Severe Hypoglycemia: How to Recognize and Respond to a Low Blood Sugar Emergency

Hypoglycemia, or low blood sugar, is a common complication for individuals managing diabetes, particularly those using insulin or certain oral medications. While mild episodes of hypoglycemia can often be managed with simple treatments like consuming glucose tablets or juice, severe hypoglycemia is a medical emergency that requires immediate intervention. Understanding the signs, symptoms, and proper response protocols can be life-saving. This article will delve into the intricacies of severe hypoglycemia, providing you with the knowledge and tools to recognize and effectively respond to a low blood sugar crisis.

Understanding Hypoglycemia: A Quick Overview

Before delving into severe hypoglycemia, it’s essential to grasp the fundamentals. Blood glucose is your body's primary energy source. When blood sugar levels drop too low (generally below 70 mg/dL), hypoglycemia occurs.

Causes of Hypoglycemia:

• Excessive Insulin: Taking too much insulin relative to food intake.
• Missed or Delayed Meals: Not eating enough carbohydrates or skipping meals.
• Increased Physical Activity: Exercising more than usual without adjusting medication or food intake.
• Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose.
• Certain Medications: Some oral diabetes medications, like sulfonylureas, can increase insulin production and lead to hypoglycemia.
• Kidney or Liver Disease: These conditions can affect how medications are processed in the body.
• Hormone Deficiencies: Conditions affecting hormone production can contribute to blood sugar regulation issues.

Recognizing Severe Hypoglycemia: Symptoms to Watch Out For

Severe hypoglycemia is characterized by such significantly low blood sugar levels that the individual requires assistance from another person to recover. Unlike milder cases, the affected person may be unable to treat themselves. Recognizing the warning signs is critical for timely intervention. Symptoms of severe hypoglycemia can include: How To Lower Blood Sugar Quickly 7 Tips For Immediate Relief

• Loss of Consciousness: The person becomes unresponsive or passes out.
• Seizures: Uncontrolled muscle spasms or convulsions.
• Inability to Swallow: Making it difficult to safely administer oral treatments.
• Marked Confusion or Disorientation: Severe cognitive impairment, making it hard to follow simple directions.
• Combativeness or Aggression: Unexpected and uncharacteristic behavior.

Table of Hypoglycemia Symptoms by Severity:

| Symptom Category | Mild Hypoglycemia | Moderate Hypoglycemia | Severe Hypoglycemia | | :-------------------- | :-------------------------------------------- | :-------------------------------------------------------------- | :------------------------------------------------------------- | | Cognitive | Shakiness, Sweating, Rapid Heartbeat | Confusion, Irritability, Difficulty Concentrating | Loss of Consciousness, Seizures, Marked Disorientation | | Physical | Hunger, Tingling Around Mouth, Blurred Vision | Weakness, Lack of Coordination, Slurred Speech | Inability to Swallow | | Behavioral/Emotional | Anxiety, Nervousness | Changes in Personality, Impaired Judgement | Combativeness, Aggression |

Responding to a Severe Hypoglycemia Emergency: Step-by-Step Guide

The primary goal in a severe hypoglycemia emergency is to raise the person's blood sugar levels as quickly and safely as possible. Here's how to respond:

1. Assess the Situation: Check for responsiveness. If the person is unconscious or having seizures, do NOT attempt to give anything by mouth due to the risk of choking.

2. Administer Glucagon (If Available): Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It is typically prescribed for individuals at risk of severe hypoglycemia.

   • How to Administer Glucagon:
     • Locate the glucagon emergency kit.
     • Follow the instructions on the kit carefully. Most kits involve mixing a powder with a liquid and then injecting the solution.
     • Inject glucagon into the thigh, arm, or buttock. It can be injected through clothing if necessary.
   • Call for Emergency Medical Assistance (911): After administering glucagon, immediately call emergency services. Even if the person regains consciousness, professional medical evaluation is essential.
   • Provide Information to Paramedics: Inform the emergency responders that the person is diabetic and experienced severe hypoglycemia. Also, tell them when and how much glucagon was administered.

   • If Conscious, Provide a Fast-Acting Carbohydrate: If the person regains consciousness and is able to swallow safely, give them a fast-acting carbohydrate source, such as:

   • Glucose tablets or gel

   • Fruit juice
   • Regular (non-diet) soda
   • Honey or corn syrup

   Important Considerations:

   • Avoid over-treating: Once the person is alert and able to eat, don't give excessive amounts of sugar, which can lead to hyperglycemia (high blood sugar).
   • Follow up with a complex carbohydrate: After giving a fast-acting carbohydrate, follow up with a longer-acting carbohydrate source such as crackers, bread, or a piece of fruit to stabilize blood sugar levels.
   • Monitor Blood Sugar Levels: If you have a blood glucose meter, check the person’s blood sugar levels regularly after administering treatment. This will help ensure that the blood sugar is rising to a safe range.

