Severe Hypoglycemia: How to Recognize and Respond to a Diabetic Emergency Severe hypoglycemia, often called insulin shock or a diabetic emergency, is ...

Severe Hypoglycemia: How to Recognize and Respond to a Diabetic Emergency

Severe hypoglycemia, often called insulin shock or a diabetic emergency, is a critical condition that can arise in individuals with diabetes. It occurs when blood sugar levels plummet to dangerously low levels, depriving the brain and other vital organs of the glucose they need to function. Recognizing the signs of severe hypoglycemia and knowing how to respond swiftly and effectively is crucial, as it can be life-saving.

This article delves into the causes, symptoms, and treatment of severe hypoglycemia, providing practical guidance to help you be prepared if you or someone you know experiences this dangerous situation. Understanding the intricacies of blood sugar management is essential for both individuals living with diabetes and their caregivers.

What is Severe Hypoglycemia and What Causes It?

Hypoglycemia, in general, refers to a state of low blood sugar (glucose) levels. It becomes severe when the low blood sugar impairs brain function, requiring assistance from another person to treat it. The danger arises because the brain relies almost exclusively on glucose for energy. When glucose levels are too low, neurological function is compromised.

Several factors can contribute to severe hypoglycemia in people with diabetes, particularly those who take insulin or certain oral medications that stimulate insulin production.

Excessive Insulin or Medication: Taking too much insulin or an excessive dose of certain oral diabetes medications (e.g., sulfonylureas) is a primary cause. Dosage errors or misunderstandings regarding medication instructions are often the culprit.
Missed or Delayed Meals: Skipping meals, delaying meals, or not consuming enough carbohydrates relative to medication dosage can lead to a drop in blood sugar. Unplanned changes in eating patterns can upset the balance between insulin and glucose.
Increased Physical Activity: Exercise increases glucose utilization by the muscles. If individuals don't adjust their insulin dosage or carbohydrate intake to compensate for increased activity levels, hypoglycemia can occur. Prolonged or strenuous exercise is particularly risky.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, especially when consumed on an empty stomach. It also can impair the ability to recognize the early warning signs of hypoglycemia.
Kidney or Liver Problems: Individuals with impaired kidney or liver function may be more susceptible to hypoglycemia, as these organs play a critical role in glucose regulation.
Illness: Certain illnesses, especially those accompanied by vomiting or diarrhea, can make it difficult to maintain stable blood sugar levels.
Errors in Insulin Administration: Mistakes in measuring or injecting insulin (e.g., using the wrong type of insulin, injecting into muscle instead of subcutaneous tissue) can lead to unpredictable insulin absorption and subsequent hypoglycemia.
Inconsistent Carbohydrate Intake: Varying the amount of carbohydrates consumed at meals can cause fluctuations in blood sugar levels, making it challenging to match insulin dosages appropriately.

Recognizing the Signs and Symptoms

Recognizing the symptoms of hypoglycemia early is crucial to prevent it from progressing to a severe state. Symptoms can vary from person to person, and they can also change over time for the same individual. Being alert to the warning signs can make a life-altering difference.

Early symptoms of mild to moderate hypoglycemia can include:

Shakiness or Trembling
Sweating
Rapid Heartbeat (Palpitations)
Anxiety or Nervousness
Hunger
Dizziness or Lightheadedness
Blurred Vision
Confusion or Difficulty Concentrating
Irritability or Mood Changes
Headache

If these symptoms are ignored or untreated, hypoglycemia can worsen, leading to severe symptoms that require immediate intervention. Signs of severe hypoglycemia include:

Loss of Consciousness: The individual becomes unresponsive and unable to be roused.
Seizures: Uncontrolled muscle spasms due to brain dysfunction.
Difficulty Speaking: Slurred speech or inability to articulate clearly.
Confusion and Disorientation: Marked confusion, inability to follow instructions, or erratic behavior.
Inability to Swallow: Making it difficult to safely administer oral treatments.

Table of Hypoglycemia Symptoms: Mild vs. Severe

| Symptom | Mild Hypoglycemia | Severe Hypoglycemia | | ------------------------ | ----------------------------- | ----------------------------- | | Shakiness | Yes | Possible, if conscious | | Sweating | Yes | Possible, if conscious | | Rapid Heartbeat | Yes | Possible, if conscious | | Anxiety | Yes | Possible, if conscious | | Hunger | Yes | Possible, if conscious | | Dizziness | Yes | Possible, if conscious | | Blurred Vision | Yes | Possible, if conscious | | Confusion | Yes | Yes | | Irritability | Yes | Yes | | Headache | Yes | Possible | | Loss of Consciousness | No | Yes | | Seizures | No | Yes | | Difficulty Speaking | No | Yes | | Inability to Swallow | No | Yes |

It’s important to remember that some individuals may not experience the typical warning signs of hypoglycemia, a condition known as hypoglycemia unawareness. This can occur in people who have had diabetes for a long time or who frequently experience low blood sugar levels. These individuals are at higher risk of developing severe hypoglycemia and need to work closely with their healthcare provider to adjust their treatment plan and improve their ability to recognize warning signs. Continuous glucose monitoring (CGM) can be particularly helpful for these individuals.

