If you have diabetes, have you ever wondered why you become sweaty when you have skipped a meal or two?
Or why do you sometimes feel irritable after taking your insulin?
These signs and symptoms could be due to hypoglycemia, a condition where your blood sugar levels drop below 70 milligrams per deciliter (mg/dl).
When our blood sugar level is low, our body is unable to perform optimally.
Hence, our body kicks into this “fight-or-flight” mode to tell us to do something about it.
Hypoglycemia can happen for many reasons and is more common in people who have diabetes.
This article focuses on the form of hypoglycemia that people with diabetes may experience, also known as diabetic shock, hypoglycemic shock, or insulin shock.
What is Diabetic Shock?
Simply put, diabetic shock is what happens when our blood sugar levels drop dangerously low.
Normally, a healthy person can maintain their blood sugar levels within a normal range, that is, between 80-100 mg/dl during fasting.
However, people with certain medical conditions, such as diabetes, may not be able to regulate their blood sugar levels.
Hence, hormones that maintain the blood sugar level at equilibrium, such as insulin and glucagon, go awry, leading to drastic highs and lows.
Diabetic shock happens when the blood sugar level dips drastically due to the high levels of insulin.
Is diabetic shock fatal?
It can be. There are different stages of diabetic shock, ranging from mild to severe. In the most severe case, the person can be rendered unconscious, and if left untreated, diabetic shock can be fatal.
How to Identify Diabetic Shock
Knowing the signs and symptoms of diabetic shock can help us respond to it quickly. The objective measurement of hypoglycemia is by using the glucometer, where the reading will be below 70 mg/dl.
Ideally, a household with someone with diabetes should have one to monitor blood sugar levels routinely.
These are some mild diabetic shock symptoms:
- Hunger
- Trembling and sweating
- Rapid heart rate
- Emotional distress, such as anxiety and irritability
- Dizziness
If left untreated, the blood sugar level will continue to drop, and more severe symptoms may occur, such as:
- Headache, usually dull and throbbing
- Confusion
While it may sound daunting, it is important to note that these symptoms are reversible.
Who Is at Risk of Diabetic Shock?
Some groups of people are at higher risk of getting diabetic shock, such as:
- Type 1 diabetics who are taking insulin
- Type 2 diabetics who are on certain medications
- People with type 2 diabetes who have kidney injuries or chronic kidney diseases
- Elderly people with diabetes
- People with diabetes who have an ongoing infection
Causes & Management of Diabetic Shock
1. Excessive insulin
Insulin is commonly used to treat type 1 diabetes as well as uncontrolled type 2 diabetes. However, excessive insulin injections inadvertently lead to diabetic shock.
This can be caused by incorrect dosage, timing as well as technique of injection. Accidentally injecting the wrong type of insulin or incorrectly injecting it into the muscle instead of just beneath the skin (subcutaneously) can also cause hypoglycemia.
If you are experiencing any symptoms of hypoglycemia while taking insulin, you should review your insulin dosage, timing, and techniques with your diabetes care team.
They can switch your insulin to newer types as they are preferred over regular insulins or isophane (NPH) insulins.
They might also recommend the use of insulin pumps to reduce the risk of diabetic shock.
2. Effects of certain anti-diabetic medications
Certain medications, such as sulfonylurea, e.g., DiaBeta, Glynase, Micronase, or Amary, can cause diabetic shock because they work by increasing insulin levels in the body.
While they are useful in lowering high blood sugar levels, incorrect dosages and timing can lead to diabetic shock.
If you are experiencing any symptoms of hypoglycemia while taking any type of medication, you should review your medication type, dosage, and timing with your diabetes care team.
3. Decreased appetite
In some infections or diseases, people can lose their appetite leading to reduce carbohydrate consumption.
Infections also increase the body’s metabolism, hence consuming glucose faster than usual.
Elderly people may also experience loss of appetite. If their anti-diabetic medication dosages are not adjusted accordingly, they can end up with excess insulin in their system.
If you notice the signs and symptoms of diabetic shock following a change in appetite, or if you are ill or unwell, you should review your dosage, timing, and techniques with your diabetes care team.
4. Reduced carbohydrates intake and/or increased physical activities
Eating foods with less carbohydrate or sugar than usual while increasing physical activities like exercise without reducing the amount of insulin taken can cause diabetic shock.
The intensity, duration, and timing of exercise can affect the levels of insulin and glucose.
Studies have shown that people who are taking insulin have a higher risk of getting diabetic shock during and after exercising.
While exercise is an extremely important lifestyle modification to regulate your blood sugar and keep fit, people with diabetes need to do so with caution.
This is especially true for those who are taking insulin to control their diabetes.
It is not recommended to exercise before bed to prevent the risk of hypoglycemia during sleep. It is best to have a snack an hour or two before exercising.
If it is a high-intensity exercise or if the duration is going to be more than an hour, bring along some snacks to have in between sessions.
