Diabetics use the medication insulin to regulate their blood sugar levels. Insulin lowers blood glucose (sugar). If too much insulin is taken--or if the normal insulin dose does not match a person's level of activity and recent food intake--the blood sugar drops to an abnormally low level. This condition is known as hypoglycemia or insulin reaction. According to the American Diabetes Association, a blood sugar level at or below 70 mg/dL represents hypoglycemia. An episode of hypoglycemia that requires assistance is considered severe hypoglycemia, also known as insulin shock. Insulin shock is a potentially life-threatening situation. Rapid treatment is imperative with the goal of restoring the blood glucose to a normal level.
Rapid-release Glucose Products
People with diabetes or the parents of diabetic children often have glucose tablets, gels or drinks on hand for treating insulin reactions. If an insulin reaction occurs and the person suffering the episode is still conscious and able to eat safely--without the risk of choking--these rapid-release glucose products can be ingested to provide a quick dose of sugar to the body. Improvement generally occurs within 15 to 20 minutes.
Glucose-rich Beverages and Foods
If rapid-release glucose products are not immediately available, glucose-rich foods or beverages can be consumed to raise the blood sugar--if the person suffering the insulin reaction can safely eat and swallow. Fruit juice, soft drinks (regular not diet), sports drinks, milk, honey and hard candy are good sources of sugar that can be quickly absorbed from the gut into the blood stream.
Glucagon Injection
Glucagon is a hormone that has the opposite effect of insulin--it raises blood glucose. Pharmaceutical companies manufacture a medicinal form of glucagon. Glucagon injections are used to treat insulin reactions, especially in circumstances in which the person suffering the reaction has lost consciousness (insulin coma) or has significantly impaired consciousness. Many people with diabetes keep a kit with a ready-to-use glucagon injection for insulin reactions. Improvement typically occurs in 10 to 25 minutes. In people who have not been eating or who have otherwise depleted their stores of liver glucose, however, glucagon may be ineffective. Intravenous glucose is needed in these situations.
Intravenous Glucose
In an emergency setting with on-scene paramedics or in a hospital emergency room, intravenous glucose, a dextrose solution, is often used to treat insulin reaction because the effect is virtually immediate. An intravenous dextrose infusion can be modulated based on repeated blood sugar levels over time. This can be advantageous in regaining blood sugar control without causing profoundly high blood sugar levels after an episode of hypoglycemia. Once the blood glucose level has been restored out of hypoglycemic range, oral food intake is resumed to reestablish a regular routine of eating, activity, and insulin dosing.
References
- National Institute of Diabetes and Digestive and Kidney Diseases: Hypoglycemia
- American Diabetes Association: Hypoglycemia
- Diabetes Care: Defining and reporting hypoglycemia in diabetes, a report from the American Diabetes Association workgroup on hypoglycemia
- "Harrison's Principles of Internal Medicine, 16th Edition"; Anthony S. Fauci, M.D., Eugene Braunwald, M.D., J. Larry Jameson, M.D., Ph.D., Dennis L. Kasper, M.D., Stephen L. Hauser, M.D., Dan L. Longo, M.D., Editors; 2004
- Merck Manual: Hypoglycemia
