People with type 1 diabetes are very much aware of the harms of hypoglycemia. Hypoglycemia happens when your blood sugar levels drop below 70 milligrams per deciliter (mg/dL) or less. Hypoglycemia can cause many severe complications if left untreated, including loss of consciousness and seizures. In extreme cases, hypoglycemia can also be life-threatening. This is why it is important to recognize the signs of hypoglycemia and know how to treat it. Here are some of the emergency treatments for hypoglycemia that every person with diabetes must be aware of.
Recognizing the Signs and Symptoms of Hypoglycemia
Hypoglycemia is a condition that commonly affects people with type 1 diabetes.(1,2) If you have hypoglycemia, it means that your blood sugar (glucose) levels have gone below normal.(3,4) For most people, having a fasting blood sugar of 70 mg/dL or 3.9 millimoles per liter (mmol/L) is an alert for hypoglycemia. However, the numbers vary for everyone, and it is best to ask your doctor about what your normal blood sugar level should look like. (5) Similarly, the symptoms of hypoglycemia also vary from person to person. The biggest part of managing type 1 diabetes is to learn how to recognize your own signs and symptoms of low blood sugar.(6)
Some of the commonly observed early symptoms of hypoglycemia may include:
- Anxiety or feeling nervous
- Pale skin
- Rapid heartbeat
- Blurry vision
- Tingling, especially around the mouth
- Slurred speech
- If you have severe hypoglycemia, it may cause the following symptoms:
- Loss of consciousness
- Convulsions or seizures
It is important that you immediately use a glucose meter or a continuous glucose monitor to keep checking your blood sugar levels if you think your blood sugar levels have gone down. You will need immediate treatment if your blood sugar levels fall to 70 mg/dL or lower. If you do not have a glucose monitor or meter available, it is best to call your doctor or your local emergency number like 911 to receive treatment as soon as possible.
If you find that home remedies are not helping and there is no improvement in your symptoms, you should contact your doctor or head to the nearest hospital right away.
If you feel you are about to lose consciousness and you don’t have any glucagon available, it is best to alert someone to contact the emergency medical services immediately.
Treating Hypoglycemia with Fast-acting Carbohydrates
The first level of emergency treatment for hypoglycemia is by eating fast-acting carbohydrates. You can either eat or even drink around 15 grams of fast-acting carbohydrates. These include:
- Half a cup of fruit juice or any non-diet soda
- One tablespoon of corn or honey syrup
- One tablespoon of sugar dissolved in water
- Glucose tablets
- Glucose gel
After consuming any of these fast-0acting carbs, check your blood sugar levels again after 15 minutes. If the levels are still too low, drink or eat another 15 grams of fast-acting carbs.(9) You should repeat these steps until you find your blood sugar levels have returned to the normal range. Until your blood sugar becomes normal gain, you should avoid having foods that contain fat, such as chocolate. Many people believe that eating chocolate can help increase their blood sugar as it is sweet. However, foods that contain fat like chocolate can take longer for the body to break down, thus increasing the risk of complications from hypoglycemia.
Once your blood sugar has returned to normal, you should have a snack or meal that contains protein and carbohydrates. This will stabilize your blood sugar levels. A good example often recommended by doctors is to eat some crackers and cheese or half of a peanut butter sandwich.(10)
In cases of children with type 1 diabetes, it is important to ask their doctor about how many grams of carbohydrates they need to be administered for treating hypoglycemia. Factors such as the age and weight of a child determine the amount of carbs they need to be given to treat hypoglycemia. Most children need less than 15 grams of carbs to bring their blood sugar levels back up.
Emergency Treatment for Severe Hypoglycemia
In severe hypoglycemia cases, a person may become too disoriented or confused to eat or drink anything that can help increase their blood sugar. In some cases, a person may also end up losing consciousness or experience seizures.(11,12)
If this happens, you need to be treated with glucagon. Glucagon is a hormone that signals your liver to immediately release the stored glucose, thus increasing your blood sugar levels.(13)
Most doctors recommend that people with type 1 diabetes buy and keep a glucagon emergency kit or nasal powder. It is also essential that you let your family, friends, coworkers, or your child’s teacher know where this emergency kit is kept and how the glucagon has to be administered.
A glucagon emergency kit contains a syringe filled with sterile liquid and a vial of powdered glucagon. In case of emergency, you need to mix the powdered glucagon and the sterile liquid together before using it. This solution can then be injected into the muscle of the thigh, upper arm, or the buttocks.
It is essential to know that the glucagon solution does not remain stable at room temperature. After being exposed to room temperate for some time, it thickens and turns into a gel. Due to this, it is important that you wait to take out the kit until you need to administer the solution before you mix the powder and sterile liquid together to make the solution.
