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

Hypoglycemia, or low blood sugar, is a common and potentially dangerous condition for individuals with diabetes, particularly those who take insulin or certain oral medications. Recognizing the symptoms and knowing how to respond quickly and effectively is crucial for managing your health and preventing severe complications. This article provides a comprehensive guide on what to do during a low blood sugar event, ensuring you are well-prepared to handle such situations.

Why Hypoglycemia Matters: Low blood sugar can occur suddenly and can manifest with various symptoms, ranging from mild to severe. Without prompt treatment, it can lead to confusion, seizures, loss of consciousness, and, in rare cases, even be life-threatening. Therefore, understanding the signs and having a clear action plan is essential for anyone at risk.

Understanding the Symptoms of Hypoglycemia

Being able to quickly recognize the signs of low blood sugar is the first and most crucial step in managing a hypoglycemic event. The symptoms can vary from person to person and may change over time, but common indicators include:

• Shakiness: Feeling shaky or trembling is a frequent early sign.
• Sweating: Excessive sweating, even in a cool environment.
• Dizziness or Lightheadedness: A sensation of spinning or feeling faint.
• Hunger: An intense feeling of hunger, even if you recently ate.
• Irritability or Mood Changes: Sudden mood swings, anxiety, or feeling easily agitated.
• Confusion or Difficulty Concentrating: Trouble thinking clearly, focusing, or making decisions.
• Rapid Heartbeat: Feeling like your heart is racing or pounding.
• Blurred Vision: Temporary vision changes, such as seeing double or blurry images.
• Weakness or Fatigue: Feeling unusually tired or weak.
• Headache: A persistent or sudden headache.

It’s important to note that some individuals may experience hypoglycemia unawareness, where they do not feel the typical warning signs. This can be especially dangerous, so regular monitoring of blood sugar levels is essential in these cases.

The 15-15 Rule: Your First Line of Defense

When you suspect you are experiencing low blood sugar, the 15-15 rule is a widely recommended and effective method for quickly raising your blood glucose levels.

What is the 15-15 Rule?

The 15-15 rule involves the following steps:

1. Check Your Blood Sugar: If possible, use a glucose meter to confirm that your blood sugar level is below 70 mg/dL (3.9 mmol/L).

2. Consume 15 Grams of Fast-Acting Carbohydrates: Choose a source of carbohydrates that will quickly raise your blood sugar. Examples include:

   • 4 ounces (120 ml) of regular soda (not diet)
   • 4 ounces (120 ml) of fruit juice
   • 1 tablespoon of honey or syrup
   • 3-4 glucose tablets
   • A tube of glucose gel
   • Wait 15 Minutes: Allow the carbohydrates to be absorbed into your bloodstream and raise your blood sugar levels.
   • Recheck Your Blood Sugar: After 15 minutes, check your blood sugar again. If it is still below 70 mg/dL, repeat the process by consuming another 15 grams of carbohydrates.

   • Follow Up with a Snack or Meal: Once your blood sugar is back within a normal range, eat a snack or meal that contains both carbohydrates and protein to help stabilize your blood sugar and prevent another drop. Good choices include: A Complete Blood Sugar Chart For Adults With And Without Diabetes

     

   • A piece of fruit with a handful of nuts

   • Crackers with cheese
   • A peanut butter sandwich

Table: Examples of 15-Gram Carbohydrate Sources

| Food Item | Serving Size | Carbohydrate Content (grams) | | ------------------------ | --------------- | ---------------------------- | | Glucose Tablets | 3-4 tablets | 15 | | Fruit Juice (Regular) | 4 ounces | 15 | | Regular Soda | 4 ounces | 15 | | Honey | 1 tablespoon | 17 | | Jelly Beans | 8 | 14 | How To Achieve Better Blood Sugar Balance With Simple Food Swaps

What to Do If You Can't Swallow or Are Unconscious

In cases of severe low blood sugar, an individual may be unable to swallow or may lose consciousness. In these situations, the following steps should be taken: Simple Steps To Improve Your Blood Sugar Control Today

