How to deal with emergency low blood sugars
Emergency low blood sugar is defined as a level less than 54mg/dl. When that occurs, immediate action is required. Glucagon should be used when blood sugar is so low that the person cannot take oral carbohydrates. We believe that all patients taking insulin and older patients taking sulfonylureas* should have access to Glucagon.
Glucagon is a hormone used to treat severe hypoglycemia (low blood sugar) in emergency situations. It works by increasing blood glucose levels.
- Glucagon Emergency Kit: This is a commonly used and widely available glucagon product. It usually comes as a powder in a vial, accompanied by a syringe containing sterile water. In case of an
emergency, the water is mixed with the powder to create an injectable solution that can be administered subcutaneously (under the skin) or intramuscularly (into the muscle). - Glucagon Nasal Powder: This is an alternative to injectable
glucagon. It comes in the form of a nasal powder that is inhaled through the nostril. The powder is absorbed through the nasal mucosa and helps to raise blood sugar levels. This option may be useful for individuals who find it difficult to administer injections or for caregivers without medical training. - Glucagon HypoPen: This is a newer formulation of glucagon that
comes pre-loaded in a single-use autoinjector device. The HypoPen is designed to be simple to use and may be more convenient for people in emergency situations. The device is activated by removing a safety cap and pressing it against the person’s skin. The injection is delivered automatically.
* Common sulfonylurea products: Glimepiride, glipizide. Glyburide, tolbutamide
How to deal with non emergency low blood sugars
THE PROBLEM. Blood sugar low, drink a Pepsi, have a candy bar or apple pie. It works but sugar goes high, take more insulin then you are low again. What to do?
Prevention: check with your diabetes medical treatment team about medication changes if getting low often. You can’t get control if going low a lot.
If sugar less than 55mg/dl you’re in trouble, maybe shaking, 
sweating and not thinking straight, GET CARBS from anywhere you can, even candy, but a Pepsi is faster. GET HELP! If driving, get off the road, if no CARBS with you, call 911, you do not have time to find a store to buy something. If you drive and this happens to you often, tell me where you drive so I can stay away from that road. We believe that anyone taking insulin should carry carbohydrates at all times.
If feeling low and or blood sugar less than 100 mg/dl but above 55, use the 15, 15, 15 rule. This avoids getting on the ups and downs.
- Check sugar (use fingersticks, Libre, Dexcom or any CGM won’t work for this).
If sugar less than 100, take 15gm CARBS, about 3 glucose tablets.
- Check sugar in 15 min.
- If sugar less than 120, take another 15gm CARBS (3 tablets).
- Check sugar in 15 min.
- If sugar less than 120, take another 15gm CARBS (3 tablets).
Repeat this every 15 minutes until sugar is above 120mg/dl.
Continue to check sugar every 15 minutes until you are sure it’s not going down again (at least 3 times after reaching 120mg/dl).
A blood sugar less than 70 makes some people feel so bad that they eat until feeling better. A satisfying feeling may not come until sugar is well over 200. Symptoms of low blood sugar may not go away for some time after the sugar is normal or elevated. Check and trust your fingerstick measurements (not CGM like Libre, Dexcom or Guardian). Symptoms of low blood sugar may occur even though the sugar is normal. We see this often when the average blood sugar has been well over 200. If this is the case, the A1c is likely over 8%. A rapid drop in blood sugar from 250 to 110 may produce symptoms. The body appears to adapt to what it is accustomed to. If sugar has been elevated and is rapidly corrected, the body thinks something is wrong, pours out hormones to increase blood sugar causing symptoms of sweating, shaking, etc.
Don’t like the chalky taste to glucose tablets?
Try firing a shot of this glucose liquid (16gm carb) for your mild low sugar. This one from Walmart.
PROs
Fast acting.
Liquid
Won’t crumble.
Good taste
CONs
Bulky (4 ½ in, 11.43 cm tall)
Will likely need several bottles in a low sugar event.
Left in car, may freeze in cold climate.
