Severe Hypoglycemia: An Emergency Guide on What to Do Severe hypoglycemia, or critically low blood sugar, is a dangerous condition that can occur in p...

Severe Hypoglycemia: An Emergency Guide on What to Do

Severe hypoglycemia, or critically low blood sugar, is a dangerous condition that can occur in people with diabetes, particularly those taking insulin or certain oral medications. Recognizing the signs and knowing how to act quickly can be life-saving. This comprehensive guide outlines the critical steps to take when dealing with severe hypoglycemia, ensuring you're prepared to respond effectively in an emergency.

Why Severe Hypoglycemia is an Emergency

Hypoglycemia occurs when the blood glucose level drops too low, typically below 70 mg/dL. While mild hypoglycemia can often be managed with quick-acting carbohydrates, severe hypoglycemia can result in:

Loss of consciousness
Seizures
Coma
Brain damage
Death

Therefore, prompt and appropriate action is crucial. It's important to understand that severe hypoglycemia requires assistance from another person because the affected individual is typically unable to treat themselves due to confusion or unconsciousness.

Recognizing the Signs and Symptoms of Severe Hypoglycemia

The early warning signs of hypoglycemia can vary from person to person, but some common symptoms include:

Shakiness
Sweating
Dizziness
Confusion
Irritability or anxiety
Rapid heartbeat
Blurred vision
Headache
Weakness

As hypoglycemia worsens, the symptoms can progress to:

Difficulty speaking
Uncoordinated movements
Inability to concentrate
Seizures
Loss of consciousness

It's essential to educate family members, friends, and coworkers about these signs so they can recognize and respond appropriately if you become hypoglycemic. People with diabetes should wear a medical identification (like a bracelet or necklace) stating they have diabetes and potentially require emergency assistance for hypoglycemia.

Table: Hypoglycemia Symptoms and Severity

| Symptom | Severity | Action | | ----------------------- | ----------- | ------------------------------------------------------------- | | Shakiness, sweating | Mild | Consume 15-20 grams of fast-acting carbohydrates | | Confusion, dizziness | Moderate | Check blood glucose; consume 15-20 grams of fast-acting carbs | | Loss of consciousness | Severe | Administer glucagon; call for emergency medical assistance | | Seizures | Severe | Call for emergency medical assistance; ensure safety |

Immediate Actions: Step-by-Step Guide to Responding to Severe Hypoglycemia

When someone is experiencing severe hypoglycemia, the following steps should be taken immediately:

Step 1: Check for Responsiveness

Assess the person's level of consciousness. If they are conscious but confused and unable to swallow, proceed to Step 2 if glucagon is available; otherwise, immediately call for emergency medical assistance. If the person is unconscious, do NOT attempt to give them anything by mouth.

Step 2: Administer Glucagon (If Available and Trained)

Glucagon is a hormone that raises blood sugar levels by stimulating the liver to release stored glucose. It is typically prescribed to individuals at risk of severe hypoglycemia, along with training for family members or caregivers on how to administer it.

Glucagon Kits: Glucagon is typically administered via an injection. The method of administration varies slightly depending on the kit but generally involves:
- Preparing the glucagon solution by mixing the powder with the liquid diluent.
- Drawing the solution into the syringe.
- Injecting the glucagon into the thigh, arm, or buttock.
Nasal Glucagon: A newer option is nasal glucagon, which is administered as a nasal spray and does not require mixing or injection.

Follow the instructions provided with the specific glucagon kit or nasal spray. After administering glucagon, do NOT attempt to force feed or give fluids.

Step 3: Call for Emergency Medical Assistance

Immediately call 911 (or your local emergency number). Provide them with the following information:

That the person is unconscious or having a seizure.
That the person has diabetes and is experiencing severe hypoglycemia.
Whether glucagon was administered.
The location.

Even if the person regains consciousness after glucagon administration, it is crucial to seek professional medical evaluation. The effects of glucagon are temporary, and blood sugar levels may drop again. Furthermore, the underlying cause of the severe hypoglycemic episode needs to be identified and addressed.

Step 4: Monitoring and Supportive Care

While waiting for medical assistance:

Turn the person on their side to prevent choking if they vomit.
Monitor their breathing and pulse. If they stop breathing, be prepared to perform CPR (cardiopulmonary resuscitation) if you are trained.
Stay with the person until paramedics arrive and provide them with all the necessary information about the situation.

Preventing Severe Hypoglycemia

Prevention is always better than cure. Several strategies can help prevent severe hypoglycemic episodes:

Regular Blood Glucose Monitoring: Regularly check blood glucose levels, especially before meals, before and after exercise, and before bedtime. This helps identify patterns and allows for timely adjustments to insulin or medication dosages.
Consistent Meal Timing and Carbohydrate Intake: Maintain consistent meal times and carbohydrate intake to match insulin or medication action.
Adjust Insulin/Medication Doses Appropriately: Work closely with your healthcare provider to adjust insulin or medication dosages based on blood glucose levels, activity levels, and dietary habits.
Carbohydrate Counting: Learn how to accurately estimate the carbohydrate content of meals and snacks to ensure proper insulin dosing.
Alcohol Consumption: Be aware of the effects of alcohol on blood glucose levels. Alcohol can impair the liver's ability to release glucose, increasing the risk of hypoglycemia, particularly when consumed on an empty stomach.
Exercise Precautions: Check blood glucose levels before, during, and after exercise. Adjust insulin or medication doses and consume extra carbohydrates as needed.
Medical Alert Identification: Wear a medical identification bracelet or necklace stating that you have diabetes and may require emergency assistance for hypoglycemia.
Educate Family and Friends: Educate family members, friends, and coworkers about the signs and symptoms of hypoglycemia and how to administer glucagon.
Continuous Glucose Monitoring (CGM): Consider using a CGM system, which continuously monitors blood glucose levels and alerts you to highs and lows. Many CGMs can now alert loved ones when blood sugar is dangerously low.

