An insulin overdose is a serious medical emergency causing a life-threatening drop in blood sugar, known as severe hypoglycemia. This situation requires immediate, informed action to stabilize your friend and prevent potentially irreversible brain damage. This guidance is not a substitute for professional medical care; you must call for emergency medical services immediately.
Prioritizing Safety and Calling Emergency Services
Your first and most important action is to contact emergency services, such as 911, without delay. An insulin overdose necessitates professional medical intervention because the drug’s effects can persist for 24 hours or longer, leading to recurrent blood sugar drops that cannot be managed safely at home. Even if initial first aid measures appear successful, the person requires continuous monitoring in a hospital setting.
When speaking to the dispatcher, remain calm and clearly state that your friend has overdosed on insulin and is experiencing severe hypoglycemia. Provide the exact location, current state of consciousness, and, if known, the type and estimated amount of insulin taken, along with the time it was administered. Follow all instructions the dispatcher gives you until medical personnel arrive, as they are trained to guide you through initial emergency procedures. The priority is to secure professional help before attempting any treatment yourself.
Recognizing the Signs of Severe Hypoglycemia
The overdose of insulin forces cells to absorb too much glucose from the blood, starving the brain of its primary fuel source. Early signs of low blood sugar include shakiness, sweating, intense hunger, and a rapid heartbeat. You might also notice paleness, clammy skin, or a sudden change in mood, such as irritability or anxiety.
As blood sugar continues to fall, symptoms become more severe, indicating a neurological emergency. These signs include marked confusion, slurred speech, difficulty concentrating, and uncoordinated movements. The progression to severe hypoglycemia is marked by an inability to swallow, seizures, and eventually, loss of consciousness or coma. Treat the symptoms aggressively as soon as they appear, regardless of a blood sugar reading, because the excess insulin is still active and will continue to drive glucose levels down.
Immediate First Aid: Conscious and Unconscious Response
The appropriate first aid response depends entirely on whether your friend is conscious and able to swallow safely. If your friend is conscious and can follow simple commands, immediately administer a fast-acting source of oral carbohydrate, aiming for 15 to 20 grams of pure glucose. This can be four glucose tablets, half a cup of fruit juice, or a can of regular soda, avoiding anything with fat or protein that would slow down absorption.
After the initial dose, monitor symptoms closely and recheck blood sugar, if a meter is available, after 15 minutes. If symptoms have not improved or blood sugar remains low, repeat the 15-gram carbohydrate dose. Do not wait for emergency medical services to arrive before beginning this treatment. This is a temporary measure, and professional help remains necessary due to the unknown quantity and type of insulin involved.
If your friend is unconscious, seizing, or unable to swallow, do not attempt to give them any food or drink, as this poses a risk of choking and aspiration. Use an emergency Glucagon injection kit, if one is available and you know how to use it. Glucagon is a hormone that triggers the liver to release its stored glucose, providing a temporary rise in blood sugar.
Administer the Glucagon injection according to the kit’s instructions, typically into the thigh or arm muscle. Immediately roll your friend onto their side into the recovery position. This position helps keep the airway open and prevents them from inhaling vomit, as nausea is a common side effect of Glucagon. Glucagon’s effect is temporary and may take 10 to 15 minutes to work, emphasizing the need for immediate medical transport.
What Happens Next: Hospital Care and Recovery
Once emergency medical services arrive, they will take over care, likely administering an intravenous (IV) bolus of dextrose, a concentrated glucose solution, to rapidly stabilize blood sugar. At the hospital, the primary concern is the risk of “rebound hypoglycemia,” especially if the overdose involved long-acting insulin analogs like glargine or detemir. Long-acting insulins can remain active for up to 96 hours, causing blood sugar to crash repeatedly.
To counter this prolonged action, medical professionals will initiate a continuous IV infusion of dextrose, often at 10% or 20% concentration, titrating the rate to maintain a stable blood glucose level. This continuous glucose delivery is maintained for the entire duration of the insulin’s toxic effect, necessitating an extended observation period, often lasting 24 hours or more, even if the patient appears stable. They will also monitor electrolyte levels, particularly potassium, as insulin can cause it to shift into cells, potentially leading to cardiac rhythm disturbances. A thorough medical evaluation will follow stabilization to determine the cause of the overdose and prevent future incidents.