What to Do During Severe Hypoglycemia: An Emergency Action Plan Severe hypoglycemia, or critically low blood sugar, is a dangerous condition that can ...

What to Do During Severe Hypoglycemia: An Emergency Action Plan

Severe hypoglycemia, or critically low blood sugar, is a dangerous condition that can occur in people with diabetes, particularly those taking insulin or certain oral medications. Recognizing the symptoms and knowing how to respond quickly and effectively is crucial. This article provides a comprehensive emergency action plan to help you, your family, and your friends handle severe hypoglycemia with confidence. Being prepared could save a life.

Understanding Severe Hypoglycemia

Hypoglycemia happens when your blood glucose level drops too low, typically below 70 mg/dL (3.9 mmol/L). Severe hypoglycemia is when your blood sugar level drops so low that you need help from someone else to treat it because you're unable to treat it yourself due to confusion, unconsciousness, or seizures.

Common Causes:

Excessive insulin dosage: Taking too much insulin relative to food intake or activity level.
Skipped or delayed meals: Not eating enough carbohydrates to match insulin doses.
Intense exercise: Physical activity without sufficient carbohydrate intake or insulin adjustment.
Alcohol consumption: Alcohol can impair the liver's ability to release glucose into the bloodstream.
Certain medications: Some diabetes medications, especially sulfonylureas, can increase the risk of hypoglycemia.

Recognizing the Symptoms:

Being able to identify the symptoms of severe hypoglycemia is the first step in taking appropriate action. The progression of symptoms can vary, but common indicators include:

Confusion and Disorientation: Difficulty thinking clearly or understanding instructions.
Slurred Speech: Trouble speaking coherently.
Loss of Coordination: Difficulty walking or maintaining balance.
Extreme Weakness or Fatigue: Feeling unusually tired and unable to move.
Seizures: Uncontrolled muscle spasms and loss of consciousness.
Unconsciousness: Complete loss of awareness and unresponsiveness.

It's crucial to remember that not everyone experiences the same symptoms, and symptoms can sometimes mimic other conditions. If you're unsure, it's always better to err on the side of caution and treat for hypoglycemia.

Emergency Action Plan: Step-by-Step Guide

When someone is experiencing severe hypoglycemia, quick action is essential. Follow these steps to respond effectively:

1. Assess the Situation

Check for responsiveness: Try to wake the person and ask them simple questions.
Look for medical identification: Check for a medical ID bracelet, necklace, or card indicating they have diabetes.
Observe symptoms: Note any signs of confusion, disorientation, or loss of consciousness.

2. Do Not Attempt Oral Treatment If Unconscious

Never try to give food or liquids to an unconscious person or someone who is having a seizure. This can cause choking.

3. Administer Glucagon (If Available)

Glucagon is a hormone that raises blood sugar levels by stimulating the liver to release stored glucose. It's available by prescription and should be readily accessible for individuals at risk of severe hypoglycemia.

Locate the glucagon kit: Keep it in a known and easily accessible location. Make sure caregivers and family members know where it is stored.
Prepare the injection: Follow the instructions provided with the glucagon kit. Typically, this involves mixing a powdered glucagon with a liquid diluent.
Administer the injection: Inject the glucagon into the thigh or arm muscle, as instructed.

Glucagon Administration: Step-by-Step

Note: Glucagon can cause nausea and vomiting, so be prepared for this possibility after the person regains consciousness.

4. Call for Emergency Medical Assistance

Even if glucagon is administered and the person starts to recover, it's crucial to call emergency services (911 in the US) immediately. Severe hypoglycemia can have underlying causes that require medical evaluation. Paramedics can provide further treatment and transport the person to a hospital if necessary.

5. Monitor the Person Closely

Check breathing: Ensure the person is breathing normally. If not, start rescue breathing or CPR if you are trained.
Position the person on their side: Once they regain consciousness, position them on their side to prevent choking if they vomit.
Continue monitoring: Stay with the person until emergency medical services arrive.

6. Provide Oral Glucose Once Conscious

Once the person regains consciousness and is able to swallow safely, give them a source of fast-acting carbohydrates to raise their blood sugar level:

Glucose tablets: Provide 3-4 tablets (check the label for carbohydrate content).
Fruit juice: Offer 4-6 ounces of fruit juice.
Regular soda: Provide 4-6 ounces of regular (non-diet) soda.
Hard candies: Give 3-4 hard candies to suck on.

