Severe Hypoglycemia: Emergency Steps Every Person with Diabetes Should Know Severe hypoglycemia, or dangerously low blood sugar, is a critical complic...

Severe Hypoglycemia: Emergency Steps Every Person with Diabetes Should Know

Severe hypoglycemia, or dangerously low blood sugar, is a critical complication of diabetes that requires immediate intervention. For individuals managing diabetes with insulin or certain oral medications, understanding the signs, symptoms, and emergency treatment protocols for severe hypoglycemia is paramount. This article provides a comprehensive guide to recognizing and responding to severe hypoglycemia, equipping you with the knowledge to protect yourself and assist others.

Understanding Severe Hypoglycemia

Hypoglycemia occurs when the blood glucose level drops below 70 mg/dL. Severe hypoglycemia is defined as a hypoglycemic event that requires assistance from another person because the individual with diabetes is unable to treat themselves. This state can be triggered by various factors, including:

Excessive insulin: Administering too much insulin relative to carbohydrate intake.
Missed or delayed meals: Insufficient food intake after taking diabetes medication.
Increased physical activity: Engaging in exercise without adjusting insulin or carbohydrate intake.
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 medications are processed and increase the risk of hypoglycemia.

Recognizing the difference between mild, moderate, and severe hypoglycemia is essential for effective management:

| Level | Blood Sugar (mg/dL) | Symptoms | Treatment | | ----------- | -------------------- | --------------------------------------------------------------------------- | --------------------------------------------------------------------------------------- | | Mild | 60-70 | Shakiness, sweating, dizziness, hunger | Consume 15-20 grams of fast-acting carbohydrates (e.g., glucose tablets, juice) | | Moderate | 40-60 | Confusion, irritability, difficulty concentrating, weakness | Consume 30 grams of fast-acting carbohydrates; monitor symptoms carefully | | Severe | < 40 | Loss of consciousness, seizure, inability to swallow, disorientation, coma | Requires assistance from another person; administer glucagon or call for emergency help |

Why is it important to learn this? Because severe hypoglycemia can rapidly lead to cognitive impairment, loss of consciousness, seizures, coma, and, in rare cases, death. Timely and appropriate action can prevent these dire outcomes.

Recognizing the Signs and Symptoms of Severe Hypoglycemia

Being able to promptly identify the signs and symptoms of severe hypoglycemia is critical. These can vary among individuals, but common indicators include:

Loss of consciousness: The individual is unresponsive and unable to be roused.
Seizures: Uncontrolled muscle spasms and loss of awareness.
Inability to swallow: Difficulty or impossibility of consuming food or liquid orally.
Severe confusion or disorientation: Profound difficulty understanding surroundings and answering simple questions.
Unresponsiveness: Failure to react to external stimuli or commands.

It is important to note that some individuals may experience hypoglycemia unawareness, where they don't experience the typical warning signs of low blood sugar. This condition is more common in people who have had diabetes for a long time, frequently experience hypoglycemia, or have autonomic neuropathy. For those with hypoglycemia unawareness, regular blood glucose monitoring and strategies to avoid low blood sugar are crucial.

Real-world example: John, a 55-year-old with type 1 diabetes, collapsed at a community event. Witnesses noted that he seemed confused and disoriented before losing consciousness. Fortunately, a bystander recognized the symptoms of severe hypoglycemia and administered glucagon, stabilizing John until paramedics arrived.

Emergency Steps to Take During a Severe Hypoglycemic Episode

When encountering someone experiencing severe hypoglycemia, swift action is vital. Here's a step-by-step guide:

Assess the Situation:
- Confirm that the individual is unresponsive or unable to treat themselves.
- Look for medical identification, such as a diabetes ID bracelet or necklace.
Administer Glucagon (if available):
- What is glucagon? Glucagon is a hormone that raises blood glucose levels by stimulating the liver to release stored glucose.
- Glucagon is available by prescription and should be readily accessible to people at risk of severe hypoglycemia. Caregivers, family members, and close friends should be trained on its administration.
- Types of glucagon:
  - Injectable Glucagon: This is the traditional form, requiring reconstitution and injection, typically into the thigh, arm, or buttock.
  - Nasal Glucagon (Baqsimi): A newer formulation administered as a nasal spray, offering a more user-friendly option.
  - Auto-injector Glucagon (Gvoke HypoPen): A prefilled pen that delivers a single dose of glucagon with a simple push-button mechanism.
- How to administer: Follow the instructions provided with the specific glucagon kit.
- Important Note: Even after administering glucagon, it's crucial to seek professional medical help.
Call for Emergency Medical Assistance:
- Immediately call emergency services (911 in the US or the appropriate number in your country) to ensure prompt medical care.
- Provide details about the person's condition, including their diabetic status and any treatments administered.
Do NOT Attempt to Give Food or Liquid Orally:
- Never try to force-feed or pour liquids into an unconscious person's mouth, as this could lead to choking or aspiration.
Position the Person on Their Side (Recovery Position):
- If the person is unconscious but breathing, place them in the recovery position to prevent choking on vomit or saliva.
- How to place someone in the recovery position:
  1. Kneel beside the person.
  2. Place the arm nearest to you at a right angle to their body.
  3. Bring their far arm across their chest, placing the back of their hand against their cheek nearest to you.
  4. Bend their far leg at the knee, pulling it upward.
  5. Gently roll the person towards you onto their side.
  6. Adjust the upper leg to ensure the person is stable and the airway is open.
Stay with the Person Until Help Arrives:
- Monitor their breathing and vital signs.
- Be prepared to provide information to paramedics upon their arrival.

