how they can affect your blood sugar levels.
    • Work closely with your healthcare provider to adjust medication dosages as needed based on your activity level, diet, and overall health.
    • Be especially careful when starting new medications, as some drugs can interact with diabetes medications and increase the risk of hypoglycemia.

    • Meal Planning and Timing:

      Related reading: How To Lower Your A1C A Complete Guide For Persons With Diabetes

    • Eat regular meals and snacks at consistent times each day.

    • Avoid skipping meals or delaying eating, especially if you take insulin or medications that increase insulin secretion.
    • Balance carbohydrate intake with medication dosages and activity levels.

    • Exercise Considerations:

    • Check blood glucose levels before, during, and after exercise.

    • Carry a source of fast-acting carbohydrate with you during physical activity.
    • Adjust insulin dosages or carbohydrate intake as needed based on the intensity and duration of your workout.
    • Be aware that exercise can lower blood glucose levels for several hours afterward.
    • Alcohol Consumption: Alcohol can interfere with the liver’s ability to release glucose, increasing the risk of hypoglycemia, especially when consumed on an empty stomach. If you choose to drink alcohol, do so in moderation and always eat food at the same time. Monitor your blood glucose levels closely.

    • Education and Awareness:

    • Educate family members, friends, and coworkers about the signs and symptoms of hypoglycemia and how to administer glucagon.

    • Wear a medical identification bracelet or necklace indicating that you have diabetes and are at risk of hypoglycemia.
    • Carry a glucagon kit with you at all times, especially when traveling or participating in activities where you may be at risk of low blood sugar.

    • Address Hypoglycemia Unawareness: For those with hypoglycemia unawareness, strategies include:

    • Avoiding tight glycemic control for a period to allow symptoms of hypoglycemia to become more noticeable.

    • Using CGM with alarms to alert you to falling glucose levels.
    • Working with your healthcare provider to gradually improve glycemic control while monitoring for hypoglycemic events.

| Prevention Strategy | Description | Benefits | | -------------------------- | -------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------ | | Regular BG Monitoring | Checking blood glucose levels frequently, using CGM systems. | Provides real-time data, alerts for low glucose, helps adjust treatment. | | Medication Management | Adjusting dosages with healthcare provider, understanding medication effects. | Prevents overmedication, optimizes glycemic control. | | Consistent Meal Timing | Eating regular meals and snacks at consistent times. | Stabilizes blood glucose levels, prevents sudden drops. | | Exercise Planning | Checking BG before, during, after exercise; adjusting insulin/carbs. | Prevents exercise-induced hypoglycemia. | | Moderate Alcohol Use | Drinking in moderation with food, monitoring BG. | Reduces the risk of alcohol-related hypoglycemia. | | Educate Support Network | Informing family, friends, and coworkers about hypoglycemia and glucagon. | Enables rapid and appropriate assistance during severe events. | | CGM/Raising A1c Target | Utilizing CGM systems to recognize blood sugar level thresholds. | Allows rapid alerts. |

The Importance of a Diabetes Emergency Plan

Having a well-defined diabetes emergency plan is crucial for individuals with diabetes and their caregivers. The plan should include the following elements:

  • Contact Information: Include emergency contact numbers for family members, healthcare providers, and local emergency services.
  • Medication List: List all medications being taken, including dosages and times of administration.
  • Allergies: Document any known allergies, especially to medications.
  • Medical Conditions: List any other medical conditions or relevant health information.
  • Glucagon Instructions: Include clear instructions on how to administer glucagon, as well as where the glucagon kit is stored.
  • Hypoglycemia Action Plan: Outline the steps to take in case of hypoglycemia, including when to administer fast-acting carbohydrate or glucagon, and when to call for emergency medical help.
  • Location of Supplies: Indicate the location of important diabetes supplies, such as blood glucose meter, test strips, insulin, syringes, and fast-acting carbohydrate.

This plan should be readily accessible to anyone who may need to assist in an emergency. Consider keeping a copy in your wallet, on your phone, and in a visible location in your home.

Related reading: Foods That Can Unexpectedly Raise Your Blood Glucose Bg

In conclusion, severe hypoglycemia is a significant concern for individuals with diabetes, but with proper knowledge, preparation, and planning, the risks can be effectively managed. Understanding the signs and symptoms, knowing how to administer glucagon, preventing episodes through diligent self-care, and having a clear emergency plan are all essential components of living safely with diabetes. Always consult with a healthcare professional for personalized advice and guidance on managing your diabetes and preventing hypoglycemic events.