Critical Steps to Take During a Severe Hypoglycemia Episode

Severe hypoglycemia, or low blood sugar, is a dangerous condition that primarily affects individuals with diabetes, particularly those using insulin or certain oral medications. Understanding the critical steps to take during such an episode can be life-saving, both for the affected individual and those around them. This article provides a detailed guide on recognizing, responding to, and preventing severe hypoglycemia.

What is Severe Hypoglycemia?

Hypoglycemia occurs when the level of glucose (sugar) in the blood drops too low. While mild hypoglycemia might cause shakiness or sweating, severe hypoglycemia is characterized by symptoms like confusion, seizures, loss of consciousness, or the inability to self-treat due to cognitive impairment. In such cases, the individual requires assistance from another person.

Recognizing the Signs and Symptoms

Early recognition of hypoglycemia symptoms is crucial in preventing it from escalating into a severe episode. Common symptoms include:

• Shakiness
• Sweating
• Dizziness or lightheadedness
• Confusion or difficulty concentrating
• Rapid heartbeat
• Blurred vision
• Headache
• Weakness or fatigue

In severe cases, these symptoms can progress to:

• Seizures
• Loss of consciousness
• Difficulty speaking
• Unresponsiveness

Knowing these signs can help you act quickly.

Immediate Actions During a Severe Hypoglycemia Episode

When someone is experiencing severe hypoglycemia, immediate action is necessary. The primary goal is to raise their blood sugar levels as quickly as possible. Here's a step-by-step guide:

1. Check for Responsiveness

First, assess the person’s level of consciousness. If they are conscious but confused, proceed with administering fast-acting carbohydrates. If they are unconscious or having a seizure, skip to step 4 and call for emergency medical assistance immediately.

2. Administer Fast-Acting Carbohydrates (If Conscious)

For someone who is conscious but unable to self-treat, you can provide a fast-acting carbohydrate source such as:

• Glucose gel or tablets: These are specifically designed to raise blood sugar quickly. Follow the product instructions for the correct dosage (usually 15-20 grams).
  • Example: 4 glucose tablets (each containing 4-5 grams of glucose).
• Juice or Regular Soda: Offer 4 ounces (120 ml) of juice or regular (non-diet) soda.
  • Example: Orange juice, apple juice, or a sugary soda like Coca-Cola.
• Hard Candies: If juice or glucose products aren't available, give them 4-5 hard candies that can be chewed quickly.
  • Example: Life Savers or similar hard candies that are easy to chew and dissolve.
• Honey or Syrup: One tablespoon (15 ml) of honey or syrup rubbed inside the cheek if the person is having difficulty swallowing.

Important Considerations:

• Avoid foods high in fat: Fat can slow down the absorption of glucose. Therefore, chocolate bars, cake, or ice cream are not ideal first-line treatments.
• Ensure they can swallow: Do not give liquids or food to someone who is unconscious, having a seizure, or has difficulty swallowing to prevent choking.

3. Wait 15 Minutes and Recheck Blood Sugar

After administering the fast-acting carbohydrates, wait 15 minutes and recheck the person’s blood sugar level using a glucose meter, if available. If the blood sugar remains low (typically below 70 mg/dL), repeat the process by giving another dose of fast-acting carbohydrates. Continue this cycle until their blood sugar rises to an acceptable level.

Here's a sample chart demonstrating how blood sugar levels should be monitored:

| Time (Minutes) | Action | Expected Blood Sugar Level (mg/dL) | Action if Level Not Reached | | :------------- | :------------------------------------------------------------ | :----------------------------------- | :------------------------------------------------------------------------------------------------------------------------------ | | 0 | Administer 15-20 grams of fast-acting carbohydrates | N/A | N/A | | 15 | Recheck blood sugar using a glucose meter | Above 70 | If below 70, administer another 15-20 grams of fast-acting carbohydrates. | | 30 | Recheck blood sugar using a glucose meter | Above 70 | If still below 70, administer another 15-20 grams of fast-acting carbohydrates and consider seeking medical assistance soon. | | 45 | If blood sugar is stabilized, provide a longer-acting snack | N/A | Ensure a balance of protein and carbohydrates to sustain the blood sugar level. |

4. Administer Glucagon (If Unconscious or Unable to Swallow)

Glucagon is a hormone that raises blood sugar levels by signaling the liver to release stored glucose into the bloodstream. It is typically available as an injectable kit or a nasal spray. If the person is unconscious, having a seizure, or cannot safely swallow, glucagon should be administered. The Ultimate Diabetic Diet Plan To Help Control Your Glucose Levels

How to Administer Glucagon:

1. Check the Expiration Date: Ensure the glucagon kit is not expired.
2. Prepare the Glucagon: Follow the instructions on the glucagon kit. Typically, this involves mixing a powdered glucagon with a liquid diluent.
3. Administer the Injection: Inject the glucagon into the thigh, arm, or buttock. You can inject through clothing if necessary.
4. Turn the Person on Their Side: After injecting glucagon, turn the person on their side in the recovery position to prevent choking if they vomit.
5. Call Emergency Services: Regardless of whether the person regains consciousness after glucagon administration, call emergency services (911 in the US). Glucagon's effects are temporary, and the person needs further medical evaluation.

