Severe Hypoglycemia: Emergency Warning Signs and What to Do Fast Severe hypoglycemia, or low blood sugar, is a critical medical condition that demands...

Severe Hypoglycemia: Emergency Warning Signs and What to Do Fast

Severe hypoglycemia, or low blood sugar, is a critical medical condition that demands immediate attention. Primarily affecting individuals with diabetes who use insulin or certain oral medications, it occurs when blood glucose levels drop to a dangerously low level. This can lead to serious consequences, including seizures, loss of consciousness, and, in rare cases, death. Understanding the emergency warning signs of severe hypoglycemia and knowing how to respond swiftly and effectively is crucial for both individuals with diabetes and their caregivers.

Understanding Hypoglycemia and Its Severity

Hypoglycemia occurs when the level of glucose in the blood drops below what is needed to fuel the body and brain effectively. For most people with diabetes, this generally means a blood glucose level below 70 mg/dL (3.9 mmol/L), though individual targets may vary. While mild to moderate hypoglycemia can usually be managed with quick-acting carbohydrates, severe hypoglycemia is a more serious situation that requires external assistance.

Why is severe hypoglycemia dangerous? The brain relies on glucose as its primary energy source. When blood sugar levels fall too low, the brain's ability to function is impaired, leading to neurological symptoms that can escalate rapidly. This is why recognizing and responding to severe hypoglycemia is so crucial.

Emergency Warning Signs of Severe Hypoglycemia

It's essential to differentiate between the symptoms of mild to moderate hypoglycemia and those indicating a severe episode. Mild symptoms might include shakiness, sweating, dizziness, or hunger. However, severe hypoglycemia presents with more alarming signs that signal an immediate threat:

Loss of Consciousness: This is perhaps the most concerning symptom, indicating the brain is significantly deprived of glucose. The individual may become unresponsive or pass out completely.
Seizures: Extremely low blood sugar can trigger seizures, which are uncontrolled electrical disturbances in the brain.
Confusion and Disorientation: Significant cognitive impairment can occur, making the person unable to think clearly, follow directions, or recognize familiar people or places.
Inability to Swallow or Take Oral Medication: If a person is too confused or disoriented, they may be unable to safely swallow food, drinks, or glucose tablets.
Erratic or Aggressive Behavior: In some cases, low blood sugar can manifest as unusual behavior, irritability, or aggression.
Marked Weakness or Difficulty Walking: Severe muscle weakness or impaired coordination can also be indicators.

Key Takeaway: If someone with diabetes exhibits any of these severe hypoglycemia symptoms, especially loss of consciousness or seizures, treat it as a medical emergency. Time is of the essence.

Immediate Steps to Take During a Severe Hypoglycemic Episode

When someone experiences severe hypoglycemia, prompt action can make a life-saving difference. Here's a step-by-step guide:

Do Not Administer Anything By Mouth If Unconscious: Attempting to give food or liquids to an unconscious person can lead to choking or aspiration.
Administer Glucagon: If available, the primary course of action is to administer glucagon. Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream.
- Understanding Glucagon Kits: Glucagon is typically available as an injectable kit or a nasal spray.
- Injectable Glucagon: Prepare and administer the injection according to the kit instructions. Typically, this involves mixing the powdered glucagon with the provided liquid and injecting it into the thigh, arm, or buttock.
- Nasal Glucagon (Baqsimi): This is a pre-filled, ready-to-use nasal spray. Simply insert the nozzle into one nostril and press the plunger. It doesn't require inhalation.
Call Emergency Services (911): After administering glucagon, immediately call for emergency medical assistance. Even if the person regains consciousness, they need to be evaluated by medical professionals.
Position the Person on Their Side: If the person is unconscious or experiencing seizures, position them on their side (recovery position) to prevent choking if they vomit.
Monitor the Person's Condition: Observe the person closely until medical help arrives. Note the time the glucagon was administered and any changes in their condition.
Related reading: What Is A Dangerously Low Blood Sugar Level Recognizing Hypoglycemia
Provide Information to Emergency Responders: When paramedics arrive, provide them with information about the person's diabetes, any medications they are taking, the symptoms they exhibited, and when glucagon was administered.
Related reading: The Blood Sugar Test Cheat Sheet When And How To Check Your Levels

Important Considerations about Glucagon:

Educate Family and Friends: Ensure that family members, friends, coworkers, and caregivers know how to recognize the signs of severe hypoglycemia and how to administer glucagon. Keep glucagon readily accessible.
Check Expiration Dates: Glucagon has an expiration date, so regularly check and replace expired kits.
Glucagon Side Effects: Side effects of glucagon are usually mild and may include nausea or vomiting.

