The following resource provides helpful information on hypoglycemia and detailed information about it’s causes; including symptoms of hypos, how to treat mild/moderate hypos, how to treat severe hypos, how to use the glucagon kit both for a person with diabetes and their relatives as well as health care professionals (including diabetes nurses, diabetes educators, general practitioners, diabetologists, endocrinologists and other specialists with an interest in diabetes).

What is a hypoglycemia?

A hypo is a short term for hypoglycemia which means low blood glucose. It can cause a wide spectrum of unpleasant symptoms, and if severe enough can lead to unconsciousness, coma or death.

There is also serious concern that severe hypoglycemia can cause neurological damage in young children and central nervous disorders in adults. Repeated episodes lead to progressive loss of sensitivity to the warning signs of hypos as well, putting some people at greater risk.

Today’s treatment for diabetes depends a great deal on self-management involving two major tasks.

  • The first is to maintain a blood glucose level ideal for your condition. Talk with your doctor or nurse to discuss what this should be.
  • The second is to be alert for early signs of problems caused by diabetes.

The two are closely linked. If blood glucose levels are kept at too high a level it can cause long term complications. But if blood glucose levels are too low, it can lead hypoglycemia.

People who use insulin or other blood sugar lowering agents need to monitor their blood glucose levels to make sure it does not fall below 4mmol/l. Below that level, one is at risk of having a hypo.

What causes a hypoglycemia?

Hypos in people with diabetes can be caused by taking too much medication, missed or poorly timed meals, too little food, more exercise than usual, hot weather, too much alcohol, emotional stress or any combination of these factors.

Today’s intensified insulin treatment regimes, which help reduce the risk of long-term complications, are also linked to an increase in the frequency of severe and mild hypoglycemic events.

If you feel the symptoms of a hypo coming on, ask yourself if you have missed a meal or perhaps taken an extra injection of insulin (it happens).

  • Hypos and diabetes medicine
    Incorrect dosages of diabetic medicine can trigger hypoglycemia

  • Hypos and diet
    When people don’t eat enough food or do not eat on time the result can be diminished glucose delivery.

  • Hypos and exercise
    Intensive exercise can trigger a hypo.

  • Hypos and alcohol
    Alcohol lowers glucose production, causing blood glucose to fall dangerously low

  • Hypos and pregnancy or breast feeding
    Pregnancy and breast-feeding can diminish glucose levels.

What are the symptoms?

Hypos feel differently from person to person.
In addition to the symptoms described on this page, early signs of hypoglycemia can be difficulty thinking and concentrating or changes in mood.

Some people do not recognize warning signs until the hypoglycemic episode becomes severe; others never sense them coming on. This condition, called “hypoglycemic unawareness,” should be brought to the attention of your doctor or nurse by you or by someone close to you who may be in a better position to recognize it.

Severe hypoglycemia presents a serious danger. Therefore, people with insulin-dependent diabetes are encouraged to regularly monitor their blood glucose to learn to be sensitive to warning signs such as those described below. A good idea is to keep a diary of your hypos. Record when they happen, and what symptoms you experienced so you become more aware of them.

Symptoms of hypoglycemia may include:

  • Anxiety
  • Blurred Vision
  • Feeling cold
  • Feeling weak
  • Drowsiness
  • Euphoria
  • Headache
  • Heavy breathing
  • Hunger
  • Irritability
  • Nausea
  • Nervousness
  • Pounding heart
  • Restless sleep
  • Sweating
  • Trembling
  • Unconsciousness

Mild & Moderate Hypoglycemia

Mild Hypoglycemia

This is the most common type of hypo. It can be treated by raising your blood glucose levels as quickly as possible. Check your blood glucose level. If it is not below normal, it is probably not a hypo. If you are in doubt, take some glucose.

Moderate Hypoglycemia

If you do not treat a mild hypo, your brain will run out of the glucose “fuel” it needs to function normally. Other people may notice your symptoms, although you may not sense the warning signs yourself.