Here’s a simplified table for quick reference on glucagon administration:

| Action | Details | | :--------------------------- | :------------------------------------------------------------ | | Check Expiration | Ensure the glucagon kit is not expired. | | Prepare Glucagon | Mix the powdered glucagon with the liquid diluent as instructed. | | Inject Glucagon | Inject into thigh, arm, or buttock. | | Recovery Position | Turn the person on their side to prevent choking. | | Call Emergency Services | Dial 911 for further medical assistance. |

5. Call for Emergency Medical Assistance

Even if the person responds to initial treatment, it is crucial to call emergency services (911) after a severe hypoglycemic event. The underlying cause of the hypoglycemia needs to be investigated, and the person may require further medical treatment and monitoring in a hospital.

6. Follow Up with a Healthcare Professional

After an episode of severe hypoglycemia, a thorough review of the person's diabetes management plan is necessary. This includes assessing medication dosages, meal plans, and physical activity levels to identify potential triggers and prevent future episodes.

Preventing Severe Hypoglycemia

Prevention is the best approach to managing severe hypoglycemia. Here are some key strategies:

1. Regular Blood Sugar Monitoring

Regularly checking blood sugar levels, especially before meals, before bedtime, and after exercise, helps identify trends and patterns. Continuous Glucose Monitoring (CGM) devices can be particularly useful for detecting and alerting individuals to impending low blood sugar.

2. Medication Management

Ensure proper understanding of diabetes medications, particularly insulin and sulfonylureas. Know the onset, peak, and duration of each medication and how it affects blood sugar levels.

| Medication Type | Key Considerations | | :-------------- | :-------------------------------------------------------------- | | Insulin | Correct dosage, injection technique, and timing with meals. | | Sulfonylureas | Risk of hypoglycemia, especially when meals are skipped. | | Other Oral Meds | Potential interactions and effects on blood sugar management. |

3. Consistent Meal Planning

Eat regular, balanced meals and snacks at consistent times each day. Ensure meals contain a balance of carbohydrates, protein, and fat to maintain stable blood sugar levels.

4. Exercise Precautions

Monitor blood sugar levels before, during, and after exercise. Adjust insulin doses or carbohydrate intake as needed to prevent exercise-induced hypoglycemia. Always carry a fast-acting carbohydrate source during physical activity.

5. Alcohol Consumption

Be cautious with alcohol consumption, as alcohol can impair the liver's ability to release glucose and increase the risk of hypoglycemia, especially when combined with insulin or sulfonylureas. Fasting Blood Glucose Vs A1C Which Diabetes Test Is More Important

6. Educate Family and Friends

Educate family members, friends, and caregivers about the signs and symptoms of hypoglycemia and how to respond in an emergency. Ensure they know how to administer glucagon and when to call for emergency medical assistance.

7. Wear Medical Identification

Wear a medical ID bracelet or necklace that indicates the person has diabetes and any relevant medical conditions or allergies. This can help emergency responders provide appropriate care in case of severe hypoglycemia.

Additional Tips for Managing Hypoglycemia

• Keep a Log: Maintain a detailed log of blood sugar levels, meals, medications, and physical activity to identify patterns and triggers for hypoglycemia.
• Work Closely with Healthcare Providers: Collaborate with a healthcare team, including an endocrinologist, diabetes educator, and registered dietitian, to optimize the diabetes management plan.
• Have a Hypoglycemia Action Plan: Develop a written hypoglycemia action plan that outlines specific steps to take in case of low blood sugar. Share this plan with family members, friends, and caregivers.

Example of a Hypoglycemia Action Plan

| Situation | Action | | :--------------------------------------------------- | :------------------------------------------------------------------------------------------------------------------------------------------ | | Mild Hypoglycemia (blood sugar 70-80 mg/dL) | Consume 15-20 grams of fast-acting carbohydrates (e.g., glucose tablets, juice). Wait 15 minutes and recheck blood sugar. | | Moderate Hypoglycemia (blood sugar below 70 mg/dL) | Consume 15-20 grams of fast-acting carbohydrates. Wait 15 minutes and recheck blood sugar. If still low, repeat. | | Severe Hypoglycemia (unable to self-treat) | If conscious but unable to self-treat: Administer fast-acting carbs. If unconscious: Administer glucagon and call 911 immediately. | | Post-Hypoglycemia | After blood sugar stabilizes, consume a longer-acting snack (e.g., peanut butter on whole-wheat crackers) to prevent recurrence. Consult doctor. | The Ultimate Guide To The A1C Test Beyond Just A Number

Conclusion

Severe hypoglycemia is a potentially life-threatening condition that requires prompt recognition and action. By understanding the signs and symptoms, knowing how to administer fast-acting carbohydrates or glucagon, and taking preventive measures, individuals with diabetes and their caregivers can effectively manage and minimize the risk of severe hypoglycemia. Remember, early intervention and education are key to ensuring the safety and well-being of those at risk. Always consult with healthcare professionals to create a personalized diabetes management plan that addresses individual needs and circumstances.

By Joshua J. Keith, D.O.