Glucagon: The Lifesaving Injection

Glucagon is a synthetic hormone designed to rapidly increase blood glucose levels. It is an indispensable tool for managing severe hypoglycemia. Can You Reverse Prediabetes A Guide To Managing Blood Sugar

• How Glucagon Works: Glucagon acts on the liver, prompting it to convert stored glycogen (a form of glucose) into glucose and release it into the bloodstream.
• Forms of Glucagon: Glucagon is available in different formulations, including:
  • Traditional Injection: Requires mixing a powder and liquid before injecting.
  • Nasal Spray: A user-friendly option that is administered into the nose. Baqsimi is one such readily available brand.
  • Auto-injector: a prefilled auto-injector pen. Gvoke HypoPen is one example.

Table comparing different Glucagon Administration options

| Feature | Glucagon Injection (Traditional Kit) | Glucagon Nasal Spray (e.g., Baqsimi) | Glucagon Auto-Injector (e.g., Gvoke HypoPen) | | :---------------- | :--------------------------------------------------- | :------------------------------------------------------- | :---------------------------------------------------------------- | | Administration | Requires mixing and injection | Administered directly into the nose | Pre-filled; Injectable Pen | | Ease of Use | More complex, requires training | Easy to use; No mixing or injection required | Easy to use, prefilled pen with no mixing | | Speed | Faster onset of action, due to intravenous effect | Quick onset of action, due to nasal lining | Quicker onset of action than mixing | | Storage | Needs proper storage conditions; check expiry date | Room temperature | Room temperature | | Needle | Requires proper handling of needle | No needle required | Prefilled needle auto injector system | Severe Hypoglycemia A Critical Safety Guide For Patients And Families

• Who Should Have Glucagon: Glucagon should be prescribed to anyone at risk of severe hypoglycemia, including individuals with:

  
  • Type 1 diabetes
  • Type 2 diabetes who use insulin or sulfonylureas
  • A history of frequent or severe hypoglycemia episodes
  • Educating Family and Friends: It’s vital to educate family members, friends, and caregivers on how to recognize severe hypoglycemia and administer glucagon correctly. Practice with a trainer kit (which contains a practice vial and syringe but no medication) to become comfortable with the injection process.
  • Expiration Dates: Always check the expiration date of the glucagon kit and replace it before it expires.

Preventing Severe Hypoglycemia: Strategies for Blood Sugar Management

Prevention is always better than cure. Implementing proactive strategies can significantly reduce the risk of severe hypoglycemic episodes.

• Consistent Meal Schedules: Maintain a regular eating schedule and avoid skipping meals. Pay particular attention to carbohydrate intake.
• Carbohydrate Counting: Work with a registered dietitian or diabetes educator to learn how to accurately count carbohydrates in your meals and snacks. This can help you match your insulin dose to your food intake more precisely.
• Regular Blood Glucose Monitoring: Check your blood sugar levels frequently, especially before meals, before exercise, and at bedtime. Continuous Glucose Monitoring (CGM) systems can be especially helpful in identifying trends and preventing hypoglycemia.
• Adjusting Medication and Insulin: Regularly review your diabetes medications and insulin dosages with your healthcare provider. Adjustments may be needed based on your activity level, diet, and overall health.
• Exercise Precautions: Monitor blood sugar levels before, during, and after physical activity. Adjust insulin or carbohydrate intake as needed to prevent hypoglycemia during exercise.
• Alcohol Awareness: Consume alcohol in moderation and always with food. Alcohol can interfere with the liver's ability to release glucose, increasing the risk of hypoglycemia.
• Medical Alert Identification: Wear a medical alert bracelet or necklace indicating that you have diabetes. This will alert emergency responders to your condition if you are unable to communicate.
• Educating Family and Friends: Ensure that your family and close friends know how to recognize the signs and symptoms of hypoglycemia and how to administer glucagon if needed.
• Keep Emergency Supplies on Hand: Glucose tablets, snacks, and your glucagon kit in easily accessible locations at home, work, and when travelling.

When to Seek Medical Attention After a Hypoglycemic Event

Even after successfully treating a severe hypoglycemic episode, it's crucial to follow up with your healthcare provider to determine the underlying cause and prevent future occurrences.

• Post-Event Evaluation: Schedule an appointment with your doctor as soon as possible after a severe hypoglycemic event.
• Review of Medications and Insulin Regimen: Your doctor will review your diabetes medications and insulin dosages to identify any potential contributing factors.
• Assessment of Underlying Health Conditions: Your doctor may evaluate you for any underlying health conditions that could be contributing to hypoglycemia, such as kidney or liver disease.
• Adjusting Diabetes Management Plan: Based on the evaluation, your doctor may recommend adjustments to your diabetes management plan, including medication changes, dietary modifications, or increased blood glucose monitoring.

Staying Informed and Prepared

Severe hypoglycemia is a serious medical emergency that requires immediate action. By understanding the signs and symptoms, knowing how to respond, and implementing preventive strategies, you can significantly reduce the risk and potentially save a life. Keep your knowledge up-to-date, maintain open communication with your healthcare team, and empower yourself and those around you to effectively manage hypoglycemia. Staying informed and prepared is the best defense against the dangers of severe low blood sugar.

By Meera Shah, M.B., Ch.B.