You can also work out an optimum meal and exercise plan with your diabetes care team, which may include a registered dietitian trained in diabetes care.
5. Tightly controlled diabetes
While it is the ultimate goal to lower your blood sugar level if you have diabetes, sometimes, too tight a control can increase the risk of diabetic shock.
This happens when you and your doctor try to control your blood sugar as close to normal as possible. It can include strict diet control and higher dosage of medications, including insulin.
If you are experiencing any symptoms of hypoglycemia, you should review your care plan with your diabetes care team.
They can advise you on ways to optimize your medications and diet, including easing the range for your target glycemic control to prevent diabetic shock.
6. Alcohol consumption
When someone consumes alcohol, their liver works very hard to metabolize the alcohol. While the liver is preoccupied with breaking down the alcohol, blood sugar control by the liver will be affected, leading to hypoglycemia.
If you have diabetes, you should be cautious with your alcohol consumption. Not only will it increase the risk of diabetic shock, but alcohol may also lead to weight gain and other adverse health effects. You should discuss this with your diabetes care team to optimize your care plan.
Treatment
The treatment of diabetic shock varies according to the severity of diabetic shock. At mild levels, you may experience hunger, trembling, irritability, or dizziness.
You should start by checking your blood sugar levels if there is a glucometer nearby. Then, you should use the 15-15 rule to correct your blood sugar level if it is below 70 mg/dl.
- Take 15 grams of sugar
- After 15 minutes, re-check the blood sugar
15 grams of sugar is equivalent to 1 tablespoon of table sugar or honey or half a cup (4 ounces) of juice or regular soft drinks.
Be careful not to overdo it because it may increase your blood sugar levels too drastically. This is an unwanted effect.
If the blood sugars are still below 70 mg/dl after 15 minutes, take another 15 grams of sugar.
After ensuring that your blood sugar levels are above 70 mg/dl, you can proceed with a meal or a snack in the next 30 minutes.
Ideally, this meal or snack should be rich in protein and complex carbohydrates to prevent hypoglycemia from happening again.
Examples of complex carbohydrates and protein-rich food are yogurt, almonds, chickpeas, and beans.
If you are aiding someone in diabetic shock who then falls unconscious, it is considered an emergency, and you should call for emergency services (911 in America).
While waiting for the ambulance, you can put them to their side with their head tilted upwards to ensure they can still breathe. This is called the “recovery position.”
If you know how to administer glucagon and there is a glucagon emergency kit nearby, you can do so by following the instructions in the package.
If you are prone to getting severe hypoglycemia, you should speak to your diabetes care team about a glucagon prescription.
People who you are usually in contact with, such as a partner, family members, or housemates, should be instructed on when and how to administer glucagon to treat severe hypoglycemia.
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Complications
If hypoglycemia is not promptly corrected, the person can worsen rapidly and develop severe symptoms such as seizures and coma. Ultimately, diabetic shock can be fatal.
Studies have also shown that recurrent episodes of diabetic shock can increase the risks of heart problems and heart attacks.
Someone who has recurrent diabetic shock may also be desensitized and develop hypoglycemia unawareness, where they remain symptom-free until diabetic shock becomes severe.
If you think you have hypoglycemia unawareness, speak with your diabetes care team to work out a management plan suited for you.
They can help you teach your body to re-learn how to react to hypoglycemia. This may mean increasing your target blood glucose levels.
Prevention
Prevention is always better than cure. Early detection of hypoglycemia allows prompt correction of blood sugar levels.
A good practice if you have diabetes is to check your blood sugar level routinely. If you are taking insulin, consider monitoring your blood sugar level with a continuous glucose monitor (CGM).
CGM helps to notify you when your blood sugar levels are low or start to fall.
Based on your blood sugar level control in the past, your diabetes care team may advise you on certain times to check your blood sugar level, including:
- Before and after meals
- Before and after exercising (and sometimes during if it is a long or intense exercise session)
- Whenever you have a change in medication dosage, insulin routine, diet plan, exercise or work schedule, appetite, or even if you are sick
- Before bed
You should make a note of any episodes of diabetic shock and review them with your diabetes care team.
In your notes, include details of your medication dosage and timing, as well as food data and a record of activities leading to the hypoglycemic event.
This can help your diabetes care team to identify the cause and help to improve your blood sugar level control.
Conclusion
Diabetic shock happens when blood sugar levels drop dangerously low (below 70 mg/dl), giving rise to symptoms such as hunger, sweating, rapid heart rate, irritability, and dizziness.
While there are many causes of diabetic shock, it boils down to high insulin levels in the system leading to low blood sugar levels.
If you have experienced diabetic shock at any point, you should inform and review the causes with your diabetes care plan to prevent future recurrences.
Early detection of hypoglycemia allows prompt correction of blood sugar levels, thus preventing further complications.
The 15-15 rule is helpful in reversing the initial stage of diabetic shock. If you are prone to severe diabetic shock, you should consult with your diabetes care team about glucagon.
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