In addition to the warning signs listed in this booklet, you may also exhibit odd signs of behaviour like being bad tempered or rude.

Make sure your family and friends understand how to recognize the signs and know how to react if it happens. They should immediately give you some juice or sugar in some liquid form—but only if you are conscious. Since some people experiencing hypos resist help, tell them they should insist on helping no matter how moody or resistant you may seem at the time. It’s just the hypo “talking”.

Severe hypoglycemia

Severe hypoglycemia requires the help of others to reverse it.

You may not notice the warning signs, and it may come on rather suddenly.

If you have a severe low blood glucose reaction and can’t treat yourself, someone needs to give you an injection of glucagon. So you need to make sure your family and friends are prepared and know what to do.

An injection will be necessary if they can’t give you a quick source of sugar. If you are unconscious, they must not attempt to give you anything by mouth because of the risk of choking.

How to use a glucagon kit

The following instructions are how to administer glucagon during an emergency:

  • Insert the needle through the rubber seal disk on the Glucagon bottle. Inject all the liquid in the syringe into the bottle. The rubber seal can be stiff, but the needle is strong enough to puncture it.
  • Leave the syringe in place and gently shake the bottle until the powder completely dissolved.
  • Make sure the plunger is totally down, then gently pull it out until all the solution is drawn up into the syringe.
  • Inject the needle into the skin, for example in the outer thigh (actually, just about anywhere will do). You can not harm the person by giving this injection.
  • When the patient responds, give them a quick sugar drink like apple juice or cola.
  • For your own health and safety, please share this information with family and friends.

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Post-Hypoglycemia

Treating mild and moderate hypoglycemia

When your blood glucose is too low, it is important to raise it quickly. This can be done with a quick source of sugar like:

  • Apple or orange juice
  • Dextrose tablets
  • Jam, syrup
  • Sugar cubes or honey
  • Candy (although chocolate works slower)
  • Sweet drinks like cola or lemonade—but not diet drinks!

After consuming one of these quick sources of glucose, it is a good idea to eat a slower source of glucose like a biscuit or piece of bread so you get a longer lasting source of sugar.
You should also stop any physical activities at once, and tell someone what is happening!

When you start to feel better have a snack or meal to make sure your blood glucose does not start to fall again.

Call your doctor/nurse or emergency service.

When the patient wakes up, give them something to drink like juice and soft drinks to raise their blood sugar level and to avoid a relapse of severe hypoglycemia.

A few useful tips

  • Manage your diet and insulin to keep your blood glucose in your target range.
  • Monitor your blood glucose frequently.
  • In general it is always a good idea to avoid alcohol.
  • Avoid skipping meals.
  • Always carry along a source of “quick sugar” like dextrose tables or juice.
  • Carry identification saying you have diabetes.
  • Tell friends, relatives, teachers, co-workers and others you trust about diabetes and the risk of hypos as well as what they can do to help.
  • Have a glucagon kit available, and make sure to check the date of expiration at least once a year—for example every New Year.
  • Ask your doctor or nurse educator to train family or close friends on how to give glucagon in cases of medical emergencies.
  • Make sure that people know that giving glucagon is safe: they can not hurt anyone by injecting it.
  • Do not swim or drive long distances alone when your blood glucose may be low like before meals.
  • If you have had a hypo, tell your doctor or nurse.
  • If you can not feel hypo symptoms, please talk to your doctor or nurse about what action you should take. You may also want to ask your spouse if they are aware of you having a hypo you are not aware of yourself. A checklist is provided in the appendix for your convenience.
  • If you do not know why your hypo occurred, talk to your doctor or nurse about adjusting your dose.

Frequently Asked Questions About Glucagon

Q: What is glucagon?

A: Glucagon is a biosynthetic human glucagon produced by Novo Nordisk. It is identical to the natural glucagon produced in the human pancreas.

