From the Guidelines
Hypoglycemic seizures are a medical emergency that occurs when blood sugar drops dangerously low, causing abnormal brain electrical activity, and can be identified by symptoms such as loss of consciousness, convulsions, muscle rigidity, twitching, and sometimes tongue biting or loss of bladder control, as noted in the 2017 American Diabetes Association standards of medical care in diabetes 1. The symptoms of hypoglycemic seizures often begin with early warning signs including:
- Sweating
- Shakiness
- Hunger
- Anxiety
- Irritability
- Confusion
- Heart palpitations As blood glucose continues to fall, more severe symptoms develop such as:
- Difficulty speaking
- Blurred vision
- Unusual behavior
- Coordination problems The seizure itself may involve loss of consciousness, convulsions, muscle rigidity, twitching, and sometimes tongue biting or loss of bladder control, and after the seizure, the person may experience extreme fatigue, confusion, headache, and have no memory of the event, as described in the treatment of type 1 diabetes synopsis 1. Hypoglycemic seizures are medical emergencies requiring immediate treatment with glucose, typically 15-20 grams orally if the person is conscious, or injectable glucagon if unconscious, as recommended by the American Diabetes Association 1. These seizures occur because the brain depends almost exclusively on glucose for energy, and without adequate supply, normal neurological function becomes impossible, leading to the electrical disturbances that manifest as seizures, and people with diabetes, particularly those using insulin or certain diabetes medications, are at highest risk for this condition, as noted in the classification of hypoglycemia 1.
From the Research
Symptoms of Hypoglycemic Seizure
- Hypoglycemic seizures can occur when blood glucose levels are severely low, and the brain is not receiving enough glucose to function properly 2
- Severe hypoglycemia can lead to altered mental status, physical symptoms, and even death if left untreated 3, 4
- Symptoms of hypoglycemia may occur at higher blood glucose levels in individuals with poor glycaemic control 5
- Hypoglycemic seizures are a medical emergency and require prompt treatment, such as administration of glucagon or carbohydrate 6, 3
Risk Factors for Hypoglycemic Seizure
- People with Type 1 and Type 2 diabetes are at risk for severe hypoglycemia, particularly those taking insulin or insulin secretagogues 3, 4
- Vulnerable patients with Type 2 diabetes, especially those with "frailty," are at increased risk of severe hypoglycemia and cardiovascular outcomes 5
- Individuals with impaired hypoglycemia awareness, frequent nocturnal hypoglycemia, or a history of severe hypoglycemia are also at increased risk 5
Treatment and Prevention of Hypoglycemic Seizure
- Glucagon is a medication used to treat severe hypoglycemia outside of a healthcare facility, and new formulations, such as intranasal and subcutaneous autoinjector formulations, have become available 6, 3
- Education and regular review are essential for people with diabetes and their caregivers to recognize symptoms, prevent, and treat hypoglycemia emergencies 4
- Continuous glucose monitoring (CGM) and optimizing insulin doses and carbohydrate intake can help reduce the risk of hypoglycemia 5