Severe Hypoglycemia: Warning Signs & What Persons with Diabetes Must Know Severe hypoglycemia, often called low blood sugar, is a dangerous condit...

Severe Hypoglycemia: Warning Signs & What Persons with Diabetes Must Know

Severe hypoglycemia, often called low blood sugar, is a dangerous condition that can occur in people with diabetes, particularly those who take insulin or certain oral medications. Understanding the warning signs, knowing how to prevent it, and being prepared to treat it are crucial for anyone managing diabetes. This comprehensive guide will cover everything you need to know about severe hypoglycemia to stay safe and healthy.

What is Severe Hypoglycemia?

Hypoglycemia occurs when the level of glucose (sugar) in your blood drops too low. While mild hypoglycemia may cause uncomfortable symptoms, severe hypoglycemia is a critical situation where a person is unable to treat themselves because of confusion, loss of consciousness, or seizures. It often requires the assistance of another person or medical intervention to restore blood sugar levels. This can happen at any time of day or night, and being aware of the risk is vital for managing your diabetes effectively.

| Blood Sugar Level (mg/dL) | Condition | Action Needed | |--------------------------|---------------------|-----------------------------------------------| | > 70 | Normal | Continue regular monitoring and management. | | 55 - 70 | Mild Hypoglycemia | Consume quick-acting carbohydrates. | | < 55 | Moderate Hypoglycemia| Consume quick-acting carbohydrates; monitor closely. | | Requires assistance. | Severe Hypoglycemia | Requires glucagon administration or emergency medical assistance. |

Understanding the Causes of Severe Hypoglycemia

Several factors can lead to severe hypoglycemia in people with diabetes. Identifying these factors can help prevent future episodes. Here are the primary causes:

Excessive Insulin Dosage: Taking too much insulin, either intentionally or unintentionally, is a common cause. This can occur due to miscalculated doses, overlapping insulin actions, or errors in insulin delivery devices.
Related reading: Severe Hypoglycemia Recognizing A Blood Sugar Emergency And What To Do
Skipping or Delaying Meals: When you take insulin or certain oral medications, the timing of your meals is critical. Skipping meals or delaying them significantly after taking medication can result in a drop in blood sugar.
Increased Physical Activity: Exercise increases insulin sensitivity and can deplete glucose stores in the body. If you are more active than usual without adjusting your medication or carbohydrate intake, your blood sugar can fall dangerously low.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, leading to hypoglycemia, especially when consumed without food.
Kidney or Liver Problems: These organs play a role in regulating blood glucose levels and clearing insulin from the body. Impaired function can lead to erratic blood sugar levels, including hypoglycemia.
Certain Medications: Some medications, such as sulfonylureas (a class of diabetes medications), can stimulate the pancreas to release more insulin, increasing the risk of hypoglycemia.
Illness: Infections and other illnesses can affect appetite, medication absorption, and overall glucose metabolism, potentially leading to hypoglycemia.

Example Scenario: Imagine John, who has type 1 diabetes, goes for a long run without eating enough beforehand or reducing his insulin dose. He feels fine initially but, after an hour, starts to experience dizziness and confusion. This is because the exercise is using up his glucose stores quickly, and the insulin in his system is pushing his blood sugar down even further. This situation can escalate into severe hypoglycemia if not treated promptly.

Recognizing the Warning Signs of Severe Hypoglycemia

Being able to recognize the warning signs of hypoglycemia is crucial to prevent it from escalating into a severe episode. Symptoms can vary from person to person, and some individuals may not experience any noticeable symptoms at all (known as hypoglycemia unawareness). Here are the common warning signs to watch for:

Early Warning Signs:

Shakiness or Trembling: A sudden onset of shakiness or trembling, especially in the hands, is a common early indicator.
Sweating: Profuse sweating, even when you are not hot or exercising, can signal low blood sugar.
Dizziness or Lightheadedness: Feeling unsteady, dizzy, or lightheaded can occur as the brain is not getting enough glucose.
Hunger: An intense and sudden feeling of hunger, even if you recently ate, can be a sign of hypoglycemia.
Rapid Heartbeat: An increased or irregular heartbeat can occur as the body tries to compensate for low blood sugar.
Anxiety or Irritability: Feeling unusually anxious, nervous, or irritable without an obvious reason can indicate hypoglycemia.

