Severe Hypoglycemia: Emergency Steps to Take for Dangerously Low Blood Sugar

Severe hypoglycemia, or dangerously low blood sugar, is a critical medical condition that can quickly become life-threatening. It occurs when the glucose level in the blood drops too low, typically below 70 mg/dL (3.9 mmol/L). While hypoglycemia is often associated with diabetes, it can also affect individuals without the condition. Recognizing the signs and knowing the appropriate emergency steps to take is crucial for preventing severe consequences, including seizures, loss of consciousness, and even death. Your Step By Step Guide To An Accurate Blood Sugar Test At Home

This article provides a comprehensive guide on understanding severe hypoglycemia, recognizing its symptoms, and outlining the emergency steps required to manage this dangerous condition effectively. We'll explore the causes, preventative measures, and long-term management strategies to ensure you're well-prepared to handle a hypoglycemic emergency.

Understanding Hypoglycemia and Its Severity

Hypoglycemia is a condition where the blood glucose level falls below the normal range required for proper bodily function. Glucose, derived from the food we eat, is the primary energy source for our cells, particularly brain cells. When glucose levels drop too low, the brain doesn't receive enough fuel, leading to a cascade of symptoms ranging from mild to severe. How To Prevent Severe Hypoglycemia A Step By Step Plan

While mild to moderate hypoglycemia can often be managed with quick-acting carbohydrates, severe hypoglycemia requires immediate intervention due to the potential for serious complications. Here’s a breakdown of the different levels of hypoglycemia:

• Mild Hypoglycemia: Blood sugar typically between 60-70 mg/dL. Symptoms may include shakiness, sweating, and mild confusion.
• Moderate Hypoglycemia: Blood sugar usually between 50-60 mg/dL. Symptoms become more pronounced, including difficulty concentrating, irritability, and coordination problems.
• Severe Hypoglycemia: Blood sugar below 50 mg/dL, or any level that causes unconsciousness, seizures, or requires assistance from another person to treat.

It is crucial to understand that these ranges can vary slightly based on individual factors and healthcare provider recommendations.

Recognizing the Symptoms of Severe Hypoglycemia

The symptoms of severe hypoglycemia can manifest rapidly and intensely. Recognizing these warning signs is crucial for timely intervention. The symptoms often fall into two categories: adrenergic (related to adrenaline release) and neuroglycopenic (related to glucose deprivation in the brain).

Adrenergic Symptoms:

• Sweating: Profuse sweating, even in cool environments.
• Shakiness: Trembling or shaking, particularly in the hands.
• Rapid Heartbeat: Palpitations or a racing pulse.
• Anxiety: Feeling nervous, agitated, or panicked.
• Hunger: Intense hunger, even after eating.

Neuroglycopenic Symptoms:

• Confusion: Difficulty thinking clearly, disorientation, or memory problems.
• Slurred Speech: Difficulty speaking clearly, mumbling, or incoherent speech.
• Blurred Vision: Double vision or difficulty focusing.
• Seizures: Uncontrolled muscle contractions or convulsions.
• Loss of Consciousness: Unresponsiveness or fainting.
• Weakness: General feeling of fatigue and lethargy.
• Numbness or Tingling: Unusual sensations, especially around the mouth.

Important Considerations:

• Symptom Variability: The specific symptoms experienced can vary from person to person and even from episode to episode in the same individual.
• Beta-Blockers: Certain medications, such as beta-blockers (often used for high blood pressure or heart conditions), can mask some of the adrenergic symptoms of hypoglycemia, making it harder to recognize.
• Hypoglycemia Unawareness: Individuals who experience frequent episodes of hypoglycemia may develop hypoglycemia unawareness, where they no longer experience the warning signs until the blood sugar is critically low. This is a dangerous condition that requires close management with a healthcare provider.

Emergency Steps to Take for Severe Hypoglycemia

When someone exhibits symptoms of severe hypoglycemia, immediate action is essential. The following steps should be taken without delay:

1. Assess the Situation and Check Blood Sugar (If Possible):

• If the person is conscious and able to cooperate, ask them about their symptoms and medical history (if known).
• If a blood glucose meter is available, check their blood sugar level immediately. Do not delay treatment if a meter is not available.
• Call for Emergency Medical Services (EMS). Even if the individual responds to initial treatment, severe hypoglycemia can have lingering effects and warrants professional medical evaluation. Dial 911 or your local emergency number. Inform them that you are dealing with a case of severe hypoglycemia and provide the location.