Example Scenario:

Sarah, who has type 1 diabetes, is hiking in the mountains. She miscalculates her insulin dose before setting out and doesn't eat enough snacks. She starts feeling shaky and confused. Her friend, Mark, recognizes the signs of hypoglycemia. Sarah loses consciousness. Mark immediately administers the glucagon pen he was trained to use and calls 911. He monitors Sarah's breathing and stays with her until the paramedics arrive. The paramedics transport Sarah to the hospital for further evaluation.

Glucagon: A Deeper Dive

Glucagon is a peptide hormone produced by the alpha cells of the pancreas. It plays a vital role in raising blood glucose levels when they drop too low. Glucagon acts on the liver to promote:

Glycogenolysis: The breakdown of glycogen (stored glucose) into glucose, which is then released into the bloodstream.
Gluconeogenesis: The synthesis of glucose from non-carbohydrate sources, such as amino acids and glycerol.

Glucagon is available in several forms:

Traditional Glucagon Emergency Kit: This requires reconstitution of the glucagon powder with a liquid diluent before injection.
Pre-filled Glucagon Syringes: These contain pre-mixed glucagon and are ready for injection.
Nasal Glucagon: This is a powder formulation that is sprayed into the nose. It is easy to administer and does not require reconstitution or injection.

The choice of glucagon formulation depends on individual preferences, ease of use, and availability.

Table: Comparison of Glucagon Administration Methods

| Feature | Traditional Glucagon Kit | Pre-filled Glucagon Syringe | Nasal Glucagon | | ------------------ | ------------------------ | --------------------------- | -------------- | | Preparation | Requires mixing | Ready to use | Ready to use | | Administration | Injection | Injection | Nasal spray | | Ease of Use | Moderate | Easy | Easy | | Training Required | Yes | Yes | Yes |

Research Note: Studies have shown that nasal glucagon is as effective as injectable glucagon in raising blood glucose levels in individuals with hypoglycemia. It is also preferred by many caregivers due to its ease of administration.

Common Misconceptions About Severe Hypoglycemia

There are several common misconceptions about severe hypoglycemia that can lead to inappropriate responses:

Misconception: If someone is unconscious, you should try to pour juice or honey into their mouth. Reality: This can be extremely dangerous as it can cause choking or aspiration (liquid entering the lungs). Never give anything by mouth to an unconscious person.
Misconception: Once someone regains consciousness after a hypoglycemic episode, they are completely fine. Reality: The effects of hypoglycemia can linger, and blood glucose levels may drop again. It is essential to monitor the person closely and ensure they receive appropriate medical evaluation.
Misconception: Glucagon will always work immediately. Reality: Glucagon may take 10-15 minutes to raise blood glucose levels. It may also be less effective if the person has depleted liver glycogen stores (e.g., due to prolonged fasting or heavy alcohol consumption).
Misconception: Only people with type 1 diabetes experience severe hypoglycemia. Reality: While severe hypoglycemia is more common in people with type 1 diabetes, it can also occur in people with type 2 diabetes, particularly those taking insulin or certain oral medications.

Building a Hypoglycemia Action Plan

Creating a detailed hypoglycemia action plan is crucial for effectively managing and responding to hypoglycemic episodes. This plan should be developed in consultation with your healthcare provider and should include the following elements:

Individualized Target Blood Glucose Range: Determine your target blood glucose range based on your individual needs and health status.
Early Warning Signs of Hypoglycemia: List your personal early warning signs of hypoglycemia.
Steps to Take for Mild to Moderate Hypoglycemia: Outline the steps to take when you experience mild to moderate hypoglycemia, including the amount of fast-acting carbohydrates to consume and when to recheck your blood glucose.
Instructions for Administering Glucagon: Provide clear instructions for how to administer glucagon, including the type of glucagon you use, the dosage, and the injection site.
Emergency Contact Information: Include the names and phone numbers of your emergency contacts, including family members, friends, and healthcare providers.
Medical Alert Information: Ensure you wear a medical identification bracelet or necklace stating that you have diabetes and may require emergency assistance for hypoglycemia.
Location of Glucagon Kit: Indicate where your glucagon kit is stored at home, at work, and in your car.
Review and Update Regularly: Review and update your hypoglycemia action plan regularly, especially if there are changes in your medication, lifestyle, or health status.

Having a well-defined hypoglycemia action plan can provide peace of mind and ensure that you and your loved ones are prepared to respond effectively to hypoglycemic emergencies.

By understanding the signs, symptoms, and appropriate actions to take during a severe hypoglycemic episode, you can help ensure the safety and well-being of yourself and others. Remember to consult with your healthcare provider for personalized advice and guidance on managing your diabetes and preventing hypoglycemia.