What to Do During a Severe Hypoglycemia (Low Blood Sugar) Emergency Severe hypoglycemia, or low blood sugar, is a critical medical emergency that can ...

What to Do During a Severe Hypoglycemia (Low Blood Sugar) Emergency

Severe hypoglycemia, or low blood sugar, is a critical medical emergency that can occur in people with diabetes, especially those taking insulin or certain oral medications. Recognizing the symptoms and knowing how to respond swiftly and effectively is crucial for preventing serious complications, including loss of consciousness, seizures, and even death. This article outlines the steps to take during a severe hypoglycemia emergency, ensuring you're well-prepared to handle such situations with confidence. We'll cover identifying symptoms, administering glucagon, and providing post-emergency care.

Identifying Severe Hypoglycemia

The first step in managing a severe hypoglycemia emergency is recognizing its signs and symptoms. While mild to moderate hypoglycemia can cause shakiness, sweating, dizziness, and confusion, severe hypoglycemia involves more alarming symptoms. Here are some indicators to watch out for:

Loss of Consciousness: The person may become unresponsive and unable to follow commands.
Seizures: Uncontrolled shaking or jerking movements indicate a critical state.
Inability to Swallow: Difficulty swallowing means oral treatments are not an option.
Extreme Confusion or Disorientation: The person may be severely confused or unable to recognize their surroundings.

It’s important to remember that symptoms can vary from person to person. Family members, friends, and caregivers of individuals with diabetes should be educated on these signs so they can act promptly. Keep a detailed log of any prior episodes to better recognize recurring symptoms.

Immediate Action: Administering Glucagon

If someone is experiencing severe hypoglycemia and is unable to take oral medication or food, glucagon is the recommended treatment. Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream, quickly raising blood sugar levels. Here's how to administer it:

1. Know Where the Glucagon Kit Is

Ensure that glucagon is readily available and that everyone who may need to administer it knows its location. Commonly, it should be located in:
- The person's home (bedroom, kitchen)
- School or workplace (nurse’s office, first-aid kit)
- Emergency medical kit during travel

2. Check the Expiration Date

Verify that the glucagon is not expired. Expired glucagon may not be effective.

3. Prepare the Injection

Nasal Glucagon: If using nasal glucagon, gently insert the applicator into one nostril and fully depress the plunger. There is no need to inhale or prime the device.
Injection Kit: The glucagon emergency kit typically contains a syringe and a vial of powdered glucagon. Follow these steps:
1. Remove the caps from the vial and syringe.
2. Inject the liquid from the syringe into the vial of powdered glucagon.
3. Gently roll the vial between your hands (do not shake) until the powder is completely dissolved.
4. Withdraw the reconstituted glucagon back into the syringe.

4. Administer the Glucagon

Nasal Glucagon: Gently insert the applicator into one nostril and fully depress the plunger.
Injection: Inject the glucagon into the person’s upper arm, thigh, or buttocks. You can inject through clothing if necessary, but ensure the area is clean if possible.

5. Call for Emergency Medical Assistance

After administering glucagon, immediately call emergency services (such as 911 in the United States) or your local emergency number. Provide clear and concise information about the situation and the treatment administered.

6. Monitor the Person

Stay with the person and monitor their condition. They should start to regain consciousness within 10 to 15 minutes. If there is no improvement after this time, consider administering a second dose of glucagon if available and if instructed by medical personnel.

Post-Emergency Care

Once the person regains consciousness, further care is essential to ensure a full recovery and prevent recurrence. Here’s what to do:

1. Provide a Fast-Acting Carbohydrate

Once the person is awake and able to swallow, give them a fast-acting carbohydrate such as fruit juice, regular soda (not diet), glucose tablets, or honey. The goal is to quickly raise their blood sugar levels.

2. Follow Up with a Long-Acting Carbohydrate

After the fast-acting carbohydrate, give them a long-acting carbohydrate like crackers, bread, or a sandwich with peanut butter. This helps stabilize blood sugar levels and prevent another drop.

3. Check Blood Sugar

Check the person's blood sugar level using a glucose meter about 15 to 20 minutes after administering the fast-acting carbohydrate. The goal is to ensure the blood sugar is rising and staying within a safe range (typically above 70 mg/dL).

4. Seek Medical Evaluation

Even if the person recovers, it’s crucial to seek medical evaluation as soon as possible. The healthcare provider can determine the cause of the severe hypoglycemia and adjust the person’s diabetes management plan to prevent future episodes.

5. Review the Incident

Work with the healthcare provider to review the incident. Discuss factors that may have contributed to the hypoglycemia, such as medication adjustments, changes in diet or exercise, or other medical conditions. Adjust the diabetes management plan accordingly.

Preventing Future Severe Hypoglycemia Episodes

Prevention is the best approach when it comes to severe hypoglycemia. Here are some strategies to help prevent future episodes:

1. Regular Blood Sugar Monitoring

Consistent blood sugar monitoring is essential. Encourage the person to check their blood sugar levels regularly, especially before meals, after exercise, and before bedtime.

2. Medication Management

Ensure medications are taken as prescribed and discuss any changes or concerns with the healthcare provider. Be aware of the potential for hypoglycemia with certain medications.

3. Dietary Considerations

Maintain a consistent meal schedule and avoid skipping meals. Consume balanced meals with adequate carbohydrates, protein, and healthy fats.

4. Exercise Planning

Adjust insulin doses or carbohydrate intake before, during, and after exercise. Monitor blood sugar levels more frequently during and after physical activity.

5. Educate Family and Friends

Educate family members, friends, and caregivers on the signs and symptoms of hypoglycemia and how to respond. Make sure they know how to administer glucagon if necessary.

6. Continuous Glucose Monitoring (CGM)

Consider using a CGM system. These devices continuously monitor blood glucose levels and can alert the person and their caregivers to impending hypoglycemia.

7. Carry Identification

Ensure the person wears a medical identification bracelet or necklace indicating they have diabetes. This alerts emergency responders to the condition.

Conclusion

Responding quickly and effectively to a severe hypoglycemia emergency can be life-saving. Recognizing the symptoms, knowing how to administer glucagon, and providing appropriate post-emergency care are critical steps. Additionally, implementing preventive strategies, such as regular blood sugar monitoring and medication management, can reduce the risk of future episodes. By staying informed and prepared, you can help protect individuals with diabetes from the potentially devastating effects of severe hypoglycemia.