{"id":5129,"date":"2025-11-30T21:43:02","date_gmt":"2025-12-01T02:43:02","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&#038;p=5129"},"modified":"2025-12-07T23:09:19","modified_gmt":"2025-12-08T04:09:19","slug":"hypoglycemic-shock-insulin-shock","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/hypoglycemic-shock-insulin-shock\/","title":{"raw":"9p14 Hypoglycemic Shock (Insulin Shock)","rendered":"9p14 Hypoglycemic Shock (Insulin Shock)"},"content":{"raw":"<strong>Hypoglycemic Shock (Insulin Shock)<\/strong>\r\n<h1><strong>Overview<\/strong><\/h1>\r\n<ul>\r\n \t<li>Caused by\u00a0<strong>excessively low blood glucose<\/strong>\u00a0levels.<\/li>\r\n \t<li>Common in\u00a0<strong>Type 1 diabetes<\/strong>\u00a0patients relying on insulin injections.<\/li>\r\n \t<li>Can also occur in\u00a0<strong>Type 2 diabetes<\/strong>\u00a0if too much oral hypoglycemic medication is taken.<\/li>\r\n \t<li><strong>Most dangerous<\/strong>\u00a0when brain cells are deprived of glucose.<\/li>\r\n<\/ul>\r\n<h1><strong>Causes<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Too much insulin<\/strong>\u00a0in circulation.<\/li>\r\n \t<li><strong>Dosage errors<\/strong>: Injecting too much insulin.<\/li>\r\n \t<li><strong>Exercise<\/strong>: Strenuous activity can lower blood glucose unexpectedly.<\/li>\r\n \t<li><strong>Skipping meals<\/strong>\u00a0after insulin injection.<\/li>\r\n \t<li><strong>Vomiting<\/strong>\u00a0after insulin administration and food intake.<\/li>\r\n<\/ul>\r\n<h1><strong>Pathophysiology<\/strong><\/h1>\r\n<ul>\r\n \t<li>Excess insulin increases\u00a0<strong>glucose transport<\/strong>\u00a0into cells via\u00a0<strong>GLUT4 (glucose transporters)<\/strong>.<\/li>\r\n \t<li>Leads to\u00a0<strong>rapid decline in blood glucose<\/strong>.<\/li>\r\n \t<li>Brain\u00a0<strong>cannot store glucose<\/strong>\u00a0and relies solely on blood glucose for energy.<\/li>\r\n \t<li>Insufficient glucose causes\u00a0<strong>neuronal dysfunction<\/strong>.<\/li>\r\n \t<li><strong>Blood glucose<\/strong>\u00a0levels drop quickly, neurons\u00a0<strong>stop functioning<\/strong>.<\/li>\r\n \t<li><strong>Pancreatic alpha cells<\/strong> secrete <strong>glucagon<\/strong> in response to low blood glucose levels.<\/li>\r\n \t<li><strong>Without insulin<\/strong>, the liver takes up less glucose, additionally the<\/li>\r\n \t<li><strong>Liver<\/strong> responds to glucagon:\r\n<ul>\r\n \t<li><strong>Glycogenolysis<\/strong>\u00a0releases stored glucose.<\/li>\r\n \t<li><strong>Gluconeogenesis<\/strong>\u00a0produces glucose from\u00a0<strong>protein<\/strong>\u00a0and\u00a0<strong>fat<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>If reserves are sufficient, <strong>glucose<\/strong> enters cells, and symptoms resolve.<\/li>\r\n \t<li>If not, continued <strong>hypoglycemia<\/strong> worsens, leading to\u00a0<strong>brain dysfunction\/damage<\/strong>.<\/li>\r\n<\/ul>\r\n<h1><strong>Symptoms<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Neurological signs:<\/strong>\r\n<ul>\r\n \t<li>Poor concentration, <strong>slurred speech<\/strong>.<\/li>\r\n \t<li>Disorientation, altered behavior.<\/li>\r\n \t<li>Appears\u00a0<strong>drunk<\/strong> (impaired coordination, <strong>staggering gait<\/strong>).<\/li>\r\n \t<li><strong>Dizziness, confusion, loss of consciousness<\/strong>, and can be <strong>fatal<\/strong> if untreated.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<ul>\r\n \t<li><strong>SNS activation (fight or flight):<\/strong>\r\n<ul>\r\n \t<li>Rapid\u00a0<strong>heart rate<\/strong>\u00a0and\u00a0<strong>breathing<\/strong>.<\/li>\r\n \t<li><strong>Sweating<\/strong>\u00a0and\u00a0<strong>tremors<\/strong>.<\/li>\r\n \t<li>Feelings of\u00a0<strong>anxiety<\/strong>\u00a0and\u00a0<strong>tremors<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<ul>\r\n \t<li><strong>Progression:<\/strong>\r\n<ul>\r\n \t<li>Loss of\u00a0<strong>consciousness<\/strong>.<\/li>\r\n \t<li>Possible\u00a0<strong>seizures<\/strong>.<\/li>\r\n \t<li>Risk of\u00a0<strong>fatality<\/strong>\u00a0if untreated.