What do I do if someone with diabetes has a hypo?
The signs of low blood sugar, the fast sugar that fixes it, the ten to fifteen minute recheck, the longer-acting carbohydrate that stops it coming straight back, and when it becomes a 999 call.
- Difficulty
- beginner
- Time
- 7 min
- Read
- 4 min
- Safety
- warning
Short answer
Signs: hunger, dizziness, anxiety or irritability, sweating, shaking, tingling lips, palpitations, tiredness or weakness, blurred vision, confusion. Give fast sugar — a small glass of fruit juice or sugary fizzy drink, 5 glucose tablets, 4 large jelly babies or 2 tubes of glucose gel. Recheck after 10 to 15 minutes. Then give longer-lasting carbohydrate: biscuits, a sandwich, or their next meal.
A hypo is one of the few emergencies with a genuinely simple fix, and the two things people get wrong are giving the wrong sort of sugar and stopping once the person perks up. It is also frequently mistaken for drunkenness, which is worth knowing before you find yourself watching someone behave oddly in the street.
Safety
Step by step
- Recognise it.NHS symptoms include feeling hungry, dizzy, anxious or irritable, sweating, shaking, tingling lips, heart palpitations, tiredness or weakness, blurred vision and confusion. It can come on quickly and the person may not recognise it themselves.
- Give fast-acting sugar.NHS advice is a small glass of fruit juice or sugary fizzy drink, five glucose or dextrose tablets, four large jelly babies, or two tubes of glucose gel. Something that gets sugar into the blood quickly, not something fatty like chocolate, which slows absorption.
- Wait and recheck after 10 to 15 minutes.If they have a glucose meter, check the blood sugar again. If not, judge by how they are. If they are not improving, repeat the fast sugar.
- Then give longer-lasting carbohydrate.Once they are better: biscuits, a sandwich, or their next meal if it is due. Without this the blood sugar drops again shortly afterwards, which is the commonest reason a hypo recurs an hour later.
- Do not give anything by mouth to someone who is not fully alert.Drowsy, very confused, or unresponsive means nothing to eat or drink at all — the choking risk is real and it is why this is the first rule rather than the last.
- Know when it becomes 999.Unresponsive with no glucagon available or nobody able to use it. No recovery within 10 minutes of a glucagon injection. Or they have been drinking alcohol, which changes how the body responds and makes a hypo more dangerous.
- Use the recovery position if they are unresponsive and breathing.Then ring 999. If they are not breathing normally, start CPR. A hypo severe enough to cause unconsciousness is an emergency regardless of the cause.
- Talk about it afterwards.A hypo severe enough to need help from someone else is worth reporting to their diabetes team, because it usually means something in the treatment or the routine needs adjusting. There are also DVLA rules about severe hypos and driving.
Tips
- Someone having a hypo can be irritable, uncooperative or aggressive, and that is the illness rather than the person. Stay calm and keep offering the sugar.
- A hypo is very commonly mistaken for drunkenness — slurred speech, unsteadiness, confusion. Many people with diabetes carry a card or wear a medical ID for exactly this reason, and it is worth looking for one.
- If someone with diabetes says they are having a hypo, believe them and act. They know the feeling better than you do.
Common mistakes
- Giving chocolate as the fast sugar — The fat in it slows sugar absorption. It is fine as the longer-lasting follow-up but it is the wrong thing for the first ten minutes.
- Stopping once they feel better — Fast sugar wears off quickly. Without a longer-acting carbohydrate afterwards, the hypo usually returns.
- Giving a diet or sugar-free drink — It contains no sugar. This happens surprisingly often, because the diet version is the one many people with diabetes have in the fridge.
- Putting sugar or gel in the mouth of an unconscious person — They cannot swallow safely and it can be inhaled. Unconscious means recovery position and 999, not anything by mouth.
If it doesn't work
They are refusing to take anything
Cause: Confusion caused by the hypo itself — Fix: Keep calm and keep offering. If they cannot or will not take it and are deteriorating, ring 999 and describe it as a suspected hypo.
They recover, then go hypo again an hour later
Cause: No longer-acting carbohydrate was given after the fast sugar — Fix: Treat it again and this time follow with a sandwich or biscuits. Mention the repeat to their diabetes team.
Someone with diabetes is unwell with very high blood sugar, thirst, and breath that smells sweet or of pear drops
Cause: Possible diabetic ketoacidosis, which is the opposite problem and is a serious emergency — Fix: Ring 999. High blood sugar with vomiting, deep rapid breathing, drowsiness or sweet-smelling breath is an emergency in its own right.
Questions people ask
What is glucagon?
An injection or nasal spray that raises blood sugar, prescribed to some people at risk of severe hypos and given by someone trained for that person. If it is not available, or you have not been shown how to use it, ring 999.
Can someone without diabetes have a hypo?
It is uncommon but possible. The treatment is the same, and someone who has an unexplained episode of low blood sugar should be assessed.
How do I know it is a hypo and not something else?
You often cannot be sure. If someone with diabetes is behaving oddly, giving sugar is the safe first move: it fixes a hypo and does very little harm if the blood sugar was high. If they do not improve, ring 999.
Does this apply to a child?
The principles are the same, with smaller quantities appropriate to their size and usually a plan already agreed with their diabetes team. Follow that plan if there is one.