What To Do After Glucagon is Administered & The Person Regains Consciousness

Once the person regains consciousness, it's important to provide them with fast-acting carbohydrates to further raise their blood sugar. Here's what to do:

Give Fast-Acting Carbohydrates: Offer them a source of quick-acting carbohydrates such as:
- Fruit juice (4 ounces)
- Regular (non-diet) soda (4 ounces)
- Glucose tablets (follow package instructions)
- Hard candies (several pieces)
- Honey or syrup (1 tablespoon)
Check Blood Sugar Levels: After 15 minutes, check their blood glucose level with a blood glucose meter. If it's still below 70 mg/dL (3.9 mmol/L), repeat the carbohydrate administration.
Follow with a Longer-Acting Snack: Once their blood sugar is above 70 mg/dL and they are feeling better, provide them with a snack that contains both carbohydrates and protein, such as:
- Crackers with peanut butter
- Cheese and fruit
- A small sandwich
Seek Medical Evaluation: Even if the person recovers completely, it's essential that they be evaluated by a healthcare provider as soon as possible to determine the cause of the severe hypoglycemic episode and adjust their diabetes management plan accordingly.

Preventing Severe Hypoglycemia

While knowing how to treat severe hypoglycemia is crucial, preventing it from occurring in the first place is the best approach. Here are some strategies:

Regular Blood Glucose Monitoring: Frequent blood glucose monitoring, especially before meals, before exercise, and at bedtime, is essential for identifying and addressing low blood sugar trends. Continuous Glucose Monitors (CGMs) can be incredibly valuable for real-time glucose monitoring and alerts.
Medication Management: Careful adherence to prescribed medication dosages and timing is crucial. Avoid skipping meals or taking too much insulin or oral diabetes medication. Work closely with your healthcare provider to adjust medication regimens as needed.
Meal Planning: Consuming regular meals and snacks, and coordinating them with medication schedules, can help prevent blood sugar fluctuations.
Exercise Precautions: Be aware that exercise can lower blood sugar levels. Check your blood glucose before, during, and after exercise, and adjust your medication or carbohydrate intake accordingly. Carry a source of fast-acting carbohydrates with you during physical activity.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose, increasing the risk of hypoglycemia. Consume alcohol in moderation and with food, and monitor your blood glucose levels closely.
Education and Awareness: Educate yourself and your loved ones about the signs and symptoms of hypoglycemia and how to prevent and treat it.
Wear a Medical Alert: Consider wearing a medical alert bracelet or necklace indicating that you have diabetes and use insulin or other medications that can cause hypoglycemia.

The Role of Continuous Glucose Monitoring (CGM)

Continuous Glucose Monitoring (CGM) has revolutionized diabetes management, particularly in preventing severe hypoglycemia. These devices provide real-time glucose readings throughout the day and night, alerting users to trends and potential low blood sugar events.

Benefits of CGM:

Early Detection of Lows: CGMs can detect falling blood sugar levels before they reach a critical point, allowing users to take action and prevent severe hypoglycemia.
Alerts and Alarms: CGMs can be programmed to send alerts when blood sugar levels are trending low or reach a predetermined threshold.
Data-Driven Insights: CGMs provide valuable data on glucose patterns, allowing users and healthcare providers to identify factors that contribute to hypoglycemia and adjust treatment plans accordingly.
Improved Glucose Control: Studies have shown that CGM use is associated with improved overall glucose control and a reduced risk of hypoglycemia.

Considerations: While CGMs offer significant benefits, they also have limitations. They require calibration and may not always be accurate. Users need to understand how to interpret the data and respond to alerts appropriately.

Conclusion: Empowerment Through Knowledge and Preparedness

Severe hypoglycemia is a serious complication of diabetes, but it is also a manageable one. By understanding the emergency warning signs, knowing how to respond promptly with glucagon and appropriate follow-up care, and implementing preventive strategies, individuals with diabetes and their caregivers can significantly reduce the risk of this dangerous condition. The key is empowerment through knowledge, preparedness, and a proactive approach to diabetes management. Always work closely with your healthcare provider to develop a personalized diabetes management plan that addresses your individual needs and minimizes the risk of hypoglycemia. Remember, vigilance and quick action can save lives.