What to Do During a Hypoglycemia (Severe Low Blood Sugar) Event

13 Sep 2025

What to Do During a Hypoglycemia (Severe Low Blood Sugar) Event

Hypoglycemia, or low blood sugar, occurs when the glucose level in your blood drops too low to fuel your body's needs. While mild hypoglycemia can often be managed with quick snacks, a severe hypoglycemia event can be frightening and requires immediate action to prevent serious consequences, including loss of consciousness, seizures, or even coma. This article provides a comprehensive guide on what to do during a severe hypoglycemia event, focusing on recognizing the signs, taking immediate steps, and preventing future episodes.

Why Understanding Severe Hypoglycemia is Critical

Understanding severe hypoglycemia is crucial for individuals with diabetes and their caregivers because it directly impacts safety and well-being. Unlike mild episodes that can be self-treated with a quick snack or sugary drink, severe episodes require assistance and potentially medical intervention. Without prompt action, severe hypoglycemia can lead to serious neurological consequences, impacting cognitive function and potentially resulting in irreversible brain damage. Moreover, recurrent severe hypoglycemic events can decrease the individual's awareness of low blood sugar symptoms, increasing their risk of further episodes. Therefore, possessing a deep understanding of the signs, causes, and proper management strategies is essential for ensuring the safety and quality of life for individuals managing diabetes. This knowledge empowers both patients and their caregivers to act decisively, mitigating risks and promoting better health outcomes.

Recognizing the Signs and Symptoms of Severe Hypoglycemia

The ability to recognize the signs and symptoms of severe hypoglycemia is the first and most crucial step in managing such an event effectively. Symptoms can vary from person to person, but generally include the following:

  • Confusion or Disorientation: Difficulty thinking clearly, impaired judgment, or acting strangely.
  • Loss of Coordination: Stumbling, clumsiness, or difficulty walking.
  • Seizures: Uncontrolled muscle spasms or convulsions.
  • Loss of Consciousness: Unresponsiveness or fainting.
  • Profuse Sweating: Unexplained and excessive perspiration.
  • Rapid Heartbeat: A noticeably fast or irregular pulse.
  • Blurred Vision: Difficulty seeing clearly.
  • Slurred Speech: Difficulty speaking clearly.

It is essential to understand that not everyone experiences the same symptoms, and some individuals may develop hypoglycemia unawareness, meaning they no longer feel the early warning signs of low blood sugar. For these individuals, severe hypoglycemia can occur with little or no warning, making it even more critical for caregivers and family members to be vigilant.

Example: John, a 60-year-old with type 1 diabetes, used to feel shaky and sweaty when his blood sugar was low. However, after several years, he developed hypoglycemia unawareness and no longer felt those early symptoms. One evening, his wife found him confused and disoriented. He quickly progressed to losing consciousness and was rushed to the hospital, where he was treated for severe hypoglycemia.

Differentiating Between Mild and Severe Hypoglycemia

| Symptom Category | Mild Hypoglycemia | Severe Hypoglycemia | | :------------------- | :---------------------------------------------------------- | :----------------------------------------------------------------------------------------------------- | | Cognitive | Shakiness, anxiety, irritability, confusion. | Confusion, disorientation, impaired judgment, seizures, loss of consciousness. | | Physical | Sweating, hunger, tingling around the mouth. | Loss of coordination, blurred vision, slurred speech, rapid heartbeat, profuse sweating. | | Response | Usually self-treatable with 15-20 grams of fast-acting carbs. | Requires assistance from another person; often needs glucagon injection or intravenous glucose at the hospital. |

Understanding the distinctions between mild and severe hypoglycemia is critical for responding appropriately. Mild episodes can generally be managed independently by the individual, while severe episodes require external assistance and may necessitate emergency medical intervention. Recognizing these differences empowers both the individual and their caregivers to take timely and effective action, preventing potential complications and ensuring better health outcomes.

Immediate Steps to Take During a Severe Hypoglycemia Event

When someone is experiencing severe hypoglycemia, prompt action is essential. Here are the steps you should take:

