Diabetic shock, also referred to as insulin or hypoglycemic shock, is a sudden drop in blood glucose levels that occurs most commonly in diabetics treated with insulin. In diabetics who are insulin-deficient, insulin injections and pump therapy are used to maintain blood glucose levels. A study in the journal Diabetic Medicine reported that 15 percent of type 2 diabetics who are treated with insulin experience severe hypoglycemia. The incidence of severe hypoglycemia is higher in type 1 diabetics. A review article in the June 2003 issue of the journal Diabetes Care reported that type 1 diabetics suffer an average of two episodes of symptomatic hypoglycemia per week and a severe episode of hypoglycemia approximately once a year.
Hypoglycemia
The American Diabetes Association recommends that fasting blood glucose levels stay above 70 mg/dL. The review article in Diabetes Care says the blood glucose threshold for cognitive impairment is between 50 and 55 mg/dL, but other symptoms may occur at blood glucose levels just below 70 mg/dL.
Causes
The most common cause of severe hypoglycemia is insulin therapy. However, intense exercise, missed meals, illness and other anti-diabetic drugs can elicit marked decreases in blood glucose levels.
Symptoms
The symptoms of diabetic shock are largely the result of glucose deprivation in the brain and activation of the adrenergic system. They include anxiety, confusion, tremors, sweating, hunger, neurological impairment, cognitive dysfunction, seizures, and possibly coma and death. The onset of symptoms typically occurs when blood glucose levels drop below 70 mg/dL. However, people not only differ in their presentation of symptoms, but also in the threshold blood glucose level that initiates the onset of symptoms.
Unawareness
In some diabetics, the awareness of symptoms may become compromised with recurrent hypoglycemic episodes. Hypoglycemic unawareness can lead to a sudden loss of consciousness with risk of injury and death. A study in the Journal of Diabetes and its Complications reports that the frequency of severe hypoglycemic episodes is higher in diabetics that have impaired awareness of hypoglycemic symptoms. Additionally, a large clinical trial study published in the American Journal of Medicine found that severe hypoglycemia occurred more often during sleep, when symptoms usually are undetected.
Treatment
The review article in Diabetes Care says most episodes of hypoglycemia can be self-treated by taking glucose tablets or by ingestion of juice, milk or crackers followed by a snack or meal. In more severe instances, type 1 diabetics may be injected with glucagon to more rapidly increased blood glucose levels. Type 2 diabetics are not treated with glucagon, but may be given a glucose solution in the emergency room. The authors of the article in Diabetes Care recommend patient education and regular self-blood glucose monitoring to prevent recurrent episodes of severe hypoglycemia.
References
- Diabetic Medicine (journal): Hypoglycemia in Insulin-treated Type 2 Diabetes
- Diabetes Care (journal): Hypoglycemia in Diabetes
- American Diabetes Association: Hypoglycemia
- Journal of Diabetes and its Complications: Classification of Hypoglycemia Awareness
- American Journal of Medicine: Epidemiology of Severe Hypoglycemia in the Diabetes Control and Complications Trial
