Diabetes nurse educator, Kate Bristow, educates us on what insulin shock is, the causes and how to spot it before it leads to hypoglycaemia.

What is insulin shock?

Insulin shock is caused by having too much insulin in your bloodstream. It can lead to hypoglycaemia (low blood glucose).

It can happen if you:

• Ignore the signs of an early hypoglycaemic event.
• Mistakenly take too much insulin.
• Miss meals or eat too little to cover the insulin dose (fasting).
• Do more exercise than usual and have not eaten enough carbohydrate (CHO) to cover the exercise or changes to a new exercise routine.
• Drink alcohol without eating any, or enough food.
• Have hypoglycaemic unawareness which can happen sometimes if you have had diabetes a long time. In other words, you don’t feel the low coming on.
• Are unwell.
• Are working so hard at managing your diabetes well (but don’t ever stop working at this).

Insulin shock is a diabetic emergency and can lead to diabetic coma, brain damage and even death.

How does it happen?

Insulin is normally made in the pancreas and is a necessary ingredient to allow the glucose in the bloodstream to enter the cells.  In someone without diabetes, the body does this automatically without you knowing about it, but in people with diabetes, it’s your job to give your body just the right amount of insulin to move the glucose from the bloodstream to your cells where it gives you the energy to function. Tough job, right?

Remember glucose is fuel for the body. If you have too much insulin in your system or you have done more physical activity and used up more of your glucose store, or perhaps not eaten enough carbs to cover the insulin you have injected, you may have a low or a hypo.

How do you recognise the signs of insulin shock?

If your blood glucose drops just a bit below normal (4mmol/L), your symptoms may be mild (Mild hypoglycaemia)

• Dizziness
• Shaking
• Sweating or a clammy feeling
• Hunger
• Anxiety
• Irritability
• A rapid pulse

This is where normally you can reverse the symptoms using the 15/15 rule.

• Have 15g quick-acting CHO (sugar, sweets, Coke, or fruit juice).
• Have a small healthy snack to help your body recover.
• After 15 minutes test your blood glucose again to see if it has improved.
• If it still has not increased, then have another 15g of quick-acting CHO.
• Keep testing until your blood glucose has stabilised.

A blood glucose level that is dropping fast can also cause:

• Headaches
• Confusion
• Fainting
• Tripping, falling and lack of coordination
• Muscle tremors and seizures
• Possible coma
• If it happens when you are asleep, it may also manifest as nightmares, crying out in your sleep or waking with sweating and confusion and possible aggression.

How do we treat insulin shock?

• If the person is experiencing the symptoms above, treat with the 15/15 rule.
• But if they are unconscious, call emergency services immediately.
• Don’t give an unconscious person something by mouth as they may choke.
• Administer glucagon if you have it available. If not, the emergency response team will have some.

How to stop insulin shock from occurring?

Prevention is always better than cure. So, always carry a hypo kit with you so you can respond immediately if your blood glucose dips too low. Your hypo kit should include your test meter, some quick-acting CHO as well as a longer-acting snack in case you are out and about (Futurelife High Protein Bars or a piece of fruit are good options).

Eat after taking your insulin and work to count carbs correctly so you don’t give too much insulin.

If exercising, you may need to adjust your insulin dose before and after the session. Discuss how to do this with your diabetes team, doctor or diabetes nurse educator.

Be cautious when drinking alcohol.

Test your blood glucose often; a continual glucose monitor (CGM) can be useful too.

Test your blood glucose levels before you drive or operate heavy machinery.

Teach your family and friends about hypoglycaemia and how to help you fix it should it occur.

Always have a glucagon injection available.

Wear a medic alert identification; ICE medical bracelets have a great range to choose from.

Header image by FreePik

Sister Lynette Lacock explains why annual checks are imperative for people living with diabetes.

Why annual checks?