  1. Assess the Situation: Quickly determine if the person is conscious and able to swallow.
  2. If Conscious and Able to Swallow:
    • Administer Fast-Acting Carbohydrates: If the person is conscious and able to swallow, give them a source of fast-acting carbohydrates. However, in cases of severe hypoglycemia, oral intake might not be enough.
    • Call for Help: Immediately call emergency services (911 in the US) or your local emergency number. Explain that the person is experiencing severe hypoglycemia and is conscious but needs further medical assistance.
  3. If Unconscious or Unable to Swallow:
    • Do NOT Attempt to Give Food or Drink: This can cause choking.
    • Administer Glucagon (If Available): Glucagon is a hormone that raises blood sugar levels. If you have a glucagon emergency kit and know how to use it, administer the injection according to the kit's instructions. Glucagon comes in two main forms:
      • Glucagon Injection: Traditional injectable form that requires reconstitution before administration.
      • Nasal Glucagon: A pre-filled, ready-to-use nasal spray that is easy to administer, even by untrained individuals.
    • Call Emergency Services Immediately: Call 911 (or your local emergency number) and inform them that the person is unconscious due to hypoglycemia. Provide clear and concise information about the situation and your location.
  4. Monitor the Person:
    • After Glucagon: If you administered glucagon, monitor the person closely for any improvement. It may take 10-15 minutes for glucagon to take effect. If the person regains consciousness, give them a long-acting carbohydrate snack (such as crackers and peanut butter) to prevent a relapse.
    • If No Improvement: If the person does not regain consciousness or has a seizure before emergency services arrive, keep them safe by clearing the area of any objects that could cause injury.
  5. Provide Information to Emergency Responders:
    • Medical History: Inform the paramedics or emergency medical technicians (EMTs) about the person's diabetes diagnosis, medications they are taking (especially insulin or other diabetes medications), and any other relevant medical conditions.
    • Actions Taken: Tell them what you have already done, such as administering glucagon and the time it was given.

Table: Glucagon Administration Comparison

| Feature | Glucagon Injection | Nasal Glucagon | | :------------------ | :-------------------------------------------------------------------------------------------------------------- | :----------------------------------------------------------------------------------------------------------- | | Preparation | Requires reconstitution by mixing a powder and liquid; may be difficult in an emergency. | Pre-filled and ready to use; no mixing required. | | Administration | Intramuscular injection. | Nasal spray. | | Ease of Use | Can be challenging for untrained individuals due to the mixing and injection process. | Easier to use, even by untrained individuals; no injection needed. | | Effectiveness | Effective if administered correctly and if the individual does not have significant liver glycogen stores depletion | Effective, with similar glucose recovery rates as the injection, even if the individual has a cold or nasal congestion. |

Important Note: Even if the person recovers after receiving glucagon, it's still crucial to seek medical attention to identify the cause of the severe hypoglycemia and prevent future episodes.

Prevention Strategies for Avoiding Severe Hypoglycemia

Preventing severe hypoglycemia is an ongoing effort that involves careful monitoring, education, and collaboration between the person with diabetes, their healthcare team, and their caregivers. Here are some effective prevention strategies:

  1. Regular Blood Glucose Monitoring:
    • Frequency: Check blood glucose levels regularly, especially before meals, before bedtime, and before and after exercise. Continuous glucose monitoring (CGM) systems can be particularly helpful in identifying trends and preventing lows.
    • Target Range: Work with your healthcare provider to establish a target blood glucose range and understand what to do if your levels fall outside that range.
  2. Consistent Meal Timing and Carbohydrate Intake:
    • Meal Planning: Eat meals and snacks at consistent times each day and ensure they contain an appropriate amount of carbohydrates, protein, and fat.
    • Carb Counting: Learn how to count carbohydrates accurately and adjust insulin doses accordingly.
  3. Medication Management:
    • Insulin Dosing: Work closely with your endocrinologist or diabetes educator to adjust insulin doses based on your diet, activity level, and blood glucose readings.
    • Medication Review: Regularly review all medications with your healthcare provider, as some medications can increase the risk of hypoglycemia.
  4. Exercise Planning:
    • Pre-Exercise Check: Check your blood glucose before, during, and after exercise.
    • Snack Availability: Have a carbohydrate snack readily available during exercise to prevent lows.
    • Insulin Adjustment: Adjust insulin doses before exercise as needed, following your healthcare provider's recommendations.
  5. Educate Caregivers and Family Members:
    • Training: Teach family members, friends, and coworkers how to recognize the signs of hypoglycemia and how to administer glucagon.
    • Emergency Kit: Keep a glucagon emergency kit readily accessible and ensure everyone knows where it is located.
  6. Wear a Medical Identification:
    • Medical Alert: Wear a medical ID bracelet or necklace that indicates you have diabetes and any other relevant medical conditions.
    • Emergency Contact: Include emergency contact information on your medical ID.
  7. Adjust Alcohol Consumption:
    • Moderate Intake: If you choose to drink alcohol, do so in moderation and always with food.
    • Blood Glucose Monitoring: Monitor your blood glucose levels more frequently when drinking alcohol, as alcohol can interfere with the liver's ability to release glucose.

