Type I Diabetes is a condition in which the body's pancreas is unable to produce insulin; a hormone responsible for regulating the availability of glucose in the bloodstream. Glucose is the source of energy for the body's cells and organs; vital for survival. In a state of hypoglycemia, there is not a substantial level of glucose, less than 70mg/dL, in the bloodstream for the body to be fueled; potentially becoming a life threatening situation. Early recognition and appropriate response will prevent a crisis.

Hypoglycemic state may be precipitated by excess intake of insulin, insufficient intake of glucose, excessive exercise or a combination of any of the above. It is important to understand that a person with diabetes diagnosis may not always recognize that they are experiencing a hypoglycemic episode. Do not leave a person unattended and notify a supervising adult or an available health professional. There may be an onset of symptoms prior to verifying blood glucose levels; fortunately with the advancement of diabetes management, electronic monitoring and identification of blood glucose levels are easily accessible and quickly identify problems.

In an early state of hypoglycemia one may exhibit any of the following symptoms: shaky, pale, dizzy, sweating, inability to focus, hungry, sleepiness or may demonstrate a change in behavior or mood. As the episode progresses, the person may appear confused, combative, uncoordinated, slurring speech and/or lethargic. Advanced symptoms may include unconsciousness, seizure and coma; a manifestation of impact on brain function.

It is imperative to respond quickly to prevent escalation of hypoglycemic episodes. If the person is conscious, alert and able to safely swallow, a food item high in sugar (fast-acting carbohydrate - a cup of milk, juice, soda) should be ingested. The person may also be carrying fast acting sugar products such as glucose tablets or glucose drinks. Fat and protein will slow glucose uptake in the body and should be avoided at this initial point. If there is no improvement within fifteen minutes the intake should be repeated.

If the situation escalates and the person exhibits advanced symptoms, it is critical to initiate emergency response. Be sure the person is lying down on their side in a safe area protected from injury. Do not attempt to stop a seizure if occurring or place anything in the mouth.

If at school: notify supervising adult, call the nurse (health professional) and dial 911 as instructed. A trained individual should administer glucagon, a hormone that prompts the liver to release sugar into the bloodstream. Again a person with a diabetes diagnosis should always carry emergency supplies and have glucagon. At school, the health center has the student's reserve supplies as well. Glucagon can be administered by a variety of methods; 1 mg via syringe/needle into the muscle, 1mg in an autoinjector under the skin or 3mg intranasally. Each product has specific manufacturer instructions. The risk of NOT giving Glucagon is more life-threatening than giving it under these emergency conditions. Always stay with the person until Emergency Medical Services arrives to attend to the situation.

Common Glucagon Products:

• https://www.lillyglucagon.com/taking-glucagon/how-to-inject
• https://www.gvokeglucagon.com/
• https://www.baqsimi.com/

Resources:

• "Type 1 Diabetes Research Funding and Advocacy." JDRF, 2020, www.jdrf.org/.
• "Learning and Diabetes." CT.gov, 2021, portal.ct.gov/SDE/Publications/Learning-and-Diabetes/Diabetes-Overview#hypoglycemia.