Late-Stage Symptoms (Indicating a Progression to Severe Hypoglycemia):

Confusion or Difficulty Concentrating: Problems with thinking clearly, focusing, or remembering things.
Slurred Speech: Difficulty speaking clearly or understanding what others are saying.
Weakness or Fatigue: Feeling extremely tired or weak, making it difficult to perform normal activities.
Blurred Vision or Double Vision: Changes in vision can occur as the brain's function is impaired.
Seizures: In severe cases, hypoglycemia can lead to seizures or convulsions.
Loss of Consciousness: Ultimately, severe hypoglycemia can result in passing out or becoming unresponsive.

Important Note: Some people with diabetes, particularly those who have had diabetes for a long time or have frequent hypoglycemic episodes, may develop hypoglycemia unawareness. This means they no longer experience the early warning signs of low blood sugar, making them more vulnerable to severe episodes. Regular blood glucose monitoring and working with a healthcare provider to adjust your treatment plan are essential if you experience hypoglycemia unawareness.

Prevention Strategies for Severe Hypoglycemia

Preventing severe hypoglycemia involves a multi-faceted approach focused on education, adherence to treatment plans, and proactive monitoring. Here are key prevention strategies for people with diabetes:

Regular Blood Glucose Monitoring:
- Check your blood sugar levels as recommended by your healthcare provider. This may include checking before meals, after meals, before bedtime, and during physical activity.
- Use a continuous glucose monitor (CGM) if recommended by your healthcare provider. CGMs provide real-time glucose readings and can alert you to trends and potential low blood sugar events.
- Keep a log of your blood sugar levels to identify patterns and potential triggers for hypoglycemia.
Medication Management:
Related reading: How To Read Your Fasting Blood Glucose Results
- Take your insulin or oral medications exactly as prescribed by your healthcare provider.
- Be aware of the onset, peak, and duration of your insulin to understand when you are most vulnerable to hypoglycemia.
- Work with your healthcare provider to adjust your medication dosages based on your blood sugar levels, diet, and activity levels.
Meal Planning:
- Eat regular meals and snacks, and avoid skipping or delaying meals.
- Coordinate your carbohydrate intake with your insulin or medication dosages.
- Learn about the carbohydrate content of different foods to help you make informed choices.
Exercise Planning:
- Check your blood sugar levels before, during, and after exercise.
- Adjust your insulin or carbohydrate intake as needed to prevent hypoglycemia during and after exercise.
- Carry a source of fast-acting carbohydrates with you during physical activity to treat low blood sugar if it occurs.
Alcohol Consumption:
- Consume alcohol in moderation, and always eat food when drinking.
- Monitor your blood sugar levels more frequently when drinking alcohol, as alcohol can affect blood sugar for several hours.
Education and Training:
- Attend diabetes education classes to learn about blood glucose management, medication use, and hypoglycemia prevention.
- Ensure your family, friends, and caregivers know how to recognize and treat hypoglycemia.
- Carry a medical identification card or wear a medical alert bracelet to inform others that you have diabetes.

| Strategy | Description | Example | |---------------------------|------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------| | Regular Monitoring | Check blood sugar regularly, using CGM if advised, and keep a log. | Checking blood sugar before each meal and at bedtime; reviewing the data weekly for patterns. | | Medication Management | Take meds as prescribed, know onset/peak/duration, adjust doses with doctor's help. | Taking insulin exactly as prescribed; adjusting the dosage based on a doctor's advice after reviewing logs. | | Meal Planning | Eat regularly, coordinate carbs with medication, learn carb counts. | Eating balanced meals; matching insulin to the amount of carbohydrates in each meal. | | Exercise Planning | Check blood sugar before, during, and after exercise; adjust insulin/carbs. | Having a snack before a workout; reducing insulin dose on active days. | | Alcohol Consumption | Drink in moderation with food, monitor blood sugar often. | Having a small snack with an alcoholic drink; monitoring blood sugar for several hours after drinking. |

