Hypoglycemia, or low blood sugar, occurs when the body’s primary energy source, glucose, drops below a healthy threshold. For most people managing diabetes, a blood glucose level below 70 mg/dL (3.9 mmol/L) signals the need for immediate action. The situation becomes dangerous because the brain relies on a constant supply of glucose for proper function. While insulin lowers high blood sugar, administering it during hypoglycemia is dangerous and can lead to life-threatening complications. The immediate response must focus entirely on quickly raising the blood glucose level to restore safety.
Recognizing the Signs of Low Blood Sugar
A drop in blood sugar triggers both immediate physical responses and cognitive changes that serve as warning signs. Initial, milder symptoms often include a feeling of shakiness or tremors and excessive sweating, which are part of the body’s adrenaline-driven counter-regulatory response. These physical signals may also be accompanied by a fast or irregular heartbeat, anxiety, or a sudden, intense feeling of hunger.
As blood glucose continues to fall, the brain suffers from a lack of fuel, leading to neuroglycopenic symptoms. This manifests as difficulty concentrating, confusion, slurred speech, or dizziness. If the condition is not corrected, it can progress to severe hypoglycemia, involving seizures, inability to safely swallow, or complete loss of consciousness. Recognizing these symptoms quickly is the first step in determining the appropriate treatment response.
Immediate Intervention for Conscious Individuals
When a person is conscious, alert, and capable of safely swallowing, the standard protocol for mild to moderate hypoglycemia is known as the 15-15 Rule. This simple guideline is designed to provide a rapid source of glucose without over-treating the low blood sugar. The first step involves consuming 15 grams of a fast-acting carbohydrate to raise the blood glucose level quickly.
Fast-acting carbohydrates are those that contain simple sugars and minimal amounts of fat or protein, which would slow the absorption of glucose into the bloodstream. Specific examples of a 15-gram serving include four ounces (half a cup) of fruit juice, four glucose tablets, or a tablespoon of honey. Avoid foods like chocolate or ice cream, as their high fat content delays the necessary rapid rise in blood sugar.
After consuming the carbohydrate, the individual should wait 15 minutes before checking their blood glucose level again. If the reading is still below 70 mg/dL, the process must be repeated by consuming another 15 grams of a fast-acting carbohydrate. This cycle continues until the blood sugar has risen above the target threshold.
Emergency Protocols for Severe Hypoglycemia
Severe hypoglycemia is characterized by an altered mental state, inability to follow commands, or unconsciousness. In this situation, attempting to give the person food or drink by mouth is dangerous because they could choke or aspirate the fluid into their lungs. The immediate treatment for this scenario is the administration of emergency glucagon.
Glucagon is a hormone that works in opposition to insulin, instructing the liver to release its stored glucose (glycogen) into the bloodstream to rapidly increase blood sugar. It is available as an injectable solution or a ready-to-use nasal powder, and caregivers should be trained on its use. Glucagon should be administered immediately, either as an injection into the thigh or arm, or via the nasal route, following product instructions.
After administering Glucagon, the person should be gently rolled onto their side into the recovery position, as nausea and vomiting may occur. If the person remains unresponsive within 15 minutes, or if the emergency kit is unavailable, call emergency medical services immediately. Medical professionals will need to monitor the person to ensure their blood sugar stabilizes and remains safe.
Follow-Up Care and Understanding the Cause
Once the blood glucose level has stabilized above the safe range, consume a small meal or snack that contains both protein and long-acting carbohydrates. This step replenishes depleted glucose stores and prevents the blood sugar from dropping again shortly after recovery. A good example is a piece of toast with peanut butter or crackers with cheese.
Following the event, documenting the incident is important for preventing future episodes. The record should include the time of the low, the blood glucose reading, the treatment administered, and any suspected causes. Low blood sugar often results from taking too much insulin for a given meal, miscalculating insulin timing, or engaging in unplanned physical activity. Reviewing these details with a healthcare provider allows for necessary adjustments to medication or meal planning.