Q: What is glucagon used for?

A: Glucagon is used to treat severe hypoglycemia (low blood sugar) reactions in non-hospital settings or when medical help is unavailable.

Q: Can patient families/friends and co-workers use the glucagon emergency kit?

A: Yes. The kit contains easy to follow instructions, so even someone without medical training can administer a glucagon injection. However training and practice can help prepare individuals to do it correctly without panicking in a real situation. Your doctor, nurse or diabetes educator will be happy to teach family, friends, teachers or co-workers how to properly administer the glucagon injection.

Q: What should my family/friends/co-workers and I discuss with my doctor/nurse about glucagon?

A: As glucagon kit is used for severe hypoglycemic emergencies in non-hospital settings as a life-saving drug. If you have a diabetic child, teenager, young adult or spouse, you may know that blood sugar can be hard to regulate. The glucagon emergency kit will enable you to administer emergency medical assistance so they can recover quickly from a hypo.

If you have diabetes, and have problems regulating your blood sugar, are under intensive insulin therapy alone or in combination with oral drugs, you should be aware that you are at risk for having frequent hypoglycemic episodes.

If you are a patient with diabetes that has a low sensitivity to hypoglycemic symptoms or has problems feeling them at all, you will want to contact your doctor or nurse for advice. The more often you experience hypoglycemia, the more “unaware” you may become, which will result in more episodes.

For most people with diabetes, it is better to being safe with a glucagon emergency kit than being sorry without one. Ask for training.

Q: What should I discuss with my family, friends, teachers or co-workers?

A: It is important that you are open about your diabetes and the risk for severe hypoglycemic episodes. Although diabetes management has improved dramatically, hypoglycemic episodes still happen. You and your family/close friends should be prepared to deal with them. For your own safety and the reassurance of those around you, please let your family/friends/co-workers know that you are a diabetic and at risk for hypoglycemia. Let them read through this booklet. Ask your doctor or nurse to train them to give you glucagon in case of an emergency.

Q: What dosages of glucagon should be used and is there a risk of over-dosing?

A: Dosage for adults is 1 mg and 0.5mg for children under 25kg. There is no danger of over-dosing.

Q: What is a glucagon emergency kit?

A: The glucagon emergency kit contains everything necessary for giving a lifesaving glucagon injection in the event of a  severe hypoglycemic emergency.

Q: How is glucagon administrated?

A: Glucagon is injected into muscle, fat or in the vein. Injection may be repeated if necessary. It should be used immediately after mixing. Discard any unused product. After use, please have your glucagon emergency kit renewed.

Q: How effective is glucagon?

A: In case of severe hypoglycemia, a glucagon injection quickly raises the blood glucose to restore consciousness within 10-15 minutes. After the person has responded to treatment, give him or her an oral carbohydrate like juice or a soft drink to restore glucose levels and prevent relapse of hypoglycemia.

Q: Does glucagon have any side effects?

A: Severe side effects are very rare, although nausea and vomiting may occur occasionally especially with doses above 1 mg or with rapid injection (less than 1 minute). You may also have rapid heart beat for a short while. If you have any other reactions that you think have been caused by glucagon, please contact your doctor, nurse or local pharmacy.

Q: How should I store glucagon?

A: The storage condition can vary from country to country, so please consult the enclosed leaflet. In most countries it can be stored for 3 years, if kept between 2°C and 8°C. The glucagon kit can be stored at room temperature (up to 25°C) for 18 months provided the expiry date has not exceeded.

Do not freeze. The glucagon vial should be protected from light. Discard any not used product after injection. Do not store for later use.

Q: Can I use glucagon emergency after the expiration date?

A: Never use glucagon after the expiration date printed on the box. As glucagon is only used in severe hypoglycemic emergencies it is very important, that you always keep track on the expiry date, so you will have an updated kit available if the unexpected event of a severe hypoglycemia should arise.