Responding to a Diabetic Emergency: Step-by-Step

If you suspect someone is experiencing severe hypoglycemia, it is crucial to act quickly. Time is of the essence, as prolonged low blood sugar can lead to brain damage and even death. The primary goal is to raise the individual's blood sugar level as rapidly and safely as possible.

Step-by-Step Guide:

Assess the Situation:
Related reading: Hypoglycemia Vs Hyperglycemia Know The Signs To Manage Your Blood Sugar
- Check for responsiveness: Can the person answer simple questions or follow commands?
- Look for a medical alert bracelet or necklace: This can provide valuable information about the person's medical condition, including whether they have diabetes.
- Observe for signs of hypoglycemia: Sweating, shaking, confusion, or altered behavior.
If the Person is Conscious and Able to Swallow:
- Administer a fast-acting source of glucose: This could include:
  - Glucose tablets or gel: Follow the product instructions; usually, 15-20 grams of glucose is recommended.
  - Juice or regular soda: 4 ounces (120 ml) is generally sufficient. Avoid diet drinks.
  - Hard candies: 3-4 pieces.
  - Honey or sugar: 1 tablespoon.
- Re-check blood sugar after 15 minutes: If possible, use a glucose meter to confirm that the blood sugar is rising. If the blood sugar is still low (typically below 70 mg/dL or 3.9 mmol/L) or if symptoms have not improved, administer another dose of fast-acting glucose.
- Follow up with a longer-acting carbohydrate source: Once the blood sugar has risen to a safe level, provide a snack containing both carbohydrates and protein (e.g., crackers with peanut butter, cheese and crackers) to help stabilize blood sugar and prevent another drop.
If the Person is Unconscious or Unable to Swallow:
- Do NOT attempt to give anything by mouth: This could cause choking.
- Administer glucagon: 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: Follow the instructions provided with the glucagon kit. Typically, the medication is injected into the muscle (thigh, arm, or buttock).
  - Nasal Glucagon: Administer the nasal spray into one nostril, following the instructions provided with the product.
- Call Emergency Medical Services (EMS) or 911 Immediately: Even after administering glucagon, it is essential to seek emergency medical care. Glucagon's effects are temporary, and the individual may need further treatment.
- Turn the person on their side: To prevent choking should vomiting occur.
- Stay with the person until help arrives: Monitor their breathing and circulation.

Important Considerations:

Glucagon Side Effects: Common side effects of glucagon include nausea and vomiting.
Glucagon Effectiveness: Glucagon may not be effective in individuals who have depleted their liver glycogen stores (e.g., those who have been fasting or have chronic liver disease).
Educating Family and Friends: Family members, friends, and coworkers of people with diabetes should be trained on how to recognize and treat severe hypoglycemia, including how to administer glucagon.
Medical Identification: People with diabetes should wear a medical identification bracelet or necklace indicating their condition and any medications they are taking. This can help emergency responders provide appropriate treatment.

Example Scenario

Imagine you are at a park when you notice a woman sitting on a bench starts to act strangely. She is sweating profusely, appears confused, and is having trouble speaking. You remember she has a medical alert bracelet indicating she has diabetes.

Step 1: Assess the situation. She is conscious but clearly disoriented.
Step 2: Because she can follow simple instructions (albeit with difficulty), you offer her a juice box from your bag.
Step 3: After 15 minutes, she is still confused, so you give her glucose tablets. You call emergency services, explaining the situation.
Step 4: You stay with her, reassuring her, until the paramedics arrive and take over her care.

Preventing Severe Hypoglycemia

Prevention is always better than cure. While not all episodes of hypoglycemia are avoidable, understanding the risk factors and taking proactive steps can significantly reduce the likelihood of severe events.