2. Administer Glucagon (If Available and Trained):

• Glucagon is a hormone that raises blood sugar levels by stimulating the liver to release stored glucose. It is available by prescription and is typically administered via injection or nasal spray.
• Who Needs Glucagon? Individuals at risk for severe hypoglycemia (e.g., those with insulin-dependent diabetes) should have a glucagon kit readily available and family members or caregivers trained in its administration.
• Administering Glucagon Injection:
  1. Check the expiration date on the glucagon kit.
  2. Follow the instructions provided in the kit carefully. Generally, this involves mixing the glucagon powder with the diluent (liquid) and injecting it into the muscle (thigh, arm, or buttock).
  3. If the person is lying down, turn them on their side to prevent choking if they vomit.
• Administering Nasal Glucagon:
  1. Check the expiration date.
  2. Follow package instructions. The nasal spray is typically administered by inserting the device into one nostril and pressing the plunger. No need to inhale.
• Important Considerations:
  • Glucagon may not be effective if the person's liver glycogen stores are depleted (e.g., in cases of prolonged starvation or chronic liver disease).
  • Some people may experience nausea or vomiting after receiving glucagon.
  • Glucagon is not a substitute for professional medical care. Always call EMS even after administering glucagon.

3. If Glucagon Is Not Available or You Are Not Trained:

• Do not attempt to give the person anything by mouth if they are unconscious, having a seizure, or unable to swallow. This could cause choking.
• Wait for EMS to arrive. While waiting, monitor the person's breathing and pulse. If they stop breathing, begin CPR if you are trained to do so.

4. After Administering Glucagon and the Person Regains Consciousness:

• Give them a fast-acting source of glucose, such as fruit juice, glucose tablets, regular (non-diet) soda, or honey.
• Follow this with a longer-acting source of carbohydrates and protein, such as crackers with peanut butter or cheese and crackers, to stabilize blood sugar levels and prevent another episode.

5. Provide Information to EMS:

• When EMS arrives, provide them with a detailed account of the situation, including:
  • The person's symptoms.
  • The time the symptoms started.
  • Any known medical conditions (especially diabetes).
  • Any medications the person is taking.
  • Whether glucagon was administered and the time it was given.

Preventing Severe Hypoglycemia

Preventing severe hypoglycemia is always the best approach. Individuals at risk should work closely with their healthcare provider to develop a comprehensive management plan. Key strategies include:

1. Regular Blood Glucose Monitoring:

• Individuals with diabetes should monitor their blood glucose levels frequently, as directed by their healthcare provider. This may involve using a blood glucose meter or a continuous glucose monitor (CGM).
• Target Ranges: Discuss target blood glucose ranges with your healthcare provider and learn how to adjust insulin or medication dosages based on blood sugar readings, food intake, and physical activity.

2. Consistent Meal Planning and Timing:

• Eat regular meals and snacks at consistent times each day to prevent fluctuations in blood sugar levels.
• Carbohydrate Counting: Learn how to estimate the amount of carbohydrates in your meals and snacks to match your insulin dosage or medication regimen.
• Balanced Diet: Consume a balanced diet that includes carbohydrates, protein, and healthy fats to provide sustained energy.

3. Medication Management:

• Take all medications as prescribed by your healthcare provider.
• Insulin Adjustment: Learn how to adjust insulin dosages based on blood glucose readings, food intake, and physical activity.
• Drug Interactions: Be aware of potential drug interactions that can affect blood sugar levels.
• Discuss Alcohol Consumption: Talk to your healthcare provider about how alcohol may affect your blood sugar control, and about how to properly manage your medication dosing as well as what to eat if you are planning on drinking alcohol.

4. Exercise Precautions:

• Check blood sugar levels before, during, and after exercise.
• Snack Before Exercise: Consume a carbohydrate-rich snack before exercising, especially if blood sugar is below 100 mg/dL.
• Adjust Insulin: Reduce insulin dosages before exercise, as directed by your healthcare provider.
• Carry a Fast-Acting Glucose Source: Always carry a source of quick-acting glucose (e.g., glucose tablets, juice) during exercise in case blood sugar drops too low.

5. Education and Awareness:

• Educate yourself, family members, and caregivers about the symptoms of hypoglycemia and the emergency steps to take.
• Wear Medical Identification: Consider wearing a medical identification bracelet or necklace that indicates you have diabetes and are at risk for hypoglycemia.

6. Continuous Glucose Monitoring (CGM):

• CGMs are devices that continuously measure blood glucose levels and provide real-time data. Some CGMs can alert the user when blood sugar levels are dropping too low, allowing for timely intervention.

7. Regular Healthcare Check-ups:

• Schedule regular check-ups with your healthcare provider to review your diabetes management plan and make any necessary adjustments.

Glucagon: A Lifesaving Medication

Glucagon is a prescription medication used to treat severe hypoglycemia in people with diabetes who use insulin or other medications that can lower blood sugar. It’s essential for those at risk and their caregivers to understand its use.