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Treatments<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Immediate carbohydrate intake<\/strong>:\r\n<ul>\r\n \t<li>Carry\u00a0<strong>fruit juice<\/strong>\u00a0or\u00a0<strong>candy<\/strong>\u00a0for quick glucose.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Unconscious patient<\/strong>:\r\n<ul>\r\n \t<li>Administer\u00a0<strong>glucose intravenously<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Aim: Rapidly restore blood glucose to prevent\u00a0<strong>brain damage<\/strong>.<\/li>\r\n<\/ul>\r\n&nbsp;\r\n\r\n<strong>Similarities to DKA (Diabetic Ketoacidosis)<\/strong>\r\n<ul>\r\n \t<li>Loss of consciousness and similar signs can\u00a0<strong>mimic DKA<\/strong>, but the cause of Hypoglycemic (Insulin) Shock is <strong>excess insulin<\/strong>\u00a0and\u00a0<span style=\"text-decoration: underline\"><strong>low glucose<\/strong><\/span> and<strong> therefore the treatment is different!<\/strong>.\r\n<ul>\r\n \t<li>Treat Hypoglycemic (Insulin) shock by administering glucose.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<ul>\r\n \t<li>The cause of DKA is <strong>insufficient insulin<\/strong> and <strong>extensive fat catabolism<\/strong> leading to ketonemia, hyperglycemia, polyuria and <span style=\"text-decoration: underline\"><strong>severe dehydration, acidosis, and electrolyte imbalances<\/strong><\/span>.\r\n<ul>\r\n \t<li>Treat DKA by administering: <strong>insulin,<\/strong> <strong>IV fluids, electrolytes and bicarbonate<\/strong>, and treating <strong>underlying cause<\/strong> (infection, diet change, etc.)<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<strong>Summary<\/strong>\r\n<ul>\r\n \t<li>Hypoglycemic shock is\u00a0<strong>life-threatening<\/strong>\u00a0and requires immediate treatment.<\/li>\r\n \t<li>Understanding the\u00a0<strong>underlying cause<\/strong>\u00a0(hyperglycemia vs. hypoglycemia) is essential.<\/li>\r\n \t<li><strong>Prevention<\/strong>\u00a0involves proper medication dosing, diet, and carrying quick-acting glucose sources.<\/li>\r\n<\/ul>","rendered":"<p><strong>Hypoglycemic Shock (Insulin Shock)<\/strong><\/p>\n<h1><strong>Overview<\/strong><\/h1>\n<ul>\n<li>Caused by\u00a0<strong>excessively low blood glucose<\/strong>\u00a0levels.<\/li>\n<li>Common in\u00a0<strong>Type 1 diabetes<\/strong>\u00a0patients relying on insulin injections.<\/li>\n<li>Can also occur in\u00a0<strong>Type 2 diabetes<\/strong>\u00a0if too much oral hypoglycemic medication is taken.<\/li>\n<li><strong>Most dangerous<\/strong>\u00a0when brain cells are deprived of glucose.<\/li>\n<\/ul>\n<h1><strong>Causes<\/strong><\/h1>\n<ul>\n<li><strong>Too much insulin<\/strong>\u00a0in circulation.<\/li>\n<li><strong>Dosage errors<\/strong>: Injecting too much insulin.<\/li>\n<li><strong>Exercise<\/strong>: Strenuous activity can lower blood glucose unexpectedly.<\/li>\n<li><strong>Skipping meals<\/strong>\u00a0after insulin injection.<\/li>\n<li><strong>Vomiting<\/strong>\u00a0after insulin administration and food intake.<\/li>\n<\/ul>\n<h1><strong>Pathophysiology<\/strong><\/h1>\n<ul>\n<li>Excess insulin increases\u00a0<strong>glucose transport<\/strong>\u00a0into cells via\u00a0<strong>GLUT4 (glucose transporters)<\/strong>.<\/li>\n<li>Leads to\u00a0<strong>rapid decline in blood glucose<\/strong>.<\/li>\n<li>Brain\u00a0<strong>cannot store glucose<\/strong>\u00a0and relies solely on blood glucose for energy.<\/li>\n<li>Insufficient glucose causes\u00a0<strong>neuronal dysfunction<\/strong>.<\/li>\n<li><strong>Blood glucose<\/strong>\u00a0levels drop quickly, neurons\u00a0<strong>stop functioning<\/strong>.<\/li>\n<li><strong>Pancreatic alpha cells<\/strong> secrete <strong>glucagon<\/strong> in response to low blood glucose levels.<\/li>\n<li><strong>Without insulin<\/strong>, the liver takes up less glucose, additionally the<\/li>\n<li><strong>Liver<\/strong> responds to glucagon:\n<ul>\n<li><strong>Glycogenolysis<\/strong>\u00a0releases stored glucose.<\/li>\n<li><strong>Gluconeogenesis<\/strong>\u00a0produces glucose from\u00a0<strong>protein<\/strong>\u00a0and\u00a0<strong>fat<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li>If reserves are sufficient, <strong>glucose<\/strong> enters cells, and symptoms resolve.