Case Study: Implementing a Hypoglycemia Prevention Plan

Patient Profile: Maria, a 45-year-old with type 1 diabetes for 20 years, experienced frequent episodes of severe hypoglycemia, particularly at night. Her healthcare team implemented a comprehensive prevention plan to address the issue.

Intervention:

  • CGM Initiation: Maria started using a continuous glucose monitor to track her blood glucose levels continuously.
  • Basal Insulin Adjustment: Her endocrinologist adjusted her basal insulin dose based on CGM data, reducing the risk of nocturnal hypoglycemia.
  • Dietary Counseling: A registered dietitian provided education on meal planning and carbohydrate counting, helping Maria better manage her blood glucose levels.
  • Hypoglycemia Awareness Training: Maria and her husband attended a training session on recognizing the signs of hypoglycemia and administering glucagon.

Outcome: Within three months, Maria experienced a significant reduction in the frequency of severe hypoglycemic events. The CGM provided valuable data for insulin adjustments, dietary changes, and increased awareness of blood glucose trends.

Essential Components of a Hypoglycemia Emergency Kit

Having a well-stocked and readily accessible hypoglycemia emergency kit is essential for anyone at risk of severe low blood sugar. The kit should include the following items: Common Mistakes That Negatively Affect Your Blood Sugar Management

  • Glucagon Emergency Kit: Contains glucagon, a hormone that raises blood sugar levels. Ensure the kit is not expired and that you and your caregivers know how to administer it properly.
  • Fast-Acting Carbohydrates: Include items like glucose tablets, glucose gel, or a small juice box. These can be used if the person is conscious and able to swallow, but they are not a substitute for glucagon in severe cases.
  • Blood Glucose Meter: To check the person's blood sugar level, if possible. However, in a severe situation, administering treatment should take priority over checking blood sugar.
  • Instructions: A clear, step-by-step guide on how to recognize and treat hypoglycemia.
  • Emergency Contact Information: A list of emergency contacts, including the person's healthcare provider, family members, and local emergency services number.
  • Medical Identification: Information about the person's diabetes diagnosis, medications, allergies, and other relevant medical conditions. This can be in the form of a medical ID card or bracelet.

Where to Keep the Kit:

  • Home: Keep the kit in a central, easily accessible location that everyone in the household knows.
  • Work/School: Keep a kit at work or school, in a place where it can be quickly retrieved in an emergency.
  • Travel: Always carry a kit with you when traveling, especially on airplanes or in remote areas.

Table: Comparing Hypoglycemia Treatments

| Treatment | Description | When to Use | | :----------------------- | :----------------------------------------------------------------------------------------------------------- | :---------------------------------------------------------------------------------------------------------------------------- | | Glucose Tablets | Pre-measured doses of glucose; quickly absorbed. | For mild to moderate hypoglycemia, if the person is conscious and able to swallow. | | Glucose Gel | Gel form of glucose; can be easier to swallow than tablets. | For mild to moderate hypoglycemia, if the person is conscious and able to swallow. | | Juice or Regular Soda | Contains sugar; rapidly raises blood glucose levels. | For mild to moderate hypoglycemia, if the person is conscious and able to swallow. | | Glucagon (Injection/Nasal) | Hormone that stimulates the liver to release stored glucose into the bloodstream; available in injectable and nasal forms. | For severe hypoglycemia, when the person is unconscious or unable to swallow. | | Intravenous Glucose | Glucose administered directly into the bloodstream; used in a hospital setting. | For severe hypoglycemia, when the person is unconscious or unresponsive and requires immediate medical intervention at a hospital. |

Ensuring the hypoglycemia emergency kit is well-stocked, up-to-date, and accessible is a vital aspect of diabetes management, particularly for those prone to severe low blood sugar events. Regular checks of the kit contents, expiration dates, and the individual's understanding of the items are essential for preparedness. This vigilance can significantly impact the response time and effectiveness of interventions during a hypoglycemic emergency, ultimately enhancing the safety and well-being of the individual. What Is An A1C Test Understanding Your A1C Blood Sugar Results

Legal and Ethical Considerations

When responding to a severe hypoglycemia event, it's essential to be aware of the legal and ethical considerations that may apply: Why Is My Fasting Blood Sugar So High 8 Possible Reasons