Types of Glucagon:

1. Injectable Glucagon: This is the traditional form, consisting of a vial of powdered glucagon and a syringe of sterile water. It requires mixing before injection.
2. Nasal Glucagon: A newer, more user-friendly option that is administered as a nasal spray. It's pre-mixed and ready to use, making it easier to administer in emergency situations.

How Glucagon Works:

Glucagon works by stimulating the liver to release stored glucose into the bloodstream, rapidly raising blood sugar levels.

Important Considerations:

• Prescription Required: Glucagon requires a prescription from a healthcare provider.
• Storage: Store glucagon according to the manufacturer's instructions. Keep it in a cool, dry place away from direct sunlight and extreme temperatures.
• Expiration Date: Check the expiration date regularly and replace the glucagon kit before it expires.
• Training: Make sure family members, caregivers, and close contacts are trained on how to administer glucagon in case of an emergency.
• Not a Substitute for Medical Care: Always call emergency services even after glucagon is administered.

Who Should Have Glucagon:

• People with type 1 diabetes.
• People with type 2 diabetes who use insulin or other medications that can cause hypoglycemia.
• People with a history of severe hypoglycemia.

Living with Diabetes: A Proactive Approach

Living with diabetes requires a proactive and informed approach to manage blood sugar levels effectively. Education is key, and working closely with a healthcare team can help individuals develop a tailored plan. Diabetic Diet Foods That Help Manage Your Blood Sugar

Key Aspects of Diabetes Management:

• Self-Monitoring of Blood Glucose (SMBG): Regular blood glucose monitoring is essential for managing diabetes effectively. This involves checking blood sugar levels using a glucose meter and recording the results.
• Healthy Eating: A well-balanced diet that includes plenty of fruits, vegetables, whole grains, and lean protein is crucial for maintaining stable blood sugar levels.
• Regular Physical Activity: Exercise helps improve insulin sensitivity and lower blood sugar levels. Aim for at least 150 minutes of moderate-intensity exercise per week.
• Medication Management: Taking medications as prescribed is essential for managing diabetes. This may include insulin, oral medications, or injectable medications.
• Stress Management: Stress can affect blood sugar levels, so finding healthy ways to manage stress is important.
• Foot Care: People with diabetes are at increased risk of foot problems, so it's important to inspect feet daily and seek medical attention for any wounds or infections.
• Eye Care: Diabetes can damage the blood vessels in the eyes, leading to vision problems. Regular eye exams are essential.
• Kidney Care: Diabetes can damage the kidneys, so regular kidney function tests are important.
• Smoking Cessation: Smoking can worsen diabetes complications, so quitting smoking is important.
• Alcohol Consumption: Alcohol can affect blood sugar levels, so it's important to consume alcohol in moderation and with food.

Long-Term Management and Follow-Up Care

Following an episode of severe hypoglycemia, it's crucial to review the circumstances that led to the event and make adjustments to the diabetes management plan as needed.

Steps to Take After a Severe Hypoglycemia Episode:

1. Review the Event: Analyze what happened leading up to the hypoglycemia episode. Consider factors such as food intake, medication dosages, physical activity, and any illnesses or stressors.
2. Consult Healthcare Provider: Schedule an appointment with your healthcare provider to discuss the event and review your diabetes management plan.
3. Adjust Medication: Your healthcare provider may adjust your medication dosages to prevent future episodes of hypoglycemia.
4. Refine Meal Planning: Work with a registered dietitian to refine your meal planning strategies and ensure you're consuming consistent and balanced meals.
5. Assess Exercise Routine: Review your exercise routine and make any necessary adjustments to prevent hypoglycemia during or after physical activity.
6. Consider CGM: If you experience frequent episodes of hypoglycemia or have hypoglycemia unawareness, talk to your healthcare provider about using a continuous glucose monitor (CGM).
7. Educate Caregivers: Ensure that family members, caregivers, and close contacts are educated about hypoglycemia and how to administer glucagon.
8. Psychological Support: Consider seeking psychological support to cope with the stress and anxiety that can result from experiencing severe hypoglycemia.

Conclusion

Severe hypoglycemia is a serious medical emergency that requires immediate recognition and intervention. Understanding the symptoms, knowing how to administer glucagon, and calling for emergency medical services are crucial steps in managing this condition effectively. By adopting proactive prevention strategies and working closely with a healthcare team, individuals at risk can minimize the likelihood of experiencing severe hypoglycemia and maintain their overall health and well-being. Remember that proactive management and preparation are your best defenses against the dangers of severe hypoglycemia.

By Catherine Madaffari, M.D.