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What is Severe Hypoglycemia and How Do You Treat It?

Severe hypoglycemia, or critically low blood sugar, is a serious condition that requires immediate medical attention. Unlike milder forms of hypoglycemia which can often be managed with a quick snack, severe hypoglycemia can cause unconsciousness, seizures, and even coma if left untreated. Understanding the causes, symptoms, and especially the treatment protocols, is crucial for individuals with diabetes and their caregivers.

Understanding Hypoglycemia and its Severity

Before delving into the specifics of severe hypoglycemia, let’s quickly recap what hypoglycemia is: It occurs when your blood glucose levels drop too low, typically below 70 mg/dL. This can happen for a variety of reasons, primarily related to diabetes management. These reasons can include:

• Taking too much insulin.
• Skipping meals or eating too few carbohydrates.
• Engaging in intense physical activity without adjusting medication or food intake.
• Alcohol consumption, especially on an empty stomach.

While mild to moderate hypoglycemia might cause symptoms like shakiness, sweating, and dizziness, severe hypoglycemia is defined by the person's inability to treat themselves due to confusion, loss of consciousness, or seizures. This often necessitates assistance from another person or emergency medical services. The 5 Best Exercises For Blood Sugar Control In Type 2 Diabetes

Recognizing the Symptoms of Severe Hypoglycemia

It's essential to recognize the symptoms of severe hypoglycemia quickly to administer timely treatment. Some key signs include:

• Unconsciousness: This is perhaps the most alarming symptom. The person is unresponsive and cannot be awakened.
• Seizures: Low blood sugar can disrupt brain function, leading to seizures.
• Confusion and Disorientation: Marked cognitive impairment is present making the affected individual unable to respond normally.
• Inability to Swallow: Difficulty swallowing may occur which prevent safe administration of oral treatment.

Note that individual experiences may vary, and some people might experience other neurological symptoms. Therefore, prompt intervention is key if you suspect someone is experiencing severe hypoglycemia. Unexpected Factors That Can Affect Your Blood Sugar

How to Treat Severe Hypoglycemia: A Step-by-Step Guide

The primary goal when treating severe hypoglycemia is to raise the person's blood sugar levels as quickly as possible. The following methods are generally employed, depending on the individual's state:

1. Administer Glucagon: Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It is available as an injectable medication or nasal spray and should be readily accessible to people at risk of severe hypoglycemia and those close to them.

   • Injectable Glucagon: If you are using an injectable glucagon kit, follow the instructions carefully. Usually, this involves mixing the glucagon powder with the diluent, then injecting the solution into the thigh, buttock, or arm.
   • Nasal Glucagon: Nasal glucagon is administered by spraying the medication into one nostril.
   • After Glucagon Administration: Once you have administered glucagon, call emergency services (911) immediately and closely monitor the person until medical help arrives. Even if they regain consciousness, they still require professional medical evaluation.

2. Do NOT Attempt to Give Food or Drink: If the person is unconscious or having a seizure, do not try to force-feed them anything. This poses a significant choking hazard.

3. Call Emergency Services (911): Even after administering glucagon, it’s crucial to contact emergency services. Severe hypoglycemia can have underlying causes that need to be addressed by medical professionals. EMS personnel can provide further treatment and transport the person to a hospital for evaluation. Hypoglycemia And Hyperglycemia Understanding The Difference

4. Provide Information to Medical Personnel: When emergency services arrive, inform them that the person has diabetes, the last time they ate or took their insulin, and that you administered glucagon. This information is crucial for guiding their treatment decisions.

5. Post-Event Monitoring: Once the immediate crisis has passed, it’s important for the individual and their healthcare team to review the events that led to the severe hypoglycemic episode. This review aims to identify potential triggers and adjust the treatment plan to prevent future occurrences.

   

Prevention Strategies for Severe Hypoglycemia

Prevention is always better than cure. Here are some key strategies to minimize the risk of severe hypoglycemia:

• Regular Blood Glucose Monitoring: Frequent blood sugar checks help identify trends and potential problems early on. Continuous glucose monitors (CGMs) can be particularly useful, as they provide real-time glucose readings and alerts for impending low blood sugar.
• Consistent Meal Timing and Carbohydrate Intake: Eating meals and snacks at consistent times each day and paying attention to carbohydrate intake helps stabilize blood sugar levels.
• Medication Management: Work closely with your healthcare provider to ensure your insulin or other diabetes medications are properly dosed. Understanding how different medications affect blood sugar is vital.
• Exercise Planning: Be mindful of how physical activity impacts blood sugar. You might need to adjust your insulin dose or eat extra carbohydrates before, during, or after exercise.
• Educate Family and Friends: Make sure your family, friends, and colleagues know how to recognize and treat severe hypoglycemia. Teach them how to administer glucagon and when to call for emergency help.
• Carry Identification: Wear a medical ID bracelet or necklace that identifies you as having diabetes. This alerts emergency responders to your condition if you become unconscious.

Glucagon: Your Emergency Backup

Glucagon is a life-saving medication that everyone at risk of severe hypoglycemia should have readily available. Discuss with your healthcare provider which type of glucagon is best for you (injectable or nasal spray) and how to properly administer it. Ensure that your family members and caregivers are also trained in its use. Make sure that the glucagon is not expired.

Debunking Myths About Severe Hypoglycemia

Several misconceptions surround severe hypoglycemia. Let's address some common ones:

• Myth: Only people with type 1 diabetes experience severe hypoglycemia.
  • Fact: While more common in type 1 diabetes, severe hypoglycemia can also occur in individuals with type 2 diabetes who are on insulin or certain oral medications.
• Myth: Giving someone with severe hypoglycemia a sugary drink will always solve the problem.
  • Fact: If the person is unconscious or having a seizure, attempting to give them something to drink can be dangerous. Glucagon is the appropriate first-line treatment.
• Myth: Once someone recovers from severe hypoglycemia, they don’t need further medical attention.
  • Fact: Even after recovering, it’s crucial to seek medical evaluation to identify the underlying cause and prevent future episodes.

Living Well with Diabetes and Minimizing Hypoglycemia Risk

Managing diabetes effectively involves proactive measures and consistent communication with your healthcare team. By prioritizing regular blood glucose monitoring, careful medication management, and education, individuals with diabetes can significantly reduce their risk of experiencing severe hypoglycemia and enjoy a healthier, more active life. Don't hesitate to reach out to your doctor or diabetes educator if you have concerns or questions about hypoglycemia management.

Key Differences: Moderate vs. Severe Hypoglycemia (HTML Table Example)

Characteristic	Moderate Hypoglycemia	Severe Hypoglycemia
Level of Consciousness	Fully conscious and alert.	May be unconscious, confused, or experiencing seizures.
Ability to Self-Treat	Can treat with oral glucose or simple carbohydrates.	Unable to self-treat due to impaired consciousness or seizures. Requires assistance.
Treatment	Oral glucose (e.g., juice, glucose tablets).	Glucagon injection or nasal spray followed by immediate medical attention.
Need for Emergency Services	Usually not required if symptoms resolve quickly with treatment.	Always required, even after glucagon administration.

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By Gregory W. Barsness, M.D.