New simplified treatment for severe hypoglycaemia

Hypoglycemia is defined as blood sugar levels dropping under 4.0 mmol/L which is lower than it should be.

Hypoglycemia can be mild, moderate, or severe based on the person’s blood glucose and condition. Here are the levels:

• Level 1 (mild) hypoglycemia: Blood glucose is less than 70 mg/dL but is 54 mg/dL or higher.
• Level 2 (moderate) hypoglycemia: Blood glucose is less than 54 mg/dL.
• Level 3 (severe) hypoglycemia: A person is unable to function because of mental or physical changes. They need help from another person. In this case, blood glucose is often below 40mg/dL.

Severe hypoglycemia is defined as having low blood glucose levels that requires assistance from another person to treat. It can occur in people with diabetes who take insulin and certain anti-diabetic tablets.

Symptoms of severe hypoglycemia:

Some early signs and symptoms of hypoglycemia may be:

• Sweating or cold, clammy skin
• Shakiness or dizziness
• Headache
• Fast, pounding heart rate

As blood glucose continues to drop, other signs and symptoms may occur, such as:

• Confusion and disorientation
• Intense nightmares whilst asleep
• Problems with vision, such as seeing double or things appearing blurred
• Problems speaking clearly, such as slurring words
• Feelings of being anxious or weak

If blood glucose goes even lower, the person may experience: 

• Convulsions / fitting / seizures
• Loss of consciousness
• Coma

Causes and risk factors:

Severe hypoglycemia in people with diabetes will usually only occur in people on blood sugar-lowering medication such as insulin, sulfonylureas or prandial glucose regulators. Severe hypoglycemia is more common in people with type 1 diabetes since they take multiple injections of insulin daily But, it can also happen in people with type 2 diabetes, especially in those that take insulin. 

Severe hypoglycemia may develop in people taking these medications as a result of:

• A regular meal being missed or delayed if medication has already been taken
• An overdose medication
• Exercise being performed without appropriate reduction in medication
• Alcohol consumption
• Declining kidney function

Preventing severe hypoglycemia:

Following the tips below can be helpful in preventing a severe hypo:

• Don’t get distracted when taking medication and eating a meal
• Eat some carbohydrate, such as bread, if a meal is delayed after taking your medication
• Consider reducing your insulin or eat more carbohydrate for up to 48 hours following exercise
• Don’t drink alcohol following exercise
• Test your blood sugar regularly after exercise
• Test your blood sugar more regularly than normal if you are struggling to recognise when you are experiencing hypo
• Talk to your doctor if you are experiencing frequent episodes of hypoglycemia
• Carry juice, candy, or glucose tablets at all times, in the event that one develops symptoms of hypoglycemia 

Treating a severe hypoglycemia:

• Severe hypoglycemia is classed as a diabetic emergency. 
• Treatment for severe hypoglycemia will depend on how conscious the person is.
• Treatment focuses on raising the person’s blood glucose quickly with a medicine called glucagon via a glucagon injection kit, this is a safe and effective way to raise blood sugar levels of someone suffering from a severe hypo. If you administer glucagon, to someone ensure the person is in the recovery position because glucagon can lead to vomiting. 
• The person usually becomes conscious again in about 5 to 15 minutes after you administer glucagon.
• If you do not have access to glucagon, call for emergency assistance and have a form of sugar (including fruit juice, a sugary drink, glucose tablets or sweets) available in case they recover.
• If someone experiencing hypoglycemia is having a seizure or is unconscious, do not attempt to feed them as this could present a risk of choking.

How to use an emergency glucagon kit?

Most often, an emergency glucagon kit contains a vial of powder (glucagon) and a syringe already filled with saline (salt water). To use the kit, follow these steps:

1. Check the date on the label to make sure the medicine hasn’t expired.
2. Remove the vial of powder and syringe from the kit.
3. Remove the covers from the vial and the needle.
4. Insert the needle into the vial. Push on the plunger to move the saline into the vial. Remove the syringe from the vial.
5. Mix the saline and the powder. Gently swirl or roll the vial until the liquid looks clear.
6. Insert the needle into the vial and draw back all of the liquid into the syringe.
7. Remove the syringe from the vial.
8. Inject the needle into the outer part of the person’s thigh, mid-way between the hip and knee or into the arm muscle.
9. Turn the person onto their side and watch for them to wake up. It may take from 5 to 15 minutes for the glucagon to act.

New treatment for severe hypoglycemia that can be administered without an injection: 

• Currently there are many products on the market for those who need insulin, but until now, people suffering from a severe hypoglycemic episode had to be treated with a glucagon injection that first had to be mixed in a several-step process.

• The U.S. Food and Drug Administration approved Baqsimi nasal powder on 24 Jul 2019, the first glucagon therapy approved for the emergency treatment of severe hypoglycemia that can be administered without an injection.

• Baqsimi is approved to treat severe hypoglycemia in patients with diabetes ages four and older.

• Baqsimi, which is a powder administered into the nose, will come in a single-use dispenser that can be given to someone suffering from a severe hypoglycemic episode. Baqsimi increases blood sugar levels in the body by stimulating the liver to release stored glucose into the bloodstream. It has the opposite effect of insulin, which lowers blood sugar levels.

• The most common adverse reactions associated with Baqsimi are nausea, vomiting, headache, upper respiratory tract irritation, watery eyes, redness of eyes and itchiness. Side effects of Baqsimi are similar to injectable glucagon, with the addition of nasal and eye-related symptoms, such as watery eyes and nasal congestion, because of the way the drug is administered.