Severe Hypoglycemia: An Emergency Guide on What to Do Hypoglycemia, or low blood sugar, is a common complication for individuals with diabetes who use...

Severe Hypoglycemia: An Emergency Guide on What to Do

Hypoglycemia, or low blood sugar, is a common complication for individuals with diabetes who use insulin or certain oral medications. While mild hypoglycemia can often be managed with a quick snack, severe hypoglycemia is a life-threatening emergency that requires immediate intervention. This guide provides a comprehensive overview of severe hypoglycemia, its causes, symptoms, and, most importantly, what steps to take in an emergency. Understanding how to recognize and respond to this condition can save lives and prevent serious complications.

Understanding Severe Hypoglycemia

Severe hypoglycemia is defined as a condition where blood glucose levels drop so low that the individual requires assistance from another person to recover. This occurs when the brain doesn't receive enough glucose to function properly, leading to a range of neurological symptoms and potential loss of consciousness. Unlike mild or moderate hypoglycemia, where the person can self-treat by consuming carbohydrates, severe episodes necessitate external help, often due to confusion, inability to swallow, or unconsciousness.

Several factors can contribute to severe hypoglycemia:

Excessive Insulin or Medication: Taking too much insulin or oral diabetes medication can lower blood sugar levels excessively.
Missed or Delayed Meals: Skipping meals or not eating enough carbohydrates can cause a drop in blood glucose.
Increased Physical Activity: Exercise can lower blood sugar, especially if it's more intense or prolonged than usual.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream.
Kidney or Liver Problems: These conditions can affect how the body processes insulin and other medications.
Drug Interactions: Certain medications can interact with diabetes medications, increasing the risk of hypoglycemia.

Risk Factors:

History of severe hypoglycemia.
Impaired awareness of hypoglycemia (difficulty recognizing early symptoms).
Cognitive impairment or dementia.
Erratic meal schedules.
Intensive insulin therapy.

Recognizing the Signs and Symptoms

Prompt recognition of severe hypoglycemia is crucial for timely intervention. The symptoms can vary from person to person, but common signs include:

Loss of Consciousness: This is the most alarming symptom, indicating the brain is severely deprived of glucose.
Seizures: Hypoglycemia can trigger seizures due to the brain's instability.
Confusion or Disorientation: The person may appear confused, struggle to answer simple questions, or seem out of touch with reality.
Unresponsiveness: Inability to respond to verbal or physical stimuli.
Inability to Swallow: This prevents the person from consuming oral treatments.
Aggressiveness or Irritability: Paradoxically, some individuals may become agitated or aggressive.
Weakness and Sweating: Although also seen in mild hypoglycemia, these symptoms are usually more pronounced.

Table: Symptoms of Severe Hypoglycemia vs. Mild Hypoglycemia

| Symptom | Mild Hypoglycemia | Severe Hypoglycemia | |---------------------------|---------------------------------------|--------------------------------------------------| | Consciousness | Fully conscious | Loss of consciousness, unresponsiveness | | Cognitive Function | Slight confusion, difficulty concentrating | Severe confusion, disorientation | | Motor Skills | Tremors, shakiness | Possible seizures, inability to swallow | | Behavior | Anxiety, irritability | Aggressiveness, marked personality changes | | Sweating | Mild to moderate | Profuse sweating | | Self-Treatment | Able to self-treat with carbohydrates | Requires assistance from others, unable to self-treat|

Immediate Actions: What to Do in an Emergency

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

Assess the Situation: Ensure the person is in a safe environment. Note the time when symptoms started. Try to determine if the person is wearing a medical ID indicating they have diabetes.
Do NOT Give Anything by Mouth if Unconscious: If the person is unconscious, having a seizure, or unable to swallow, DO NOT attempt to give them food, drink, or medication orally. This can lead to choking and aspiration.
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 or nasal spray.
- Injectable Glucagon:
  - Locate the glucagon kit and follow the instructions for reconstitution. Typically, you need to mix the powder with the liquid provided.
  - Inject the glucagon into the muscle (thigh, arm, or buttock).
  - After injection, turn the person on their side in case of vomiting (recovery position).
- Nasal Glucagon (Baqsimi):
  - Remove the device from its packaging.
  - Insert the tip of the device into one nostril and press the plunger to deliver the glucagon.
  - It does not require inhalation and can be administered even if the person is congested.

