A Person with Diabetes' Guide to Navigating Hypoglycemia (Severe Low Blood Sugar)

Living with diabetes requires constant vigilance, especially when it comes to managing blood sugar levels. While much attention is given to hyperglycemia (high blood sugar), hypoglycemia (low blood sugar) – particularly severe hypoglycemia – can be just as dangerous, if not more so. This comprehensive guide aims to equip individuals with diabetes and their caregivers with the knowledge and tools needed to understand, prevent, recognize, and treat severe low blood sugar. Simple Habits For Effortless Blood Sugar Balance Every Day

Understanding Hypoglycemia: The Basics

Hypoglycemia occurs when your blood glucose levels drop too low. This usually happens when the body doesn't have enough glucose, which is the primary source of energy for cells. For people with diabetes, hypoglycemia is often a side effect of taking insulin or certain oral medications that stimulate insulin release.

What's Considered Low?

Generally, blood glucose below 70 mg/dL (3.9 mmol/L) is considered hypoglycemic. However, individual targets may vary depending on your doctor’s recommendations and personal experiences. Regularly monitoring your blood sugar with a blood glucose meter is crucial for identifying and addressing hypoglycemia early.

Causes of Hypoglycemia in People with Diabetes

Several factors can contribute to low blood sugar, including:

• Excessive Insulin: Taking too much insulin, or injecting it incorrectly, is a primary cause.
• Skipped or Delayed Meals: Not eating enough carbohydrates or skipping meals altogether.
• Increased Physical Activity: Exercising without adjusting medication or increasing carbohydrate intake.
• Alcohol Consumption: Alcohol can impair the liver’s ability to release glucose, especially when consumed without food.
• Certain Medications: Some diabetes medications, especially sulfonylureas, are more likely to cause hypoglycemia.
• Kidney or Liver Problems: Impaired kidney or liver function can affect glucose metabolism.

Recognizing the Symptoms of Hypoglycemia

Being able to recognize the symptoms of hypoglycemia is critical for timely intervention. Symptoms can vary from person to person, and some individuals may experience "hypoglycemia unawareness," where they don't feel the early warning signs.

Mild to Moderate Hypoglycemia Symptoms:

• Shakiness
• Sweating
• Dizziness or lightheadedness
• Hunger
• Irritability or anxiety
• Confusion
• Rapid heartbeat
• Blurred vision
• Weakness

Severe Hypoglycemia Symptoms:

Severe low blood sugar requires immediate assistance because the person may be unable to treat themselves. Symptoms include: The Surprising Breakfast Habit For Better Blood Sugar Control All Day

• Loss of consciousness
• Seizures
• Inability to eat or drink
• Unresponsiveness

What is Severe Hypoglycemia?

Severe hypoglycemia is defined as a hypoglycemic event that requires assistance from another person to treat. This means the individual is unable to self-treat, either because they are unconscious, confused, or having seizures. Severe low blood sugar is a medical emergency and needs prompt action.

Treating Severe Hypoglycemia: A Step-by-Step Guide

When someone is experiencing severe hypoglycemia, follow these steps:

1. Call for Help: Immediately call emergency services (911 in the US, or your local emergency number). Explain that the person is having a diabetic emergency due to severe low blood sugar.
2. Administer Glucagon (if available):
   • Glucagon is a hormone that raises blood sugar levels. It’s typically prescribed to individuals at risk of severe hypoglycemia and should be readily available to caregivers or family members.
   • Follow the instructions on the glucagon kit carefully. Glucagon can be administered via injection into the thigh, arm, or buttocks. Nasal glucagon is also available and may be easier to administer.
   • After administering glucagon, turn the person on their side in case of vomiting.
3. Do Not Attempt to Give Food or Drink: If the person is unconscious or having a seizure, do not try to force them to eat or drink anything. This could cause choking.
4. Monitor: Once the person regains consciousness (or after emergency services arrive), monitor their blood sugar levels and provide a longer-acting carbohydrate source (like a sandwich or fruit) to prevent a recurrence.
5. Inform the Individual's Healthcare Provider: It's vital to inform the individual’s doctor or diabetes care team about the episode so they can review the treatment plan and make necessary adjustments.