Diabetes is a complicated chronic condition that effects many areas of your body. Uncontrolled diabetes is a major risk factor for deterioration of your health. It’s important to know the condition of your eyes, feet, teeth, heart and kidneys. To do this, you need to have a yearly assessment and learn how to keep these areas healthy and problem free.

Eyes

Sometimes a rapid deterioration in eyesight is the first sign of diabetes. Elevated blood glucose affects the capillaries, feeding the retina in the back of your eye which will affect your vision. People with diabetes are also prone to cataracts and glaucoma.

This annual check is much more than reading an eye chart to check your vision. You should expect your doctor to dilate your eyes with drops and look into your eyes with special magnified lenses.

Finding problems early and being treated will go a long way in preserving your eyesight.

Feet

Checking your feet daily is vital. Note any cracks or sores that aren’t healing, changes in the nails or colour of the skin. Even changes in sensation can mean you need to see your doctor before your annual check-up.

Uncontrolled diabetes can lead to peripheral neuropathy which means you may not feel that your shoes are too tight or that they are giving you blisters. If you already have decreased sensation, then paying attention to your feet is imperative.

Diabetes can also cause circulatory problems that cause delayed healing. For this reason, if you have a cut or ulcer that isn’t healing on its own you need to see your doctor as soon as possible.

Teeth

Seeing your dentist regularly will not only help you keep your teeth clean and gums healthy, but it can also reduce the risk of heart disease.

Cleaning and flossing your teeth regularly will decrease the amount of bacteria in your mouth so there is less bacteria to get into your bloodstream therefore reducing your risk of heart attack.

On an annual visit, your dentist will check for cavities and gum disease. While you are there, book an appointment with the oral hygienist and have your teeth cleaned.

Remember with elevated glucose levels you’ll already be more prone to infections and gum disease, so this check is important.

Heart

Having diabetes makes it more likely that you will suffer from heart disease. Therefore, you need take special care to keep your heart in the best shape possible.

There are multiple tests your doctor can do to check your heart depending on your age, condition and symptoms. These tests may include the following:

Electrocardiogram checks the electrical circuitry.

Echocardiogram or ultrasound to check heart and its blood supply.

Stress Test to see how your heart reacts to physical activity.

Coronary angiogram to measure and possibly widen vessels.

Kidneys

Hypertension and uncontrolled blood glucose can cause kidney damage over time. So, first and foremost you must keep these two conditions under control. Once damaged it can’t be reversed.

One of the first signs that there is damage to the kidneys filtering system is protein in the urine. This can be determined from a urine test in your doctor’s rooms. They may also want to draw blood and check kidney function by looking at how well they filter waste from the blood.

It’s also essential to let your doctor know if you have any symptoms of a bladder infection, such as frequent urination, burning and cloudy urine. An untreated bladder infection can lead to kidney damage as well.

Final thought

You may have noticed that all these check-ups have something in common: checking for problems related to microcirculation. Because diabetes can affect the small blood vessels, it will also affect the health of the organ or tissue they are supplying blood and oxygen to.

As explained before, the main culprits are uncontrolled blood glucose and hypertension. By checking your blood glucose levels and blood pressure regularly and making sure it’s within normal limits, you will prevent some of the progressive damage that occurs when you have diabetes.

Knowing the results of your annual checks will empower you to stay on top of your diabetes and to do your best to keep yourself healthy and prevent future problems.

References

https://www.paceyemd.com/blog/i-have-diabetes-how-often-should-i-have-my-eyes-checked/

https://www.cdc.gov/diabetes/library/features/healthy-feet.html

https://www.sharecare.com/health/diabetes-oral-health/can-my-dentist-diagnose-diabetes

https://www.webmd.com/diabetes/diabetes-your-heart-tests-you-may-need

https://www.hopkinsmedicine.org/gim/faculty-resources/core_resources/Patient%20Handouts/Handouts_May_2012/Preserving%20Kidney%20Function%20When%20You%20Have%20Diabetes.pdf

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