Here are some strategies for preventing severe hypoglycemia:

Regular Blood Glucose Monitoring: Frequent blood glucose monitoring is essential, especially for individuals who take insulin or medications that can cause hypoglycemia. Discuss with your healthcare provider how often you should check your blood sugar and what your target range should be. Continuous glucose monitoring (CGM) systems can provide real-time glucose readings and alerts for low blood sugar levels, further enhancing prevention.
Consistent Meal Timing and Carbohydrate Intake: Eat meals and snacks at regular intervals and ensure that carbohydrate intake is consistent from day to day. Work with a registered dietitian or certified diabetes educator to develop a meal plan that meets your individual needs and preferences.
Medication Management: Take diabetes medications as prescribed and carefully follow your healthcare provider's instructions regarding dosage and timing. Be aware of the potential side effects of your medications, including hypoglycemia. If you experience frequent low blood sugar levels, discuss with your healthcare provider whether a medication adjustment is needed.
Exercise Planning: Adjust insulin dosages or carbohydrate intake when engaging in physical activity. Check blood sugar levels before, during, and after exercise. Carry a fast-acting source of glucose with you in case your blood sugar drops.
Alcohol Consumption: Consume alcohol in moderation and always with food. Be aware that alcohol can lower blood sugar levels for several hours after consumption. Check blood sugar levels more frequently when drinking alcohol.
Sick Day Management: Develop a sick day plan with your healthcare provider. Illness can affect blood sugar levels, so it's important to know how to adjust your medication and diet when you're not feeling well.
Diabetes Education: Participate in diabetes education programs to learn more about managing your condition effectively. These programs can provide valuable information and support, helping you to better understand your diabetes and prevent complications.
Communication with Healthcare Team: Maintain open communication with your healthcare team. Report any frequent episodes of hypoglycemia or hypoglycemia unawareness. Work together to adjust your treatment plan as needed.

Table of Prevention Strategies

| Strategy | Description | Benefits | | ----------------------------- | -------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------- | | Regular Blood Glucose Monitoring | Checking blood sugar levels frequently using a glucose meter or continuous glucose monitor (CGM). | Helps identify and address low blood sugar trends early, allows for timely adjustments to medication and lifestyle. | | Consistent Meal Timing & Carb Intake | Eating meals and snacks at regular intervals, maintaining consistent carbohydrate portions. | Stabilizes blood sugar levels, prevents large fluctuations that can lead to hypoglycemia. | | Medication Management | Taking diabetes medications as prescribed, understanding potential side effects. | Ensures optimal medication effectiveness, minimizes the risk of medication-induced hypoglycemia. | | Exercise Planning | Adjusting insulin dosages or carbohydrate intake before, during, and after exercise. | Prevents exercise-induced hypoglycemia, optimizes blood sugar control during physical activity. | | Alcohol Consumption | Consuming alcohol in moderation and with food, monitoring blood sugar levels closely when drinking. | Minimizes the risk of alcohol-induced hypoglycemia, allows for timely intervention if blood sugar levels drop too low. | | Sick Day Management | Having a sick day plan in place, knowing how to adjust medication and diet when ill. | Helps maintain stable blood sugar levels during illness, prevents complications related to uncontrolled blood sugar. | | Diabetes Education | Participating in diabetes education programs to learn more about managing the condition effectively. | Improves knowledge and skills related to diabetes management, empowers individuals to make informed decisions about their care. | | Communication with Healthcare Team | Reporting frequent hypoglycemia or hypoglycemia unawareness, collaborating to adjust treatment plan. | Ensures timely and appropriate medical intervention, optimizes treatment outcomes, prevents further complications. |

Living with Diabetes: Staying Prepared

Living with diabetes requires continuous vigilance and proactive management. It is important to embrace a comprehensive approach that includes not only medication and monitoring but also education, support, and a strong focus on self-care.

Develop a Diabetes Management Plan: Work closely with your healthcare provider to create a personalized diabetes management plan that includes your target blood sugar levels, medication schedule, meal plan, exercise routine, and sick day guidelines.
Carry a Diabetes Emergency Kit: Always carry a diabetes emergency kit containing a fast-acting source of glucose, glucagon (if prescribed), a glucose meter, and your medical identification.
Educate Your Support Network: Educate your family, friends, and coworkers about your diabetes and how to recognize and treat hypoglycemia. Make sure they know where your glucagon kit is located and how to administer it.
Join a Support Group: Connect with other people living with diabetes through support groups or online communities. Sharing experiences and learning from others can provide valuable emotional support and practical advice.
Stay Informed: Stay up-to-date on the latest advances in diabetes care and management. Attend diabetes conferences, read reputable websites and publications, and participate in online forums.
Advocate for Yourself: Be an active participant in your healthcare. Ask questions, express your concerns, and advocate for the care and support you need.

By taking these steps, you can empower yourself to live a healthy and fulfilling life with diabetes, while minimizing the risk of severe hypoglycemia and other complications.

Conclusion

Severe hypoglycemia is a serious complication of diabetes that demands immediate attention. Recognizing the signs, understanding the causes, and knowing how to respond effectively can be life-saving. While severe hypoglycemia can be frightening, with proper education, preparation, and a proactive approach to diabetes management, individuals with diabetes can significantly reduce their risk and live full and healthy lives. Always consult with your healthcare provider for personalized advice and guidance regarding your diabetes care.