hypoglycemia | insulin shock

DIABETES - HYPOGLYCEMIA
INSULIN SHOCK

Q. What is insulin shock? My husband, who has had diabetes for more than 25 years, went into "insulin shock" two years ago. He lost all memory of the previous 30 years and remains disabled, although rehabilitation therapy has helped. I'd like to know more about what happened. Is there anything I can do to help him regain some of what he lost?

A. So-called insulin shock is a form of coma due to severe hypoglycemia (low blood sugar). Hypoglycemic coma has many possible causes, but the most common cause is taking too large a dose of insulin. Hypoglycemia is a medical emergency since it can lead to permanent brain damage if not treated in a timely manner. The human brain is highly dependent on glucose and oxygen to maintain its normal function. An adult human brain normally extracts about 60 to 80 milligrams of glucose per minute from circulating blood. When there's not enough glucose in the blood to meet the brain's needs, its function may become impaired. While there is not an exact relationship between the level of blood glucose and the neurological signs and symptoms, there appears to be a relationship between the degree and duration of hypoglycemia and the severity of the neurological impairment. For example, after 30 minutes of hypoglycemia, there may be excessive sweating, salivation, sleepiness, and restlessness. After two to three hours, there may be loss of contact with reality, dilated pupils, and convulsions. And after four to five hours, there may be coma, possibly accompanied by paralysis, abnormal movements, unusual positioning of the arms and legs, and small pupils. The brain cells that normally use the most glucose are the most susceptible to hypoglycemia, as well as to ischemia (decreased blood supply) and hypoxia (decreased oxygen supply). The brain damage that results from all of these causes is similar and especially affects the hippocampus (which is important for learning and memory) and the cerebellum (which is important for coordination and balance). Unfortunately, damage to these important brain areas can be permanent, and no treatment is currently available. Preventing severe hypoglycemia or treating it rapidly is essential to avoid brain damage. (Frank A. Rubino, M.D., Consultant in Neurology, Mayo Clinic, Professor of Neurology, Mayo Clinic Graduate School of Medicine, Jacksonville, Florida)

Reprinted with permission from Diabetes Self-Management
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