What to Do During a Severe Hypoglycemia Episode: A Step-by-Step Guide Severe hypoglycemia, or low blood sugar, is a serious condition that can occur i...

What to Do During a Severe Hypoglycemia Episode: A Step-by-Step Guide

Severe hypoglycemia, or low blood sugar, is a serious condition that can occur in individuals with diabetes, especially those who take insulin or certain oral medications. Recognizing the signs and knowing how to respond quickly is crucial to prevent serious complications such as seizures, loss of consciousness, or even death. This guide provides a step-by-step approach to handling a severe hypoglycemia episode, ensuring you and those around you are prepared to act effectively.

Understanding Severe Hypoglycemia

Hypoglycemia happens when blood glucose levels drop too low, usually below 70 mg/dL. Severe hypoglycemia is defined as a hypoglycemic event requiring assistance from another person to administer carbohydrates or glucagon or take other corrective actions.

Recognizing the symptoms early is critical. Symptoms of mild to moderate hypoglycemia can include:

Shakiness
Sweating
Dizziness
Hunger
Irritability
Confusion
Rapid heartbeat

If left untreated, these symptoms can progress to severe hypoglycemia, which may involve:

Loss of consciousness
Seizures
Inability to eat or drink
Unresponsiveness

Early recognition and prompt action are essential to manage the situation effectively and prevent the escalation of symptoms.

Step-by-Step Guide to Handling a Severe Hypoglycemia Episode

When someone experiences severe hypoglycemia, immediate action is needed. Here’s a step-by-step guide to follow:

1. Recognize the Signs of Severe Hypoglycemia

The first step is to recognize that a severe hypoglycemic episode is occurring. Look for signs such as unresponsiveness, seizures, or inability to swallow. Time is of the essence, and quick recognition can prevent further complications.

2. If the Person Is Conscious and Able to Swallow

If the person is conscious, but showing signs of severe hypoglycemia (such as confusion, disorientation), and is able to swallow:

Administer a Fast-Acting Carbohydrate: Provide a source of fast-acting carbohydrates to raise blood sugar levels quickly. Good options include:
- Glucose tablets or gel (follow the product instructions for dosage).
- Fruit juice (4 ounces).
- Regular (non-diet) soda (4 ounces).
- Hard candies (about 3-4 pieces, but avoid if there is a risk of choking).
Avoid Fatty Foods: Do not give foods high in fat, such as chocolate or peanut butter, as they can slow down the absorption of glucose.
Monitor the Person: Check blood glucose levels 15 minutes after administering the carbohydrate. If blood sugar remains low (below 70 mg/dL), repeat the carbohydrate treatment.
Follow Up with a Complex Carbohydrate and Protein: Once the person is feeling better and blood sugar levels have improved, provide a snack containing a complex carbohydrate and protein to stabilize blood sugar. Options include:
- Crackers with cheese.
- Peanut butter on whole-wheat bread.
- A glass of milk with a piece of fruit.

| Action | Explanation | |----------------------------|----------------------------------------------------------------------------| | Fast-Acting Carbs | Quickly raise blood glucose levels. | | Avoid Fatty Foods | Prevent delayed absorption of glucose. | | Monitor | Ensure blood glucose levels are rising and stabilize. | | Complex Carbs & Protein | Provide sustained energy and prevent another drop in blood sugar. |

3. If the Person Is Unconscious or Unable to Swallow

Related reading: What Is A Normal A1C Blood Sugar Level

If the person is unconscious, having a seizure, or unable to swallow, do not attempt to give them anything by mouth, as this could cause choking. Instead:

Administer Glucagon: Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It is available as an injectable kit or a nasal spray. If you have a glucagon kit and know how to use it:
- Injectable Glucagon: Follow the instructions on the glucagon kit to prepare and administer the injection, typically into the thigh, arm, or buttock.
- Nasal Glucagon: Follow the instructions on the nasal glucagon spray to administer it into one nostril.
Call for Emergency Medical Assistance: Immediately call emergency services (911 in the United States) or your local emergency number. Provide them with details about the situation and that the person has diabetes and is experiencing severe hypoglycemia.
Turn the Person on Their Side: To prevent choking in case of vomiting, gently turn the person onto their side in the recovery position.
Stay with the Person: Remain with the person until emergency medical services arrive. Be prepared to provide information about their medical history, medications, and the steps you’ve taken.

| Action | Explanation | |-------------------------|-------------------------------------------------------------------------------------| | Administer Glucagon | Raises blood glucose levels quickly by releasing stored glucose. | | Call 911 | Professional medical help is essential in severe cases. | | Turn on Side | Prevents choking in case of vomiting. | | Stay with Person | Provide support and information to medical personnel upon their arrival. |

4. Post-Episode Care and Prevention

After the severe hypoglycemic episode has been resolved:

Medical Evaluation: Encourage the person to see their healthcare provider as soon as possible to evaluate the cause of the episode and adjust their diabetes management plan.
Review Medications: Work with their healthcare provider to review all medications, particularly insulin or sulfonylureas, to ensure proper dosing and timing.
Diabetes Education: Consider diabetes education sessions to improve understanding of diabetes management, including blood glucose monitoring, medication administration, and carbohydrate counting.
Carry Identification: Ensure the person wears a medical identification bracelet or necklace indicating they have diabetes and any other relevant medical information. This can help first responders provide appropriate care in case of an emergency.
Inform Others: Educate family members, friends, and coworkers about diabetes, hypoglycemia, and how to respond in an emergency. Ensure they know where to find the glucagon kit and how to administer it.

5. Understanding Glucagon

Glucagon is a hormone that can quickly raise blood sugar levels when someone is experiencing severe hypoglycemia and cannot take glucose orally.