7. Check Blood Sugar Levels

After providing a source of carbohydrates, check the person's blood sugar level every 15 minutes. If the blood sugar remains low, repeat the carbohydrate treatment until it returns to a safe range.

8. Follow Up

After the immediate crisis, it's important to:

Review the episode: Discuss the event with the person to identify potential causes and preventive measures.
Adjust diabetes management plan: Work with a healthcare provider to adjust medication, diet, or exercise regimens to reduce the risk of future episodes.
Educate caregivers and family members: Ensure everyone knows how to recognize and treat severe hypoglycemia.

Preventing Severe Hypoglycemia

While it's important to know how to respond to severe hypoglycemia, prevention is the best strategy. Here are some tips for minimizing the risk:

Consistent meal timing: Eat regular meals and snacks to maintain stable blood sugar levels.
Carbohydrate counting: Learn how to count carbohydrates accurately to match insulin doses to food intake.
Regular blood glucose monitoring: Check blood sugar levels frequently, especially before meals, exercise, and bedtime.
Insulin dose adjustment: Adjust insulin doses as needed based on blood sugar readings, food intake, and activity levels.
Wear medical identification: Carry a medical ID bracelet or card indicating you have diabetes.
Educate family and friends: Teach them how to recognize and treat hypoglycemia.

Strategies for Minimizing Hypoglycemia Risk:

| Strategy | Description | Example | | :------------------------ | :------------------------------------------------------------------------------------------------------------------------------------------------- | :---------------------------------------------------------------------------------------------------------------------------- | | Regular Monitoring | Frequent blood glucose checks to identify and address lows early. | Checking blood sugar before meals, at bedtime, and after exercise. | | Carb Counting | Accurately matching insulin doses to carbohydrate intake. | Using a carbohydrate counting app to calculate the amount of insulin needed for a meal. | | Insulin Adjustment | Adjusting insulin doses based on blood glucose levels, meals, and activity. | Reducing the pre-exercise insulin dose to prevent hypoglycemia during physical activity. | | Consistent Meals | Eating meals and snacks at consistent times each day to avoid fluctuations in blood glucose. | Eating breakfast, lunch, and dinner at approximately the same times each day. | | Emergency Supplies | Keeping a readily available supply of fast-acting carbohydrates and glucagon. | Carrying glucose tablets or gel in a purse or backpack. Having a glucagon kit at home and informing family members of its location. | | Educating Others | Ensuring family, friends, and colleagues know how to recognize and treat hypoglycemia. | Explaining the signs of hypoglycemia and the proper use of glucagon to close contacts. |

Educating Others About Hypoglycemia

A critical part of managing and preparing for severe hypoglycemia involves educating those around you. By ensuring that your family, friends, and colleagues understand what to do in an emergency, you are significantly improving your chances of receiving prompt and appropriate care.

Key Steps in Education:

Recognizing the Symptoms: Teach others to recognize the early warning signs of hypoglycemia, such as shakiness, sweating, confusion, and irritability.
Understanding the Protocol: Explain the step-by-step emergency action plan, including when and how to administer glucagon and the importance of calling emergency services.
Practical Training: Conduct practical training sessions on using the glucagon kit. Many pharmacies or diabetes educators offer demonstrations.
Accessibility of Supplies: Ensure that everyone knows where emergency supplies, such as glucagon and fast-acting carbohydrates, are stored.
Regular Review: Periodically review the emergency plan with your support network to refresh their knowledge and address any questions or concerns.

Example Scenario:

Imagine a situation where a colleague with diabetes becomes confused and disoriented at work. If their coworkers have been educated about hypoglycemia, they can quickly assess the situation, check for medical identification, and administer glucagon if necessary. This immediate response can prevent a potentially life-threatening situation.

Conclusion

Severe hypoglycemia is a serious but manageable complication of diabetes. By understanding the causes, recognizing the symptoms, and following a well-defined emergency action plan, you can respond effectively and potentially save a life. Remember to keep glucagon readily available, educate your family and friends, and work closely with your healthcare team to prevent future episodes. With preparation and knowledge, you can face severe hypoglycemia with confidence.