Insulin is a hormone produced by the pancreas, central to how the body uses glucose for energy. It acts as a key, allowing glucose from the bloodstream to enter cells where it is converted or stored. For individuals with diabetes, where the body either does not produce enough insulin or cannot effectively use it, synthetic insulin is a necessary medication to regulate blood sugar. Precise insulin dosing is important for managing blood glucose, as imbalances can lead to complications.
Understanding Hypoglycemia
Taking too much insulin can lead to hypoglycemia, or low blood sugar. This occurs when administered insulin drives excessive glucose out of the bloodstream and into cells, leaving insufficient glucose for the body’s vital functions, particularly the brain. For most individuals with diabetes, hypoglycemia is defined as a blood sugar level below 70 milligrams per deciliter (mg/dL). Symptoms can manifest quickly and vary.
Mild to moderate hypoglycemia often presents with noticeable signs. These include shakiness, sweating, chills, and extreme hunger. Individuals might also experience a faster heart rate, dizziness, confusion, irritability, or anxiety. Other symptoms can involve pallor, tingling or numbness in the lips, tongue, or cheeks, and difficulty concentrating. These early indicators serve as important warnings.
When blood sugar levels continue to fall, severe hypoglycemia can develop, posing a serious risk. Symptoms include blurred or double vision, slurred speech, clumsiness, disorientation, inability to eat or drink, muscle weakness, and drowsiness. In severe cases, seizures or loss of consciousness can occur. If left untreated, severe hypoglycemia can lead to brain damage or death. Some individuals, particularly those with long-term diabetes, may experience hypoglycemia unawareness, where they do not feel typical warning symptoms until their blood sugar is dangerously low.
Immediate Actions for Too Much Insulin
If someone experiences symptoms of mild to moderate hypoglycemia, prompt action is necessary. The American Diabetes Association recommends the “rule of 15.” This involves consuming 15 grams of fast-acting carbohydrates, such as four glucose tablets, half a cup of fruit juice or regular soda, or one tablespoon of sugar, honey, or corn syrup. After consuming carbohydrates, wait 15 minutes and then recheck blood sugar.
If blood sugar remains below 70 mg/dL after 15 minutes, repeat consuming another 15 grams of fast-acting carbohydrates and waiting another 15 minutes. This cycle continues until blood sugar returns to a safe range. Once blood sugar is stable, and if the next meal is not soon, a snack with carbohydrates and protein, like cheese crackers, can help maintain blood sugar and prevent another drop. Avoid over-treating, as consuming too many carbohydrates too quickly can lead to high blood sugar.
For severe hypoglycemia, where an individual is disoriented, unconscious, or unable to swallow safely, emergency measures are required. Food or drink should not be given due to choking risk. Instead, a glucagon injection should be administered if available and prescribed. Glucagon is a hormone that quickly raises blood glucose by signaling the liver to release its stored glucose.
Glucagon can be given as an injection into the outer mid-thigh or arm muscle, or as a nasal powder. After administering glucagon, the person should be turned onto their side to prevent choking if vomiting occurs. Emergency services should be called immediately if glucagon is not available, if the person does not recover within 10 minutes, or if there is any doubt about how to proceed.
Preventing Insulin Overdose
Preventing insulin overdose involves careful management and consistent practices. Accurately measuring insulin doses is paramount; individuals should double-check their dose before injection and use proper technique. Errors can occur from misreading syringes or vials, or from confusing different types of insulin. Storing insulin correctly and checking expiration dates also contribute to safe use.
Matching insulin doses to carbohydrate intake and meal timing is another preventative measure. Rapid-acting and short-acting insulins are typically taken just before or with meals, as they cover the rise in blood sugar that follows eating. Skipping meals after taking these insulins can lead to a dangerous drop in blood sugar. Understanding the different types of insulin—rapid, short, intermediate, and long-acting—and their respective onset, peak, and duration of action is important to avoid accidental stacking or misdosing.
Regular blood glucose monitoring is fundamental for preventing insulin overdose. Frequent checks allow individuals to make informed decisions about their insulin doses and identify trends that indicate adjustment. Monitoring helps in understanding how food, physical activity, and medication affect blood sugar. Working closely with a healthcare provider or diabetes educator is crucial for establishing and adjusting insulin regimens. They can provide personalized guidance, address concerns, and help optimize the treatment plan to minimize hypoglycemia risk.