Treatment of Severe Hypoglycemia

When severe hypoglycemia occurs, the individual is often unable to treat themselves, making it a medical emergency. The primary goal is to raise the blood sugar levels quickly. The two main treatments for severe hypoglycemia are glucagon and intravenous glucose.

Glucagon Administration:

What is Glucagon? Glucagon is a hormone that helps raise blood sugar levels by stimulating the liver to release stored glucose into the bloodstream. It is available as an injectable medication and as a nasal spray.
When to Use Glucagon: Glucagon should be administered when a person with diabetes is unconscious or unable to swallow, indicating a severe hypoglycemic episode.
How to Administer Glucagon:
1. Injectable Glucagon:
  - Follow the instructions provided with the glucagon kit.
  - Typically, you will need to mix the glucagon powder with the diluent provided in the kit.
  - Inject the glucagon into the thigh, arm, or buttock.
  - After the injection, turn the person onto their side to prevent choking in case they vomit.
2. Nasal Glucagon:
  - Follow the instructions provided with the nasal glucagon device.
  - Administer the glucagon into one nostril.
After Glucagon Administration: Call emergency services (911 in the US) immediately after administering glucagon, even if the person regains consciousness. Glucagon provides a temporary increase in blood sugar, and further medical evaluation and treatment are necessary.

Intravenous Glucose:

What is Intravenous Glucose? Intravenous glucose is a concentrated glucose solution administered directly into the bloodstream through an IV line.
When to Use Intravenous Glucose: This treatment is typically administered in a hospital or emergency medical setting when glucagon is not available or effective, or when the person requires more immediate glucose elevation.
How Intravenous Glucose Works: The glucose solution rapidly increases the blood sugar level, helping to restore normal brain function and prevent further complications.
After Intravenous Glucose Administration: Medical professionals will monitor the person's blood sugar levels and provide additional treatment as needed to stabilize their condition.

Steps to Take in an Emergency

Here's a step-by-step guide on what to do when someone is experiencing severe hypoglycemia:

Related reading: Type 1 Vs Type 2 Diabetes A Simple Comparison

Recognize the Signs: Look for confusion, unconsciousness, seizures, or other signs of severe hypoglycemia.
Check for Medical ID: Look for a medical ID bracelet or card indicating the person has diabetes.
Administer Glucagon: If available, administer glucagon according to the package instructions.
Call Emergency Services: Call 911 immediately, even if the person regains consciousness after glucagon administration.
Provide Information: Provide medical personnel with as much information as possible about the person's condition, diabetes history, and any medications they are taking.
Monitor Breathing: If the person is not breathing, begin CPR if you are trained to do so, until emergency services arrive.

| Treatment | Description | When to Use | |--------------------|-----------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Glucagon Injection | Hormone that raises blood sugar by releasing stored glucose from the liver. | When the person is unconscious or unable to swallow and showing signs of severe hypoglycemia; follow the instructions in the glucagon kit carefully. | | Nasal Glucagon | Glucagon administered through the nose, raising blood sugar levels quickly. | Alternative to the injectable glucagon; can be used similarly when the person is unconscious or unable to swallow; follow the instructions on the device. | | IV Glucose | Concentrated glucose solution administered directly into the bloodstream through an IV line. | Typically administered in a hospital or emergency medical setting; used when glucagon is ineffective or not available, or when the person requires immediate glucose elevation. |

Educating Family and Friends

Educating family, friends, and caregivers is essential for managing diabetes and preparing for potential emergencies like severe hypoglycemia. People who are close to someone with diabetes should be familiar with the warning signs of low blood sugar, know how to administer glucagon, and understand when to call emergency services.

