What to do for a type 2 diabetic experiencing severe hypoglycemia after blood glucose levels dropped significantly?

Emergency Management of Severe Hypoglycemia in Type 2 Diabetes

For a blood glucose of 46 mg/dL in a type 2 diabetic patient, immediate treatment with 15-20g of fast-acting carbohydrates is required, followed by reassessment in 15 minutes and administration of additional glucose if levels remain below 70 mg/dL. 1, 2

Immediate Management Algorithm

1. Assess consciousness and ability to swallow safely:

   • If conscious and able to swallow: Administer 15-20g of fast-acting glucose orally
   • If unconscious or unable to swallow: Administer glucagon 0.5-1.0mg IM/SC or 20-40mL of 50% glucose solution IV 1, 2

2. Recheck blood glucose after 15 minutes:

   • If still <70 mg/dL: Repeat glucose administration
   • If ≥70 mg/dL but <3.9 mmol/L: Provide a substantial meal or snack containing complex carbohydrates and protein 1

3. For severe persistent hypoglycemia (still <54 mg/dL after initial treatment):

   • Administer 60mL of 50% glucose solution IV if available 1
   • Consider hospital admission if hypoglycemia is recurrent or severe 2

Recommended Sources of Fast-Acting Carbohydrates

• Preferred option: Pure glucose (glucose tablets) 1
• Alternative options:
  • Fruit juice (4 oz)
  • Regular (non-diet) soda (4 oz)
  • Honey (1 tablespoon)
  • Sugar cubes (3-4)
  • Hard candy 2, 3

Important: Protein-rich carbohydrate sources should NOT be used for treating hypoglycemia as they may increase insulin response without raising blood glucose adequately 1

Post-Emergency Management

After stabilizing blood glucose levels:

1. Identify the cause of hypoglycemia:

   • Excessive insulin dose
   • Missed or delayed meals
   • Increased physical activity
   • Alcohol consumption
   • Medication interactions 3

2. Adjust diabetes management:

   • Consider reducing insulin doses, particularly basal insulin if overnight hypoglycemia occurred (10-20% reduction) 2
   • Simplify insulin regimen if recurrent hypoglycemia occurs 2
   • Review timing of insulin administration relative to meals 2

3. Provide patient education:

   • Recognition of hypoglycemia symptoms
   • Proper use of glucose monitoring
   • Carrying emergency glucose sources at all times
   • Importance of medical alert identification 2

Special Considerations

• Elderly patients are at higher risk for severe hypoglycemia and may have reduced ability to recognize symptoms 2
• Patients with recurrent hypoglycemia may develop hypoglycemia unawareness, making recognition of early warning signs difficult 3
• Patients on beta-blockers may have blunted symptoms of hypoglycemia 3
• Patients with renal or hepatic impairment may have altered glucose metabolism, increasing hypoglycemia risk 2

Follow-up Recommendations

• Schedule follow-up within 1-2 weeks to assess effectiveness of interventions 2
• Review blood glucose logs with particular attention to overnight readings 2
• Consider referral to diabetes education program for comprehensive management strategies 2
• For patients with frequent episodes of hypoglycemia, consider relaxing glycemic targets (A1C <8.0% rather than stricter goals) 2