Prevention is Key: Avoiding Severe Hypoglycemia

Preventing severe low blood sugar is far better than reacting to it. Here are some preventative measures: High Blood Sugar Symptoms Vs Low Blood Sugar Symptoms Know The Difference

• Regular Blood Glucose Monitoring: Frequent monitoring helps identify trends and allows for proactive adjustments.
• Consistent Meal Timing: Eat meals and snacks at regular intervals to maintain stable blood glucose levels.
• Carbohydrate Counting: Learning how to accurately count carbohydrates in foods can help match insulin doses to carbohydrate intake.
• Adjusting Insulin for Exercise: Reduce insulin doses or increase carbohydrate intake before, during, and after physical activity, based on individual needs and blood sugar readings.
• Alcohol Awareness: Consume alcohol in moderation and always with food. Be aware that alcohol can affect blood sugar levels for several hours.
• Medication Management: Work closely with your healthcare provider to adjust medication dosages as needed, particularly when making changes to diet, exercise, or overall health.
• Wearing a Medical Alert ID: Wearing a medical alert bracelet or necklace that identifies you as having diabetes can provide crucial information to first responders in an emergency.
• Continuous Glucose Monitoring (CGM): A CGM provides real-time blood glucose readings and alerts you to trends, helping you proactively manage your blood sugar levels and reduce the risk of hypoglycemia. Many CGMs can now predict impending lows.
• Educate Family and Friends: Make sure your loved ones know how to recognize the symptoms of hypoglycemia and how to administer glucagon.

Debunking Common Myths About Hypoglycemia

Let's address some common misconceptions surrounding hypoglycemia:

• Myth: Hypoglycemia only happens to people who take too much insulin.
  • Reality: While excessive insulin is a common cause, other factors like skipped meals, exercise, and alcohol can also lead to hypoglycemia.
• Myth: If someone is unconscious, you should pour juice down their throat.
  • Reality: Never force food or liquid into the mouth of an unconscious person, as this can cause choking. Use glucagon if available.
• Myth: Once someone has recovered from hypoglycemia, they are fine.
  • Reality: It’s crucial to monitor blood sugar levels after treating hypoglycemia to prevent recurrence. A longer-acting carbohydrate source should be consumed.

The Role of Technology in Managing Hypoglycemia

Technology plays a crucial role in mitigating the risks of severe low blood sugar.

• Insulin Pumps: Insulin pumps can deliver a more precise and consistent dose of insulin compared to injections, which can help reduce the risk of hypoglycemia. Many newer pumps integrate with CGMs and can automatically suspend insulin delivery when blood sugar levels drop too low (hybrid closed loop systems).
• Continuous Glucose Monitors (CGMs): CGMs provide real-time blood glucose readings and alerts when blood sugar levels are trending low.
• Mobile Apps: Many apps help track blood glucose levels, medication dosages, and food intake, which can aid in better diabetes management and hypoglycemia prevention.

When to See a Doctor

Consult your healthcare provider if you experience frequent or severe hypoglycemic episodes, or if you have "hypoglycemia unawareness." They can help adjust your treatment plan, review your medication regimen, and provide additional education on managing your diabetes.

Hypoglycemia Unawareness

Hypoglycemia unawareness is a dangerous condition where a person no longer experiences the warning signs of low blood sugar. This increases the risk of severe hypoglycemia. Regular blood glucose monitoring, using a CGM, and working closely with your healthcare provider are crucial for managing this condition. Sometimes, avoiding low blood sugars for a period of time can help restore awareness.

Living a Full Life with Diabetes

Despite the challenges, people with diabetes can live full and active lives. By understanding the risks of hypoglycemia, taking preventative measures, and being prepared to treat it effectively, you can confidently manage your condition and minimize the impact of severe low blood sugar. Regular communication with your healthcare team is key to developing a personalized plan that works for you. Remember that managing diabetes is a continuous learning process, and seeking support and education can make a significant difference in your overall well-being.

Resources

Here are some helpful resources for learning more about diabetes and managing hypoglycemia:

• American Diabetes Association (ADA): www.diabetes.org
• Juvenile Diabetes Research Foundation (JDRF): www.jdrf.org
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): www.niddk.nih.gov

Key Takeaways

• Severe hypoglycemia is a medical emergency requiring immediate intervention.
• Glucagon is a life-saving medication that can raise blood sugar levels in an emergency.
• Prevention through regular monitoring, consistent meal timing, and careful medication management is crucial.
• Continuous Glucose Monitors (CGMs) and insulin pumps can significantly reduce the risk of hypoglycemia.
• Education and support are vital for effectively managing diabetes and preventing severe complications.

Topic	Key Action
Hypoglycemia Symptoms	Learn to recognize early warning signs to prevent severe episodes.
Glucagon Administration	Keep glucagon readily available and educate caregivers on how to use it.
Preventative Measures	Monitor blood sugar regularly, maintain consistent meal schedules, and adjust medication as needed.
Technology Utilization	Consider using CGMs and insulin pumps for better glucose control.
Medical Consultation	Regularly consult your healthcare provider for treatment plan adjustments.

By Michael S. Underhill, D.O.