Table: Glucagon Dosage by Age

| Age Group | Injectable Glucagon Dosage | |-----------------------|---------------------------| | Adults and Children > 25kg (55 lbs) | 1 mg | | Children < 25kg (55 lbs) | 0.5 mg |

Note: Nasal glucagon has a fixed dose regardless of weight.

Related reading: Blood Sugar And Weight Loss The Surprising Connection You Need To Know
Call Emergency Services (911): Regardless of whether glucagon is administered or the person starts to recover, always call emergency services (911 in the US or your local emergency number). They can provide advanced medical care and ensure the person receives appropriate monitoring and treatment in a hospital setting.
Monitor and Observe: Continue to monitor the person's breathing, pulse, and level of consciousness. Be prepared to provide information to emergency responders about the situation and any medications the person is taking.
Post-Event Care: Once the person regains consciousness and is able to swallow, give them a fast-acting source of glucose, such as fruit juice, glucose tablets, or regular soda. Follow this with a longer-acting carbohydrate source like crackers and peanut butter to prevent a recurrence of hypoglycemia.

Prevention Strategies: Minimizing the Risk of Severe Hypoglycemia

Prevention is always better than cure. People with diabetes and their caregivers can take several steps to minimize the risk of severe hypoglycemia:

Education and Awareness: Ensure the individual with diabetes, their family, and caregivers are well-educated about hypoglycemia, its causes, symptoms, and treatment.
Regular Blood Glucose Monitoring: Frequent blood glucose monitoring, especially before meals, before bedtime, and after exercise, can help identify trends and prevent dangerous drops in blood sugar. Continuous Glucose Monitors (CGMs) are particularly helpful as they provide real-time glucose readings and can alert the user to impending hypoglycemia.
Medication Management: Work closely with a healthcare provider to adjust medication dosages as needed based on blood glucose readings, diet, and activity levels.
Meal Planning: Stick to a consistent meal schedule and consume a balanced diet with adequate carbohydrates, proteins, and fats. Avoid skipping meals or drastically changing meal times.
Exercise Planning: Monitor blood glucose before, during, and after exercise. Adjust insulin dosages or consume extra carbohydrates as needed to prevent hypoglycemia.
Alcohol Awareness: Be aware of the effects of alcohol on blood glucose and consume alcohol in moderation, if at all. Always eat food when drinking alcohol.
Hypoglycemia Unawareness Training: Some individuals with diabetes may develop hypoglycemia unawareness, where they no longer experience the warning symptoms of low blood sugar. Structured education programs and CGM use can help restore awareness of hypoglycemia.
Carry Fast-Acting Glucose: Always carry a source of fast-acting glucose, such as glucose tablets or gel, to treat mild hypoglycemia quickly before it progresses to a severe episode.
Medical Identification: Wear a medical ID bracelet or necklace that clearly states that the person has diabetes and is at risk of hypoglycemia. Include emergency contact information.

Special Considerations

Children: Children are more susceptible to hypoglycemia due to their smaller size and less predictable eating habits. Careful attention to medication dosages, meal planning, and exercise management is essential.
Elderly: Older adults may have impaired kidney or liver function, increasing their risk of hypoglycemia. Cognitive impairment or dementia can also make it more difficult to recognize and treat low blood sugar.
Related reading: The Role Of Insulin How It Controls Your Blood Glucose Levels
Pregnant Women: Pregnant women with diabetes require strict blood glucose control to prevent complications for both the mother and the baby. Hypoglycemia can be particularly dangerous during pregnancy and should be avoided.

Conclusion

Severe hypoglycemia is a serious medical emergency that demands prompt recognition and immediate action. This guide provides essential information on how to identify symptoms, administer glucagon, and call for professional help. By understanding the causes, symptoms, and treatment protocols for severe hypoglycemia, individuals with diabetes, their families, and caregivers can be better prepared to handle such emergencies effectively. Furthermore, proactive measures to prevent hypoglycemia through education, regular monitoring, and medication management can significantly reduce the risk of life-threatening episodes. With the right knowledge and preparation, severe hypoglycemia can be managed, allowing individuals with diabetes to live healthier and safer lives.