How Should I Be Treated If I Develop Severe Hypoglycemia?

— -- Question: How should I be treated if I develop severe hypoglycemia?

Answer: Well let's first define severe hypoglycemia. As a medical community, we define severe hypoglycemia as requiring the treatment from another person. Maybe it's a schoolteacher for a child, maybe it's a spouse, maybe it's a sibling, maybe it's a roommate. So severe hypoglycemia has nothing to do with what the blood sugar level is, it has to do with: Can the patient treat himself or herself without assistance?

Normally when hypoglycemic symptoms occur or the blood sugar is found to be low simply from doing a test, we ask the patient to treat it with simple carbohydrate. We use something called the 15-15 rule here at the University of Washington, where we treat the hypoglycemia with 15 grams of quick-acting carbohydrate. And we ask the patient to check the blood sugar 15 minutes later. If after 15 minutes, after 15 grams of carbohydrate, the glucose has not started on its way up we will treat with another 15 grams of carbohydrate and repeat the process.

Now somebody with severe hypoglycemia, it's a whole different ballgame. Because this is where family members, co-workers, or schoolteachers need to be involved. And what we generally do is we (teach) these individuals how to use a medication called glucagon. Glucagon can be given as an injection just like insulin. But glucagon raises the blood sugar in somebody who is unresponsive. Occasionally, patients can take in oral carbohydrate with assistance from a family member, but often glucagon is required, and it is due to this that we ask patients to come in and have their family members learn about gluacogn. As a rule of thumb, however, we only teach glucagon routinely in type 1 diabetes, although we occasionally do do it also for patients with type 2 diabetes.

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