A diabetic seizure is a severe medical emergency, a physical manifestation of acute neurological dysfunction caused by an extremely low blood glucose level, or severe hypoglycemia. While the event may look like a conventional epileptic seizure, the underlying cause is a rapid lack of essential fuel for the brain, leading to erratic electrical activity. Recognizing and responding immediately to this episode is crucial, as prolonged severe hypoglycemia can result in lasting brain damage or death.
The Metabolic Trigger: Severe Hypoglycemia
The brain is heavily dependent on glucose, the primary energy source for the central nervous system, and has minimal internal reserves. Normally, the body maintains blood glucose levels above 70 milligrams per deciliter (mg/dL). When levels drop, the brain suffers from neuroglycopenia, and the risk of seizure increases significantly when blood glucose falls below 54 mg/dL (severe hypoglycemia).
When the brain is deprived of glucose, its normal electrical signaling processes become chaotic. This energy deficit causes neurons to misfire, leading to the rapid and uncontrolled muscular contractions and altered mental status that define the seizure-like activity. This neurological breakdown signals a profound energy crisis. The event is most common in people with diabetes who use insulin or medications that increase insulin release, often due to accidental overdose, skipped meals, or excessive exercise.
Recognizing the Physical Manifestations
The onset of a diabetic seizure is often preceded by earlier, less severe symptoms of hypoglycemia. Initial signs can include the person appearing unusually confused, irritable, or anxious, sometimes accompanied by slurred speech or difficulty with coordination. Physical symptoms like profuse sweating, paleness, or a rapid heart rate may also be present, as these are the body’s attempts to raise blood sugar.
As blood sugar continues to fall, the acute phase begins, often involving a sudden loss of consciousness. The person may then exhibit convulsions, characterized by uncontrolled jerking movements of the limbs, muscle rigidity, or twitching. These movements may include behaviors like teeth clenching or a temporary loss of bladder control.
The individual may appear to be staring blankly or their eyes may roll back, and they will be unresponsive to verbal commands or physical stimulation. After the seizure activity subsides, the person typically enters a postictal state, where they may be sleepy, confused, or have a headache. The recovery from this state can take time, and the person may have no memory of the event itself.
Immediate Emergency Response Steps
The primary goal during a suspected diabetic seizure is to ensure the person’s safety and restore their blood glucose level. If the person is actively convulsing, protect them from injury by moving objects away and placing something soft beneath their head. Do not attempt to restrain their movements or put anything into their mouth, as this can cause injury or choking.
Once the seizure activity stops, or if the person is unconscious but not actively seizing, immediately turn them onto their side into the recovery position. This position helps prevent choking on saliva or vomit while waiting for medical help. If the person is unconscious or unable to swallow safely, do not administer any food or liquid by mouth, as this creates a risk of aspiration.
For an unconscious person, the most effective immediate treatment is the injection of glucagon, provided a kit is available and the bystander is trained. Glucagon is a hormone that instructs the liver to release stored glucose into the bloodstream, rapidly raising blood sugar. Emergency medical services should be called immediately in all cases of severe hypoglycemia causing unresponsiveness, even if glucagon is administered.
Differentiation and Criteria for Calling 911
A diabetic seizure is caused by severe hypoglycemia, but the symptoms can sometimes be confused with other conditions, including a non-diabetic seizure or a stroke. A key difference is that low blood sugar symptoms generally improve very quickly upon the administration of glucose, which is not the case for a stroke or a conventional seizure. Another diabetic crisis, Diabetic Ketoacidosis (DKA), is caused by high blood sugar and typically has a gradual onset, characterized by deep, rapid breathing and a fruity odor on the breath.
Emergency services must be called immediately if the person is unconscious and cannot be safely given oral sugar, or if they are conscious but unable to swallow with a blood glucose reading below 70 mg/dL. Calling 911 is also required if the seizure lasts longer than five minutes, or if the person has not regained full consciousness or alertness within 10 to 15 minutes after receiving glucagon. Professional help is also necessary if the person is seriously injured during the episode or if this is their first known seizure.