1. Administer Glucagon: Glucagon is a hormone that can quickly raise blood sugar levels. It is available as an injectable medication or nasal spray and should be prescribed by a doctor for individuals at risk of severe hypoglycemia. Family members, caregivers, and close contacts should be trained on how to administer glucagon properly.
   • Injectable Glucagon: Follow the instructions provided with the glucagon kit. Typically, it involves mixing the glucagon powder with a liquid and injecting it into the thigh, arm, or buttock.
   • Nasal Glucagon: Follow the instructions provided with the nasal glucagon device. Typically, it involves inserting the device into one nostril and pressing the plunger to deliver the glucagon.
2. Call for Emergency Medical Assistance: After administering glucagon, call emergency services (911 in the United States or your local emergency number) immediately. Provide them with information about the situation, including that the person is unconscious due to hypoglycemia and has been given glucagon.
3. Do Not Attempt to Give Food or Drink: When someone is unconscious or unable to swallow, do not attempt to give them food or drink, as this could cause choking.
4. Monitor Breathing: Check the person's breathing and be prepared to perform rescue breathing or CPR if necessary, until medical help arrives.

Important Note: Glucagon typically takes about 10-15 minutes to work. Once the person regains consciousness and is able to swallow, give them a long-acting source of carbohydrates, such as a snack or meal, to prevent another drop in blood sugar.

Preventing Future Episodes of Hypoglycemia

Preventing low blood sugar episodes is a critical aspect of diabetes management. Several strategies can help minimize the risk:

1. Monitor Blood Sugar Regularly: Frequent blood sugar monitoring provides valuable information about how different factors, such as food, exercise, and medications, affect your glucose levels. This allows you to make informed decisions about your diabetes management plan.
2. Adjust Medication Doses as Needed: Work closely with your healthcare provider to adjust your medication dosages as needed. If you experience frequent episodes of hypoglycemia, your doctor may need to lower your insulin or oral medication doses.
3. Eat Regular Meals and Snacks: Avoid skipping meals or going for long periods without eating. Eating regular meals and snacks helps maintain stable blood sugar levels.
4. Balance Carbohydrate Intake: Pay attention to the amount of carbohydrates you consume at each meal and snack. Work with a registered dietitian to develop a meal plan that provides adequate carbohydrates while avoiding large spikes in blood sugar.
5. Be Mindful of Exercise: Exercise can lower blood sugar levels, so it's important to take precautions before, during, and after physical activity. Check your blood sugar before exercising, and have a carbohydrate-rich snack if it's too low. Carry a source of fast-acting carbohydrates with you during exercise, and check your blood sugar periodically.
6. Limit Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose, which can lead to hypoglycemia, especially if you're taking insulin or certain oral medications. If you choose to drink alcohol, do so in moderation and always eat food with it. Monitor your blood sugar levels closely after drinking alcohol.
7. Educate Family and Friends: Make sure your family members, friends, and close contacts are aware of your diabetes and know how to recognize and treat hypoglycemia. Teach them how to administer glucagon in case of emergency.
8. Wear a Medical Identification: Consider wearing a medical identification bracelet or necklace that indicates you have diabetes and take medication that can cause hypoglycemia. This can help ensure you receive appropriate medical care in case of an emergency.
9. Keep a Hypoglycemia Log: Maintain a log of your hypoglycemia episodes, including the date, time, symptoms, blood sugar level, and treatment. This information can help you and your healthcare provider identify patterns and make adjustments to your diabetes management plan.
10. Continuous Glucose Monitoring (CGM): Consider using a CGM system, which continuously tracks your glucose levels and alerts you when they are too low or too high. CGM can be particularly helpful for individuals with hypoglycemia unawareness or frequent episodes of hypoglycemia.

Key Takeaways for Managing Hypoglycemia

• Recognition is Key: Knowing the symptoms of low blood sugar is the first and most crucial step.
• The 15-15 Rule Works: Use the 15-15 rule to quickly raise your blood sugar levels when you experience symptoms.
• Glucagon is Essential: Keep glucagon on hand and ensure family members know how to administer it in case of severe hypoglycemia.
• Prevention is Possible: Adopt strategies to prevent hypoglycemia, such as regular blood sugar monitoring, balanced carbohydrate intake, and careful medication management.

By being prepared, knowledgeable, and proactive, you can effectively manage low blood sugar events and maintain a healthier, more stable life with diabetes. Always consult with your healthcare provider for personalized advice and treatment plans.

By Dan Echols, M.D.