Availability: Glucagon is available by prescription in two main forms:
- Injectable Glucagon Kits: These kits contain a vial of powdered glucagon and a syringe with sterile water. The water is injected into the vial, mixed, and then injected into the person.
- Nasal Glucagon Spray: This is a pre-filled, ready-to-use nasal spray that delivers glucagon through the nose.
Administration:
- Injectable Glucagon: Follow the instructions included with the kit. Typically, you inject the solution into the thigh, arm, or buttock.
- Nasal Glucagon: Insert the nozzle into one nostril and press the plunger to release the medication.
What to Expect: Glucagon usually starts to raise blood sugar levels within 10-15 minutes. Once the person regains consciousness and is able to swallow, give them a source of carbohydrates to prevent another drop in blood sugar.

| Glucagon Type | Administration | Onset of Action | Notes | |-------------------|-----------------------|-----------------|-----------------------------------------------------------------------------------------| | Injectable | Intramuscular/SubQ | 10-15 minutes | Requires mixing; ensure proper injection technique. | | Nasal Spray | Intranasal | 10-15 minutes | Ready-to-use; does not require mixing; administer even if the person has nasal congestion. |

Practical Tips for Preventing Severe Hypoglycemia

Prevention is always better than cure. Here are practical tips to help prevent severe hypoglycemia:

Regular Blood Glucose Monitoring: Monitor blood glucose levels regularly as recommended by your healthcare provider. Keep a log of your readings and note any patterns or trends.
Meal Planning: Follow a consistent meal plan that includes balanced amounts of carbohydrates, proteins, and fats. Avoid skipping meals or delaying them.
Medication Management: Take diabetes medications as prescribed and at the correct times. If you make changes to your medication regimen, do so under the guidance of your healthcare provider.
Exercise Safely: Adjust insulin or carbohydrate intake before, during, and after exercise to prevent hypoglycemia. Monitor blood glucose levels more frequently when exercising.
Alcohol Consumption: Drink alcohol in moderation and always with food. Alcohol can interfere with liver function and increase the risk of hypoglycemia.
Sick Days: When you're sick, continue to monitor blood glucose levels regularly and adjust insulin or medication dosages as needed, according to your sick day plan.
Travel Planning: When traveling, pack extra supplies of diabetes medications, glucose monitoring equipment, and glucagon. Be aware of time zone changes and adjust medication timing accordingly.
Continuous Glucose Monitoring (CGM): Consider using a CGM system, which can provide real-time blood glucose readings and alerts you to highs and lows. This can help you make proactive adjustments to your diabetes management plan.

| Prevention Strategy | Description | |-----------------------------|------------------------------------------------------------------------------------------------| | Regular Monitoring | Provides insight into blood glucose trends and patterns. | | Meal Planning | Maintains consistent blood glucose levels throughout the day. | | Medication Management | Ensures proper dosing and timing of diabetes medications. | | Safe Exercise | Prevents hypoglycemia during and after physical activity. | | Moderate Alcohol Use | Avoids interference with liver function and reduces hypoglycemia risk. | | Sick Day Planning | Adjusts medication and monitoring during illness to maintain blood glucose control. | | Travel Preparedness | Ensures availability of supplies and awareness of time zone changes. | | CGM Use | Provides real-time glucose data and alerts for highs and lows. |

What NOT To Do During A Hypoglycemic Episode

Understanding what to avoid during a hypoglycemic episode is equally as important as knowing what actions to take. Here are some key "do nots":

Do Not Give Food or Drink to an Unconscious Person: This poses a significant choking risk. As mentioned earlier, if the person is unconscious or unable to swallow, do not attempt to give them anything by mouth. Use glucagon instead and call for emergency assistance.
Related reading: Decoding Your Blood Sugar Range A Chart For Every Age
Do Not Inject Insulin: Giving insulin when someone has low blood sugar will only worsen the situation, driving blood glucose levels down further. Ensure that you confirm the person’s condition and blood glucose level before considering any insulin administration.
Do Not Leave the Person Alone: Always stay with the person until they have fully recovered and their blood glucose levels have stabilized. Even after administering treatment, continue to monitor them closely.
Do Not Ignore the Symptoms: Early recognition of hypoglycemia symptoms is critical. Ignoring the initial signs can lead to a more severe episode. Act quickly at the first indication of low blood sugar.
Do Not Overcorrect with Too Much Sugar: Giving too much fast-acting carbohydrate at once can cause a rapid spike in blood glucose, leading to hyperglycemia (high blood sugar). Follow recommended guidelines for carbohydrate intake and monitor glucose levels to avoid overcorrection.

| Action to Avoid | Reason | |-------------------------------|-------------------------------------------------------------------------------------------------------| | Feeding Unconscious Person | Prevents choking and aspiration, which can lead to serious complications. | | Injecting Insulin | Avoids further lowering blood glucose levels and exacerbating hypoglycemia. | | Leaving the Person Alone | Ensures continuous monitoring and assistance until recovery. | | Ignoring Symptoms | Prevents progression to more severe hypoglycemia and associated risks. | | Overcorrecting with Sugar | Prevents rebound hyperglycemia, which can complicate diabetes management. |

Conclusion

Severe hypoglycemia is a frightening but manageable condition with the right knowledge and preparation. By understanding the signs, following the step-by-step guide for treatment, and taking preventive measures, you can effectively handle and mitigate the risks associated with severe hypoglycemia. Being proactive, educating yourself and others, and working closely with your healthcare team are crucial steps in ensuring a safe and healthy life for individuals with diabetes. Remember, quick action and preparedness can make all the difference in a severe hypoglycemic emergency.