  1. Good Samaritan Laws: Many jurisdictions have Good Samaritan laws that protect individuals who provide assistance to someone in need during an emergency, as long as they act in good faith and without gross negligence. These laws generally shield volunteers from liability if their actions, while trying to help, unintentionally cause harm. It is crucial to understand the specific laws in your region to ensure that you are protected when assisting someone in a medical emergency.
  2. Informed Consent: If the person is conscious and able to make decisions, it's important to obtain their consent before providing assistance. However, if the person is unconscious or incapacitated, implied consent applies, meaning you can assume they would want you to help them in a life-threatening situation.
  3. Scope of Practice: Be aware of your limitations and only provide assistance that you are trained and qualified to give. For example, if you are not trained to administer glucagon, it's best to call for emergency medical assistance rather than attempting to administer it yourself.
  4. Documentation: After the event, document what happened, including the person's symptoms, the actions you took, and the time they were taken. This information can be helpful for healthcare providers and legal purposes.
  5. Privacy: Respect the person's privacy and only share information about their medical condition with those who need to know, such as healthcare providers and family members.
  6. Emergency Medical Services Act: The Emergency Medical Services Act is legislation enacted in many jurisdictions to regulate the delivery of emergency medical care. This act typically outlines the standards of care that emergency medical personnel must adhere to and the protocols they should follow in various emergency situations.
  7. HIPAA Compliance: The Health Insurance Portability and Accountability Act (HIPAA) sets standards for the protection of sensitive patient health information. While HIPAA primarily applies to healthcare providers and related entities, individuals providing first aid should also be mindful of maintaining patient privacy to the extent possible.
  8. Duty to Act: The "duty to act" principle varies by jurisdiction and refers to the legal obligation of certain individuals, such as healthcare professionals or caregivers, to provide assistance to someone in distress. However, in many places, bystanders do not have a legal duty to intervene in an emergency, although ethical considerations often encourage assistance where possible.
  9. Negligence: Negligence is a legal term that refers to a failure to exercise the care that a reasonably prudent person would exercise in similar circumstances. In the context of providing assistance during a medical emergency, negligence could occur if a person acts recklessly or fails to act in a way that a reasonably competent individual would.
  10. Abandonment: Abandonment refers to the act of deserting or forsaking someone to whom a duty of care is owed. In emergency medical situations, abandonment could occur if a caregiver or healthcare provider initiates assistance but then abruptly ceases providing care without ensuring that the person's needs are adequately met.

By understanding these legal and ethical considerations, you can provide assistance safely and responsibly while protecting yourself and the person you are helping.

The Importance of Ongoing Education and Support

Managing diabetes and preventing severe hypoglycemia requires ongoing education and support. Here are some resources that can help:

  • Diabetes Education Programs: Enroll in a diabetes self-management education program (DSME) to learn more about diabetes management, including how to prevent and treat hypoglycemia.
  • Support Groups: Join a support group for people with diabetes to share experiences, learn from others, and receive emotional support.
  • Healthcare Professionals: Work closely with your healthcare team, including your endocrinologist, certified diabetes educator (CDE), registered dietitian, and primary care physician, to develop a personalized diabetes management plan.
  • Online Resources: Utilize reputable online resources, such as the American Diabetes Association (ADA) and the Juvenile Diabetes Research Foundation (JDRF), for up-to-date information on diabetes management.

Table: Key Resources for Diabetes Management

| Resource | Description | Benefits | | :--------------------------------------- | :----------------------------------------------------------------------------------------------------------------------- | :-------------------------------------------------------------------------------------------------------------------------------------- | | American Diabetes Association (ADA) | Nonprofit organization providing information, advocacy, and support for people with diabetes. | Access to educational materials, support services, and research updates. | | Juvenile Diabetes Research Foundation (JDRF) | Nonprofit organization focused on research for type 1 diabetes. | Funding for research, advocacy for people with type 1 diabetes, and resources for families and individuals affected by the disease. | | Certified Diabetes Educator (CDE) | Healthcare professional specializing in diabetes education and management. | Personalized guidance on diabetes management, including blood glucose monitoring, insulin therapy, and lifestyle modifications. | | Endocrinologist | Physician specializing in endocrine disorders, including diabetes. | Expertise in managing complex diabetes cases, including insulin pump therapy, and addressing related health conditions. | | Registered Dietitian | Healthcare professional specializing in nutrition therapy. | Dietary guidance for managing blood glucose levels, weight management, and overall health. |

By taking advantage of these resources, people with diabetes can gain the knowledge, skills, and support they need to prevent severe hypoglycemia and live healthy, fulfilling lives. Ongoing education and support are crucial for empowering individuals to effectively manage their diabetes and minimize the risk of complications. It enables them to stay informed about the latest advancements in diabetes care, adopt best practices in self-management, and navigate the challenges that come with living with the condition. This comprehensive approach to diabetes education and support fosters better health outcomes and promotes a higher quality of life.

By Dana M. Harris, M.D.