Like any other medication, glucagon can also cause side effects such as vomiting, nausea, or headache.(14)
Another alternative to injectable glucagon is the glucagon nasal powder. The US Food and Drug Administration (FDA) recently approved glucagon nasal powder as an alternative to injectable glucagon for the treatment of severe hypoglycemia.(15) Glucagon nasal powder does not need to be mixed with any solution and is ready to use once taken out of the box. You or anybody else just needs to spray it into one of the nostrils. The nasal spray works even if you are experiencing severe hypoglycemia that leads to loss of consciousness.
What to Avoid When Having An Episode of Hypoglycemia?
If you think you are experiencing an episode of hypoglycemia, it is important to avoid eating foods that contain fat. You should also avoid using insulin or take any other glucose-lowering medications for bringing up your blood sugar. In fact, these medications and insulin will cause your blood sugar levels to go down, even more, putting you at a greater risk of severe hypoglycemia.
Before you go back to taking your usual prescribed medications, it is essential that you get your blood sugar levels within the normal range again.
Remember that hypoglycemia can be fatal if left untreated. Treating hypoglycemia as soon as you spot the early symptoms and being prepared for a potential episode of severe hypoglycemia can help keep you safe and avoid a life-threatening condition.
Eating fast-acting carbohydrates can help increase your blood sugar level rapidly. However, if you find your symptoms have still not gotten better or you start to become disoriented, lose consciousness, or develop seizures, you may require emergency glucagon treatment.
If you have type 1 diabetes, it is a good idea to ask your doctor about glucagon emergency kits and glucagon nasal powder and understand how to use the kit if the need arises.
- Daneman, D., 2006. Type 1 diabetes. The Lancet, 367(9513), pp.847-858.
- Atkinson, M.A., Eisenbarth, G.S. and Michels, A.W., 2014. Type 1 diabetes. The Lancet, 383(9911), pp.69-82.
- McCrimmon, R.J. and Sherwin, R.S., 2010. Hypoglycemia in type 1 diabetes. Diabetes, 59(10), pp.2333-2339.
- Battelino, T., Phillip, M., Bratina, N., Nimri, R., Oskarsson, P. and Bolinder, J., 2011. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes care, 34(4), pp.795-800.
- Diabetes. 2020. Normal Blood Sugar Ranges And Blood Sugar Ranges For Adults And Children With Type 1 Diabetes, Type 2 Diabetes And Blood Sugar Ranges To Determine People With Diabetes.. [online] Available at: <https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html> [Accessed 17 November 2020].
- Diabetes.org. 2020. Hypoglycemia (Low Blood Glucose) | ADA. [online] Available at: <https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hypoglycemia> [Accessed 17 November 2020].
- Cryer, P.E., Fisher, J.N. and Shamoon, H., 1994. Hypoglycemia. Diabetes care, 17(7), pp.734-755.
- Gold, A.E., Macleod, K.M. and Frier, B.M., 1994. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes care, 17(7), pp.697-703.
- Chow, C. and Chow, J. eds., 2011. Hypoglycemia for Dummies. John Wiley & Sons.
- Hermayer, K.L., Cawley, P., Arnold, P., Sutton, A., Crudup, J., Kozlowski, L., Hushion, T.V., Sheakley, M.L., Epps, J.A., Weil, R.P. and Carter, R.E., 2009. Impact of improvement efforts on glycemic control and hypoglycemia at a university medical center. Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine, 4(6), pp.331-339.
- Zoungas, S., Patel, A., Chalmers, J., De Galan, B.E., Li, Q., Billot, L., Woodward, M., Ninomiya, T., Neal, B., MacMahon, S. and Grobbee, D.E., 2010. Severe hypoglycemia and risks of vascular events and death. New England Journal of Medicine, 363(15), pp.1410-1418.
- DCCT Research Group, 1991. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The American journal of medicine, 90(4), pp.450-459.
- Kedia, N., 2011. Treatment of severe diabetic hypoglycemia with glucagon: an underutilized therapeutic approach. Diabetes, metabolic syndrome and obesity: targets and therapy, 4, p.337.
- Scott, R.V. and Bloom, S.R., 2018. Problem or solution: The strange story of glucagon. Peptides, 100, pp.36-41.
- U.S. Food and Drug Administration. 2020. FDA Approves First Treatment For Severe Hypoglycemia That Can Be Administered Without An Injection. [online] Available at: <https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-severe-hypoglycemia-can-be-administered-without-injection> [Accessed 17 November 2020].
- Sherr, J.L., Ruedy, K.J., Foster, N.C., Piché, C.A., Dulude, H., Rickels, M.R., Tamborlane, W.V., Bethin, K.E., DiMeglio, L.A., Fox, L.A. and Wadwa, R.P., 2016. Glucagon nasal powder: a promising alternative to intramuscular glucagon in youth with type 1 diabetes. Diabetes care, 39(4), pp.555-562.