Hypoglycemic Shock (Insulin Shock)

Overview

• Caused by excessively low blood glucose levels.
• Common in Type 1 diabetes patients relying on insulin injections.
• Can also occur in Type 2 diabetes if too much oral hypoglycemic medication is taken.
• Most dangerous when brain cells are deprived of glucose.

Causes

• Too much insulin in circulation.
• Dosage errors: Injecting too much insulin.
• Exercise: Strenuous activity can lower blood glucose unexpectedly.
• Skipping meals after insulin injection.
• Vomiting after insulin administration and food intake.

Pathophysiology

• Excess insulin increases glucose transport into cells via GLUT4 (glucose transporters).
• Leads to rapid decline in blood glucose.
• Brain cannot store glucose and relies solely on blood glucose for energy.
• Insufficient glucose causes neuronal dysfunction.
• Blood glucose levels drop quickly, neurons stop functioning.
• Pancreatic alpha cells secrete glucagon in response to low blood glucose levels.
• Without insulin, the liver takes up less glucose, additionally the
• Liver responds to glucagon:
  • Glycogenolysis releases stored glucose.
  • Gluconeogenesis produces glucose from protein and fat.
• If reserves are sufficient, glucose enters cells, and symptoms resolve.
• If not, continued hypoglycemia worsens, leading to brain dysfunction/damage.

Symptoms

• Neurological signs:
  • Poor concentration, slurred speech.
  • Disorientation, altered behavior.
  • Appears drunk (impaired coordination).
  • Staggering gait.

• SNS activation (fight or flight):
  • Rapid heart rate and breathing.
  • Sweating and tremors.
  • Feelings of anxiety and tremors.

• Progression:
  • Loss of consciousness.
  • Possible seizures.
  • Risk of fatality if untreated.

Treatments

• Immediate carbohydrate intake:
  • Carry fruit juice or candy for quick glucose.
• Unconscious patient:
  • Administer glucose intravenously.
• Aim: Rapidly restore blood glucose to prevent brain damage.

Similarities to DKA (Diabetic Ketoacidosis)

• Loss of consciousness and similar signs can mimic DKA, but the cause of Hypoglycemic (Insulin) Shock is excess insulin and low glucose.
• The cause of DKA is insufficient insulin and extensive fat catabolism leading to ketonemia, hyperglycemia, polyuria and severe dehydration, acidosis, and electrolyte imbalances.

Summary

• Hypoglycemic shock is life-threatening and requires immediate treatment.
• Understanding the underlying cause (hyperglycemia vs. hypoglycemia) is essential.
• Prevention involves proper medication dosing, diet, and carrying quick-acting glucose sources.