Insulin shock is the common term for severe hypoglycemia, meaning the blood glucose level has fallen dangerously low, typically below 54 mg/dL. This serious complication is primarily associated with diabetes management, especially in individuals using insulin or certain oral medications. Glucose is the main energy source for the brain; when levels drop too steeply, the brain is deprived of the fuel required to function properly. If left untreated, severe hypoglycemia can rapidly progress and lead to life-threatening consequences.
Recognizing the Warning Signs
The body responds to dropping blood sugar by releasing hormones like adrenaline, triggering noticeable early symptoms. These initial, mild signs, often occurring when blood glucose falls below 70 mg/dL, serve as warnings. Symptoms include a fast heartbeat, nervousness, shakiness, trembling, excessive hunger, paleness, sweating, and tingling around the mouth or cheeks. Recognizing these “adrenergic” symptoms indicates the need for immediate action before the condition worsens.
As blood sugar continues to fall, brain function is impaired, leading to neuroglycopenic symptoms. These more severe signs include confusion, difficulty concentrating, slurred speech, and clumsiness, sometimes resembling intoxication. Without intervention, the individual may become disoriented, unable to swallow, or lose consciousness. In the most severe instances, this lack of energy can result in seizures or a coma.
Understanding the Causes
Insulin shock occurs due to an imbalance between glucose-lowering medication, carbohydrate intake, and energy expenditure. The most common trigger is taking too much insulin or certain diabetes medications, such as sulfonylureas, relative to the body’s needs. This excess medication rapidly pushes glucose out of the bloodstream, causing a swift drop in blood sugar.
Delaying or missing a meal after taking insulin or an insulin-stimulating drug is a significant risk factor. If food is not consumed, the medication continues to lower blood sugar without the necessary glucose supply to counteract the effect. Vigorous or prolonged physical activity can also cause a drop, as muscles use glucose quickly and insulin sensitivity increases afterward. Furthermore, consuming alcohol, especially without food, affects the liver’s ability to release stored glucose reserves, increasing the likelihood of hypoglycemia.
Immediate Action and Treatment
The response to low blood sugar depends on the severity of symptoms and the person’s ability to swallow safely. For mild to moderate symptoms where the individual is alert, the standard practice is the “Rule of 15.” This involves consuming 15 grams of a fast-acting carbohydrate source to quickly raise blood glucose.
Suitable 15-gram options include:
- Four ounces of fruit juice.
- Four ounces of regular soda.
- Three to four glucose tablets.
- One tablespoon of honey or sugar.
Foods high in fat, such as chocolate or cookies, should be avoided because the fat content slows sugar absorption, delaying the necessary blood sugar increase. After consuming the carbohydrate, the individual should wait 15 minutes and then recheck their blood glucose level.
If the reading is still below 70 mg/dL, the 15-gram carbohydrate treatment is repeated until the blood sugar returns to a safe range. Once stabilized, a small snack containing protein and a longer-acting carbohydrate, such as fruit and peanut butter, should be eaten to prevent the level from dropping again. This two-step approach ensures both an immediate fix and sustained blood sugar stability.
In cases of severe hypoglycemia, where the person is confused, unable to swallow, or has lost consciousness, immediate intervention by a caregiver is necessary. Never attempt to give food or liquid to an unconscious person, as this poses a serious risk of choking. Treatment requires the administration of emergency glucagon, a hormone that prompts the liver to release its stored glucose. Glucagon is available as an injection or a nasal spray and must be administered by a trained family member or caregiver. Emergency services should be called immediately if the person has lost consciousness, is having a seizure, or if symptoms persist 15 minutes after glucagon has been given.