Key Points to Cover in Your Education:

Recognizing Hypoglycemia: Teach them how to identify the early and late-stage symptoms of hypoglycemia. Make sure they understand that symptoms can vary and that some people may experience hypoglycemia unawareness.
Administering Glucagon: Provide detailed instructions on how to use the glucagon kit (both injectable and nasal versions). Have them practice the steps so they are comfortable administering it in an emergency.
When to Call for Help: Emphasize the importance of calling 911 immediately after administering glucagon or if the person remains unconscious or has seizures.
Understanding Diabetes: Give them a basic understanding of diabetes, insulin, and how different factors like food, exercise, and stress can affect blood sugar levels.
Knowing the Treatment Plan: Share details about the person's diabetes management plan, including their medication dosages, meal schedules, and exercise routines.

Practical Tips for Training:

Hands-On Practice: Use a training glucagon kit (available from some manufacturers) to practice the steps of glucagon administration.
Role-Playing Scenarios: Simulate different situations where hypoglycemia might occur and have them practice responding appropriately.
Written Instructions: Provide clear, written instructions on how to recognize and treat hypoglycemia. Keep these instructions in an easily accessible location.
Emergency Contact Information: Make sure they have a list of emergency contacts, including healthcare providers, family members, and local emergency services.

Example Dialogue:

"Hey, I want to make sure you know what to do if my blood sugar drops too low and I can't help myself. First, watch for signs like confusion, sweating, or if I seem out of it. If that happens, grab my glucagon kit – it's in the medicine cabinet. Follow the instructions in the kit to give me the injection. After that, call 911 immediately, even if I start to wake up. It's really important to get me checked out by professionals."

By taking the time to educate those around you, you can create a support system that is prepared to help you in the event of a severe hypoglycemic episode, significantly improving your safety and well-being.

Living Well with Diabetes: Staying Informed and Proactive

Managing diabetes effectively and minimizing the risk of severe hypoglycemia requires ongoing education, proactive monitoring, and a strong partnership with your healthcare team. Here are some key steps you can take to stay informed and proactive in your diabetes management:

Stay Informed:

Attend Diabetes Education Programs: Participate in diabetes education classes to learn about the latest advancements in diabetes care, including new medications, technologies, and management strategies.
Read Reliable Resources: Follow reputable websites, journals, and organizations (such as the American Diabetes Association and the Juvenile Diabetes Research Foundation) to stay up-to-date on the latest research and guidelines.
Join Support Groups: Connect with other people with diabetes through support groups or online communities. Sharing experiences and insights can provide valuable emotional support and practical advice.

Be Proactive:

Regularly Review Your Treatment Plan: Work with your healthcare provider to review and adjust your treatment plan as needed, based on your blood sugar levels, lifestyle, and overall health.
Monitor Your Blood Sugar Levels Diligently: Check your blood sugar levels as recommended by your healthcare provider and keep a log of your results. This information can help you identify patterns and trends, allowing you to make informed decisions about your medication, diet, and activity.
Communicate Openly with Your Healthcare Team: Be honest with your healthcare provider about any challenges you are facing in managing your diabetes, such as frequent hypoglycemia, medication side effects, or difficulties with your diet or exercise plan.
Carry Emergency Supplies: Always carry a source of fast-acting carbohydrates with you to treat low blood sugar if it occurs. In addition, make sure you have glucagon readily available and that your family and friends know how to use it.
Wear Medical Identification: Wear a medical ID bracelet or necklace to inform others that you have diabetes. This can be particularly important in emergency situations where you may be unable to communicate.

By staying informed and proactive in your diabetes management, you can reduce your risk of severe hypoglycemia, improve your overall health and well-being, and live a full and active life with diabetes. Regular communication and education can improve your confidence and help ensure you’re equipped to handle any challenges that arise.