Recognizing Severe Hypoglycemia: Symptoms and Emergency Actions

Hypoglycemia, or low blood sugar, is a common concern for individuals with diabetes, especially those who use insulin or certain oral medications. While mild hypoglycemia can often be managed with quick carbohydrate intake, severe hypoglycemia is a serious medical condition that requires immediate intervention. This article delves into recognizing the symptoms of severe hypoglycemia and the critical emergency actions necessary to take. Understanding these signs and responses can be life-saving. Fasting Blood Sugar Vs Postprandial Blood Sugar What S The Difference

What is Severe Hypoglycemia?

Before diving into symptoms and actions, let's define severe hypoglycemia. It's characterized by blood sugar levels that are dangerously low – typically below 70 mg/dL – and that lead to mental or physical incapacitation requiring assistance from another person. This level of low blood sugar can impair brain function, leading to potentially serious consequences if left untreated. It's crucial to distinguish it from milder forms that can be self-treated.

Symptoms of Severe Hypoglycemia

The symptoms of severe hypoglycemia can vary from person to person, but generally include the following: The 7 Best Exercises For Long Term Blood Sugar Control

• Loss of Consciousness: This is often the most alarming symptom. The individual may become unresponsive and unable to awaken easily.
• Seizures: Low blood glucose levels can disrupt the electrical activity in the brain, triggering seizures.
• Confusion and Disorientation: Severe impairment of cognitive function can make it difficult for the person to think clearly, follow instructions, or even recognize familiar surroundings.
• Slurred Speech: The individual might struggle to speak clearly, resembling intoxication.
• Unusual Behavior: Erratic or aggressive behavior, even combativeness, can occur.
• Inability to Swallow: This is particularly dangerous if the person needs oral treatment.
• Profuse Sweating: Though sweating can occur in mild hypoglycemia, with the severe kind it is often more pronounced and generalized.
• Weakness and Coordination Problems: Significant muscle weakness and an inability to maintain balance are also indicators.

It's important to remember that someone experiencing severe hypoglycemia might not be able to recognize their condition or ask for help. Therefore, others need to be vigilant and aware of these potential signs.

Emergency Actions for Severe Hypoglycemia

When encountering someone exhibiting signs of severe hypoglycemia, swift and decisive action is essential. Here's a step-by-step guide to the emergency actions to take:

1. Call for Emergency Medical Assistance (911 or Local Equivalent): This is the MOST IMPORTANT first step. Do not delay calling emergency services, even if you administer immediate treatment.
2. Do NOT Give Food or Drink if Unconscious: Attempting to feed or hydrate an unconscious person can lead to choking and aspiration.
3. Administer Glucagon (If Available): Glucagon is a hormone that raises blood sugar levels quickly. If the individual with hypoglycemia has a glucagon emergency kit, follow the instructions provided carefully. If you are unfamiliar with administering glucagon, emergency responders can administer it upon arrival. Key steps include:
   • Check the expiration date on the glucagon kit.
   • Prepare the glucagon injection as directed (usually involves mixing powder with liquid).
   • Inject the glucagon into the thigh, arm, or buttock.
   • Turn the person onto their side (recovery position) in case of vomiting.
4. Monitor the Person Closely: Continuously observe the person's breathing, responsiveness, and overall condition until emergency medical personnel arrive.
5. Provide Information to Emergency Responders: Inform them about the person's medical history (if known), their diabetes status, and what actions you have already taken. This information will assist them in providing the best possible care.
6. Follow-Up: Once the emergency is addressed, encourage the person to consult with their healthcare provider to review their diabetes management plan and prevent future severe hypoglycemic events.

Glucagon: A Critical Emergency Medication

As mentioned above, glucagon plays a critical role in treating severe hypoglycemia. It’s essential that individuals at risk of low blood sugar events have a glucagon emergency kit readily available and that family members, caregivers, and close friends know how to administer it. It's recommended to practice administering glucagon (using a training device, if available) to build confidence in case of an emergency. Here's a quick overview of Glucagon:

• Mechanism: Glucagon stimulates the liver to release stored glucose into the bloodstream, rapidly raising blood sugar levels.
• Administration: It is typically administered as an injection. Newer formulations of glucagon, such as nasal sprays, are also available, offering an easier method of administration. Always check the expiration date and follow the specific instructions provided with the kit.
• Side Effects: Common side effects of glucagon include nausea and vomiting. Turning the person onto their side after administration can help prevent aspiration if vomiting occurs.
• Important Note: Glucagon is not a substitute for prompt medical attention. Even after administering glucagon, it is crucial to call for emergency medical assistance.

Preventing Severe Hypoglycemia

Prevention is the best approach to avoid severe hypoglycemia. Here are some proactive measures:

• Consistent Blood Sugar Monitoring: Regularly checking blood glucose levels, especially before meals, before exercise, and before bedtime, can help identify trends and prevent significant drops in blood sugar. Consider using a continuous glucose monitor (CGM).
• Medication Management: Take diabetes medications exactly as prescribed and understand how they can affect blood sugar levels.
• Meal Planning and Timing: Eating regular meals and snacks and coordinating insulin doses with food intake can help maintain stable blood sugar levels.
• Carbohydrate Counting: Learn to accurately estimate the carbohydrate content of meals to adjust insulin doses accordingly.
• Exercise Precautions: Be aware that physical activity can lower blood sugar levels. Check blood glucose before, during, and after exercise, and adjust insulin or carbohydrate intake as needed.
• Alcohol Awareness: Alcohol can interfere with the liver's ability to release glucose, increasing the risk of hypoglycemia, especially when consumed without food. Drink alcohol in moderation and with meals.
• Education and Awareness: Educate yourself and your loved ones about hypoglycemia, its symptoms, and how to prevent and treat it.
• Medical Alert Identification: Wear a medical alert bracelet or necklace indicating you have diabetes, alerting responders in case of an emergency.

Conclusion

Severe hypoglycemia is a potentially life-threatening complication of diabetes. Recognizing the symptoms and knowing how to take appropriate emergency actions can significantly improve outcomes. Promptly calling for medical assistance, administering glucagon (if available), and closely monitoring the person are crucial steps. Furthermore, proactive prevention through consistent blood sugar monitoring, proper medication management, and awareness of risk factors is essential for minimizing the likelihood of severe hypoglycemia episodes. Discuss your diabetes management plan with your healthcare provider and ensure you have a plan in place for treating severe hypoglycemia. The Ultimate Food List To Lower Your A1C Blood Sugar

To further illustrate different intervention approaches for different symptoms, consider this:

Symptom	Immediate Action	Rationale
Loss of Consciousness	Call 911; Administer glucagon; Turn to recovery position	Ensures medical support and prevents aspiration; Glucagon raises blood sugar.
Seizures	Call 911; Protect the person from injury; Monitor breathing	Requires immediate medical evaluation; Prevents harm during the seizure.
Severe Confusion/Disorientation	Call 911 if severe; Administer glucagon if available and trained	May require medical assistance to rule out other causes; Aims to correct **low blood glucose** rapidly.
Inability to Swallow	Call 911; Do not attempt to give oral food or liquid. Administer Glucagon if available and trained	Risk of choking is high; Ensure prompt medical attention; alternative delivery via glucagon needed.

By Karen Grothe, Ph.D., L.P.