Low Blood Sugar? Avoid the Emergency Room
Here’s how to recognize and treat severe hypoglycemia quickly – with emergency glucagon – and avoid a trip to the hospital.
When you have diabetes, life can often feel like a juggling act to keep your glucose levels within your target range. Staying on top of diabetes management is essential, but you may still face unpredictable and sudden swings in glucose levels due to medications, lifestyle (particularly exercise), or illness. After all, there are over 42 factors that can affect blood sugar.
Hypoglycemia (low blood sugar) occurs when glucose values fall below 70 mg/dL. This is typically a result of too much insulin in the body for what you need at that time. You should always treat lows right away, whether your blood sugar is below 70 mg/dL or trending towards that. If your glucose levels drop below 54 mg/dL, you must act immediately to raise your blood sugar. If not treated quickly, severe hypoglycemia can occur, which is very dangerous and can lead to seizures, coma, or even death.
Part of being prepared for a low blood sugar emergency is knowing the signs and what treatment is needed to return to stable glucose levels. Whether you live with diabetes or are a parent or caregiver, here’s how to recognize severe hypoglycemia and what different rescue options are available in the event of an emergency.
What are the signs of dangerously low blood sugar?
Severe hypoglycemia is an extreme case of low blood sugar that occurs when a person’s body can’t supply the brain with enough glucose to function properly. During severe hypoglycemia, you may experience more serious symptoms than you normally feel when you have low blood sugar. Symptoms of hypoglycemia often follow a progression:
- Shakes, sweatiness, and elevated heart rate
- Hunger and weakness
- Not enough sugar for the brain to fully function (called neuroglycopenia)
- Confusion
- Combativeness
- Disorientation
- Seizures
- Loss of consciousness
It’s important to take these signs seriously when they occur. In many cases, the release of hormones such as adrenaline will signal that your glucose levels are trending low – this is what causes initial symptoms. When the body doesn’t release these hormones or respond to the warning signals of hypoglycemia, this is referred to as hypoglycemia unawareness. If you have hypoglycemia unawareness, you may not notice or experience the early symptoms of low blood sugar.
People with diabetes who experience this condition are at increased risk of prolonged low glucose levels and should talk to their healthcare team about changes to their diabetes treatment plan. One helpful strategy is wearing a continuous glucose monitor (CGM), which provides real-time glucose readings and sets off an alarm when glucose levels are too high or low.
How to treat severe lows with emergency glucagon
In severe cases, glucagon can be used to quickly raise blood glucose levels, especially when someone is vomiting, not able to swallow, or is unresponsive. Glucagon is a hormone (a natural chemical made by your body) that prompts the body to release stored sugar into the bloodstream.
Glucagon is used to treat people with diabetes for severe hypoglycemia at home – and to avoid costly and frightening visits to the hospital. In the majority of cases, emergency glucagon is administered by someone else, so it is important that your care-partners, loved ones, friends, colleagues, and school staff know how and when to give you glucagon.
If you are a parent or caregiver for a child with diabetes, talk to a healthcare professional about the correct dose of emergency glucagon for children.
The American Diabetes Association recommends that glucagon should be prescribed to everyone who takes insulin or is at high risk for hypoglycemia. If you do not have a prescription, ask your healthcare provider about glucagon. If you have a prescription, make sure to get it filled, and if you have filled it, make sure your supplies are current. Most emergency glucagon will expire within one to two years.
Every emergency hypoglycemia kit should include current glucagon as well as glucose tablets or sugary snacks, a glucose monitor (either a CGM or blood glucose meter), and emergency contact information. Emergency glucagon can be injected or administered by nasal spray.
The recent development of ready-to-use and premixed glucagon has made it easier to administer rescue glucagon quickly and effectively in emergency situations. These next-generation glucagon options can save care-partners time, particularly if the person with severe hypoglycemia has lost consciousness. Here are the options currently available.
- Baqsimi: This form of glucagon is administered like a nasal spray. It comes in a single-use dispenser that requires just three steps to use: remove the device from the tube, insert the tip of the device into one nostril, and push the plunger all the way down to administer a dose. It does not require inhalation, meaning that it can be successfully administered by another person even if the receiver of the glucagon is unconscious. It is a needle-free glucagon option and works just as well as injectable glucagon.
- Gvoke HypoPen: This is an emergency glucagon autoinjector with no visible needles. It requires two simple steps: remove the cap, and press the pen against the skin (the person’s arm, leg, or wherever is available). Upon contact with the skin, the automatic injector will deliver a rescue dose of glucagon and retract the needle. Gvoke also comes in a pre-filled syringe that is ready for manual injection as an alternative option to the HypoPen.
- Zegalogue: This fast-acting option also comes in a pre-filled syringe or an auto-injector device. It has a similar effect to Baqsimi and Gvoke, resolving severe hypoglycemia much faster than traditional rescue glucagon.
The bottom line
It’s essential to treat lows before or as they happen to prevent severe blood sugar episodes. However, severe hypos still happen, especially if too much insulin is taken, meals are skipped, after intense exercise, or during sleep. The good news is, having emergency glucagon on hand is a quick and easy way to correct even severe lows, and avoid a trip to the emergency room.
Learn more about blood sugar management here: