take carbohydrate will raise blood glucose levels too high. So remember, it is important to treat the blood glucose level, not the symptoms.
SIGNS OF MILD OR MODERATE HYPOGLYCEMIA
You may feel one or more of the following:
Another reason why people overtreat hypoglycemia is because they eat whatever is available without counting carbohydrates. Doing this is much easier than making sure you only get 15 grams of carbohydrate, especially if you are scared, but it can lead to high, fluctuating blood sugars and contributes to poor diabetes control. The overwhelming appetite that accompanies hypoglycemia can sometimes be hard to ignore. Having a plan ahead of time can help control the amount of carbohydrate eaten. An easy solution is to always have a few sources of 15 grams of carbohydrate handy, such as glucose gel or tablets.
Severe Hypoglycemia
The treatment of severe hypoglycemia is different from that for mild or moderate lows. Because the severe low indicates that the brain has very little of the glucose it needs for energy, it is critical to treat these incidents much more aggressively. In these situations, treat first, ask questions later.
If the person experiencing severe hypoglycemia is conscious and able to swallow safely, give 30 grams of glucose immediately and then check his or her blood glucose level. Stay with the person, as the situation may change.
SIGNS OF SEVERE HYPOGLYCEMIA
THE RULE OF 15
After confirming that the blood glucose is low via fingerstick:
If someone is unconscious or having a seizure, avoid using oral treatments. This person cannot swallow correctly and may suffocate or choke if food or liquids go into the windpipe.
GLUCAGON
Glucagon is used to treat severe lows. Glucagon is a hormone produced by the pancreas that helps the liver make and release glucose into the bloodstream. When injected, glucagon tells the liver to quickly release its stored glucose into the bloodstream. Glucagon comes in small vials or easy-to-use emergency kits. Make sure your close relatives or anyone else with whom you spend a lot of time (spouse, other family members, friends, coworkers, etc.) understands when and how to give a glucagon injection. Your diabetes team can teach anyone how to give glucagon. Glucagon, like insulin, does expire, so you’ll need to check the expiration dates for glucagon kits in your diabetes supply kits.
Glucagon is injected into the muscles of the thigh or arm. Adults should use the whole vial (1 mg, or 100 units on an insulin syringe). The amount of glucagon used for children is different than that for adults (see GLUCAGON DOSING FOR CHILDREN AND ADOLESCENTS for dosing in infants, toddlers, children, and adolescents). As soon as the glucagon is given, check blood glucose levels, and, if necessary, repeat it in 15 minutes. Be sure to notify your diabetes team of the severe low because changes to your insulin regimen may be required.
If no glucagon is available, call 911 immediately. Glucose gel (or even cake icing) can be used to treat a severe low if glucagon is not available. Squirt the glucose gel or cake icing into the mouth between the cheeks and gums. Carbohydrate is absorbed here, but not as rapidly as desired in an emergency.
Glucagon can also be used in children or adults who have low blood glucose levels and are not able to eat or drink because of vomiting or other reasons. Talk to your diabetes team about using glucagon in these circumstances.
GLUCAGON DOSING FOR CHILDREN AND ADOLESCENTS
The amount of glucagon used for young children and adolescents with diabetes is based on age, as indicated in the chart below, or by weight. Use an insulin syringe to draw up the glucagon and inject it. Talk to your diabetes center for their recommendations on glucagon dosing.
| Age | Amount of glucagon | ||
| 4 years old or younger | 0.1 mg (10 units) | ||
| 5–10 years old | 0.2 mg (20 units) | ||
| 11 years old or older | 0.5 mg (50 units) |
CALLING 911
There are differing schools of thought regarding if and when to call 911. Some recommend only calling 911 if the glucagon does not work, you cannot find it, or you forget how to use it. Others suggest calling 911 immediately. This way there will not be a delay in the paramedics’ arrival if you cannot find the glucagon or if you panic when trying to use it. Talk to your diabetes team about when you should call 911.
PREVENTION OF HYPOGLYCEMIA
Most of the time, with proper