Hypoglycaemia first aid

Overview

Hypoglycaemia (said: hy-po-gly-SEE-mee-uh) is when your blood sugar level drops too low. Blood sugar, also called glucose, is the main source of energy for your body. When it falls too low, your body and brain do not get the energy they need. First aid for hypoglycaemia means giving fast-acting sugar immediately to raise blood sugar to a safe level.

Yes, hypoglycaemia is a common side effect of diabetes treatment. Many people with diabetes experience mild episodes from time to time.

It mainly affects people with diabetes, especially those who use insulin or certain oral medications. However, it can also occur in people without diabetes, though this is much rarer.

Symptoms

Common symptoms

• Shakiness or trembling
• Sweating
• Feeling hungry
• Fast heartbeat
• Dizziness or light-headedness
• Headache
• Irritability or feeling anxious
• Pale skin

Symptoms in children

• Crankiness or crying more than usual
• Tiredness or weakness
• Clumsiness or unsteady walking
• Complaints of feeling funny or dizzy
• Nightmares or crying out during sleep

Symptoms in older adults

• Confusion or trouble concentrating
• Slurred speech that looks like a stroke
• Dizziness or falls
• Blurred vision
• Weakness or feeling faint
• Behaviour changes, such as becoming withdrawn or agitated

Causes

Main causes

• Taking too much insulin or diabetes medication
• Skipping or delaying meals
• Eating less than usual without adjusting medication
• Unplanned or excessive physical activity
• Drinking alcohol, especially on an empty stomach

Risk factors

• Type 1 diabetes
• Type 2 diabetes treated with insulin or certain tablets (sulphonylureas or glinides)
• Irregular meal patterns or fasting
• Kidney or liver disease
• Older age (higher risk for severe episodes)

When to see a doctor

See a doctor urgently if:

• If you have diabetes and experience a severe hypoglycaemia episode that requires emergency help
• If you have repeated hypoglycaemia episodes despite following your usual treatment plan
• If you lose consciousness or have a seizure from low blood sugar

Book a routine appointment if:

• If you have mild hypoglycaemia episodes more than once a week
• If you are unsure about your medication dose or when to take it
• If you have symptoms of hypoglycaemia but do not have diabetes

Diagnosis

Hypoglycaemia is diagnosed by checking your blood sugar level with a glucose meter (a small device that reads a drop of blood from your finger). A reading below 70 mg/dL (3.9 mmol/L) is generally considered low. In a first aid situation, you often treat based on symptoms if a meter is not available.

Tests that may be done

• Finger-prick blood glucose test (the most common way to confirm low blood sugar)
• Continuous glucose monitoring (CGM) – a sensor under the skin that tracks glucose levels day and night
• Blood tests in a hospital to check for other causes if hypoglycaemia happens without diabetes

What to expect at your appointment

If you have symptoms and are able, you will test your blood sugar with a meter. If it is low (below 70 mg/dL or 3.9 mmol/L), you should eat or drink fast-acting sugar right away. After 15 minutes, test again to make sure the level has risen. Your healthcare provider may review your diabetes management to help prevent future episodes.

Treatment

Treatment for hypoglycaemia is immediate. The goal is to raise blood sugar quickly with fast-acting carbohydrates. If the person is conscious and able to swallow, give them something sugary by mouth. If they are unconscious or having a seizure, do not give anything by mouth – call emergency services immediately.

Self-care at home

• Follow the '15-15 rule': eat or drink 15 grams of fast-acting sugar (for example, 3 to 4 glucose tablets, half a cup of fruit juice or regular soda, a tablespoon of sugar or honey) and wait 15 minutes.
• Recheck blood sugar after 15 minutes. If still low, repeat with another 15 grams of sugar.
• Once blood sugar returns to normal, eat a longer-lasting snack that includes protein or starch, such as a sandwich, crackers with cheese, or milk, to prevent another drop.
• Always carry fast-acting sugar with you – glucose tablets, sweets, or juice boxes.
• Teach family, friends, and coworkers how to help if you have a severe episode.

Medical treatments

If a person is unconscious or cannot swallow, emergency medical help is needed. Healthcare providers may give a medication that raises blood sugar quickly, usually injected into a muscle or given through a vein. These treatments are only used in emergency situations and are not available without a prescription. Your doctor can teach a family member how to use an emergency glucagon kit if you are at risk for severe hypoglycaemia. After an emergency, you will be monitored and may need further treatment to keep blood sugar stable.

When is surgery considered?

Surgery is not a treatment for hypoglycaemia. In very rare cases where hypoglycaemia is caused by a tumour in the pancreas (insulinoma), surgery may be considered to remove the tumour. This is decided on a case-by-case basis.

Living with this condition

Living with diabetes means being prepared for possible hypoglycaemia. Always carry a source of fast-acting sugar and your glucose meter. Wear a medical ID bracelet or carry a card that says you have diabetes. Check your blood sugar before driving, exercising, or going to bed. Let people close to you know how they can help.

Lifestyle tips

• Eat regular meals and snacks – do not skip meals.
• If you drink alcohol, eat food at the same time and limit how much you drink.
• Adjust your insulin or medication dose before exercise, with guidance from your doctor.
• Get enough sleep – tiredness can make it harder to recognise symptoms.

Diet and exercise

Eat balanced meals that include carbohydrates, protein, and healthy fats. If you exercise, check your blood sugar before and after, and have a snack if needed. Your healthcare team can help you create a meal plan and exercise routine that fits your treatment.

Mental health and emotional wellbeing

Fear of hypoglycaemia can cause anxiety and make you avoid activities you enjoy. It is normal to feel worried. Talk to your doctor or a diabetes educator about how to manage these feelings. Support from family, friends, or a support group can also help.

Prevention

Hypoglycaemia cannot always be prevented, but the risk can be greatly reduced. Knowing your warning signs, checking your blood sugar regularly, and sticking to your meal and medication schedule all help. Work with your doctor to fine-tune your treatment.

Screening programmes

If you have diabetes, your doctor will check your blood sugar control regularly (A1c test) and review your blood glucose logs. If you have episodes of hypoglycaemia, tell your doctor so they can adjust your treatment.

Complications

If left untreated

• Severe confusion or inability to think clearly
• Loss of consciousness (coma)
• Seizures
• Falls or accidents, including car crashes
• Heart rhythm problems (rare)
• Long-term brain damage (very rare, usually only with prolonged severe low blood sugar)

Long-term outlook

Hypoglycaemia is a normal part of life for many people with diabetes. With good education, a personalised treatment plan, and support from your healthcare team, most episodes can be managed quickly and safely. Severe episodes are serious but can often be prevented with careful monitoring and preparation.

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