Data Point: A study published in Diabetes Care found that timely glucagon administration significantly reduces the risk of hospitalization and serious complications associated with severe hypoglycemia.

Practical Tips for People with Diabetes and Their Caregivers

Preventing severe hypoglycemia involves a proactive and informed approach. Here are essential strategies for individuals with diabetes and their caregivers:

For People with Diabetes:

Regular Blood Glucose Monitoring:
- Check blood glucose levels frequently, especially before meals, bedtime, and exercise.
- Consider continuous glucose monitoring (CGM) for real-time glucose readings and alerts.
Medication Management:
- Adhere strictly to prescribed insulin or medication dosages.
- Understand the onset, peak, and duration of your insulin or medications.
- Consult your healthcare provider before making any changes to your treatment plan.
Meal Planning and Timing:
- Eat regular meals and snacks at consistent times to match medication schedules.
- Balance carbohydrate intake with insulin dosages.
- Be mindful of hidden sugars in processed foods and beverages.
Exercise Precautions:
- Monitor blood glucose levels before, during, and after physical activity.
- Adjust insulin dosages or carbohydrate intake as needed to prevent hypoglycemia.
- Carry a readily available source of fast-acting carbohydrates (e.g., glucose tablets, juice) during exercise.
Alcohol Awareness:
- Be aware that alcohol can impair the liver's ability to release glucose and increase the risk of hypoglycemia, especially when consumed on an empty stomach.
- Consume alcohol in moderation and with food.
Educate Family and Friends:
- Ensure that your close contacts know how to recognize and respond to severe hypoglycemia.
- Provide them with access to glucagon and training on its administration.
Wear Medical Identification:
- Wear a medical ID bracelet or necklace indicating that you have diabetes.
- Include emergency contact information and details about your medical condition.

For Caregivers:

Learn the Signs of Hypoglycemia:
Related reading: Fast Acting Snacks To Treat Hypoglycemia Low Blood Sugar
- Be familiar with the early warning signs of low blood sugar, such as shakiness, sweating, and confusion.
- Recognize the symptoms of severe hypoglycemia, including loss of consciousness and seizures.
Understand Glucagon Administration:
- Receive proper training on how to administer glucagon, including the correct dosage and injection technique.
- Ensure that you know where the glucagon kit is stored and how to access it quickly in an emergency.
Provide Support and Encouragement:
- Offer emotional support and understanding to the person with diabetes.
- Help them adhere to their treatment plan and monitor their blood glucose levels.
Communicate with Healthcare Providers:
- Attend medical appointments with the person with diabetes to stay informed about their condition and treatment.
- Communicate any concerns or questions to their healthcare provider.
Be Prepared for Emergencies:
- Keep emergency contact information readily available.
- Know the location of the nearest hospital or emergency medical facility.

Example: Maria, a caregiver for her husband with diabetes, took a course on diabetes management and glucagon administration. When her husband experienced a severe hypoglycemic episode, she confidently administered glucagon and called for emergency medical assistance, potentially saving his life.

Staying Informed and Prepared

Managing diabetes and mitigating the risk of severe hypoglycemia requires continuous learning and adaptation. Stay informed about the latest advances in diabetes care, participate in support groups, and regularly consult with your healthcare team. Proactive measures, combined with knowledge and preparedness, are key to preventing and managing this potentially life-threatening condition.

By understanding the complexities of severe hypoglycemia and taking the necessary precautions, individuals with diabetes and their caregivers can significantly reduce the risk and impact of this emergency situation. Education, vigilance, and a well-coordinated response plan are the cornerstones of effective management.