<\/li>\n<li>If not, continued <strong>hypoglycemia<\/strong> worsens, leading to\u00a0<strong>brain dysfunction\/damage<\/strong>.<\/li>\n<\/ul>\n<h1><strong>Symptoms<\/strong><\/h1>\n<ul>\n<li><strong>Neurological signs:<\/strong>\n<ul>\n<li>Poor concentration, <strong>slurred speech<\/strong>.<\/li>\n<li>Disorientation, altered behavior.<\/li>\n<li>Appears\u00a0<strong>drunk<\/strong> (impaired coordination, <strong>staggering gait<\/strong>).<\/li>\n<li><strong>Dizziness, confusion, loss of consciousness<\/strong>, and can be <strong>fatal<\/strong> if untreated.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>SNS activation (fight or flight):<\/strong>\n<ul>\n<li>Rapid\u00a0<strong>heart rate<\/strong>\u00a0and\u00a0<strong>breathing<\/strong>.<\/li>\n<li><strong>Sweating<\/strong>\u00a0and\u00a0<strong>tremors<\/strong>.<\/li>\n<li>Feelings of\u00a0<strong>anxiety<\/strong>\u00a0and\u00a0<strong>tremors<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Progression:<\/strong>\n<ul>\n<li>Loss of\u00a0<strong>consciousness<\/strong>.<\/li>\n<li>Possible\u00a0<strong>seizures<\/strong>.<\/li>\n<li>Risk of\u00a0<strong>fatality<\/strong>\u00a0if untreated.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Treatments<\/strong><\/h1>\n<ul>\n<li><strong>Immediate carbohydrate intake<\/strong>:\n<ul>\n<li>Carry\u00a0<strong>fruit juice<\/strong>\u00a0or\u00a0<strong>candy<\/strong>\u00a0for quick glucose.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Unconscious patient<\/strong>:\n<ul>\n<li>Administer\u00a0<strong>glucose intravenously<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li>Aim: Rapidly restore blood glucose to prevent\u00a0<strong>brain damage<\/strong>.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Similarities to DKA (Diabetic Ketoacidosis)<\/strong><\/p>\n<ul>\n<li>Loss of consciousness and similar signs can\u00a0<strong>mimic DKA<\/strong>, but the cause of Hypoglycemic (Insulin) Shock is <strong>excess insulin<\/strong>\u00a0and\u00a0<span style=\"text-decoration: underline\"><strong>low glucose<\/strong><\/span> and<strong> therefore the treatment is different!<\/strong>.\n<ul>\n<li>Treat Hypoglycemic (Insulin) shock by administering glucose.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>The cause of DKA is <strong>insufficient insulin<\/strong> and <strong>extensive fat catabolism<\/strong> leading to ketonemia, hyperglycemia, polyuria and <span style=\"text-decoration: underline\"><strong>severe dehydration, acidosis, and electrolyte imbalances<\/strong><\/span>.\n<ul>\n<li>Treat DKA by administering: <strong>insulin,<\/strong> <strong>IV fluids, electrolytes and bicarbonate<\/strong>, and treating <strong>underlying cause<\/strong> (infection, diet change, etc.)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Summary<\/strong><\/p>\n<ul>\n<li>Hypoglycemic shock is\u00a0<strong>life-threatening<\/strong>\u00a0and requires immediate treatment.<\/li>\n<li>Understanding the\u00a0<strong>underlying cause<\/strong>\u00a0(hyperglycemia vs. hypoglycemia) is essential.<\/li>\n<li><strong>Prevention<\/strong>\u00a0involves proper medication dosing, diet, and carrying quick-acting glucose sources.<\/li>\n<\/ul>\n","protected":false},"author":1370,"menu_order":20,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[],"contributor":[60],"license":[57],"class_list":["post-5129","chapter","type-chapter","status-web-only","hentry","contributor-zoe-soon","license-cc-by-nc-sa"],"part":63,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5129","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":5,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5129\/revisions"}],"predecessor-version":[{"id":5259,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5129\/revisions\/5259"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/63"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5129\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=5129"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=5129"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=5129"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=5129"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}