What to do about hypoglycemia (low blood sugar) due to insufficient insulin?

From the Guidelines

If you have low insulin levels, consult a healthcare provider immediately for proper diagnosis and treatment, as delaying treatment can lead to severe complications such as diabetic ketoacidosis, a life-threatening condition requiring emergency treatment. For type 1 diabetes, insulin replacement therapy is essential, typically using multiple daily injections or an insulin pump with combinations of rapid-acting (like Humalog, Novolog, or Fiasp) and long-acting insulins (such as Lantus, Levemir, or Tresiba) 1. For type 2 diabetes with insufficient insulin, oral medications like metformin, sulfonylureas, or DPP-4 inhibitors may be prescribed first, with insulin added if necessary.

Key Considerations

• While waiting for medical care, maintain stable blood sugar by eating regular meals with complex carbohydrates, staying hydrated, and avoiding sugary foods.
• Monitor blood glucose levels frequently, as low insulin can lead to hyperglycemia (high blood sugar), which may progress to diabetic ketoacidosis in type 1 diabetes—a life-threatening condition requiring emergency treatment.
• Insulin is crucial because it allows cells to use glucose for energy; without it, glucose builds up in the bloodstream while cells starve, forcing the body to break down fat for fuel and producing dangerous ketones.

Hypoglycemia Treatment

• In cases of hypoglycemia, ingestion of 15–20 g glucose is the preferred treatment, although any form of carbohydrate that contains glucose may be used 1.
• The response to treatment of hypoglycemia should be apparent in 10–20 min; however, plasma glucose should be tested again in 60 min, as additional treatment may be necessary.

Nutrition Therapy

• Strategies for all people with diabetes include portion control, choosing nutrient-dense, high-fiber foods, and avoiding sugary drinks and foods with added sodium, fat, and sugars 1.
• For individuals with type 1 diabetes and insulin-requiring type 2 diabetes, learning how to count carbohydrates or using another meal planning approach to quantify carbohydrate intake is crucial to match mealtime insulin to carbohydrates consumed.

Prevention of Complications

• Prevention of hypoglycemia and hyperglycemia is key, especially in older adults and those with advanced disease, where careful monitoring of oral intake and adjustment of medications as necessary can help prevent these complications 1.

From the FDA Drug Label

If a hypersensitivity reaction occurs, the patient should discontinue SOLIQUA 100/33 and promptly seek medical attention. Changes in insulin regimen (e.g., insulin strength, manufacturer, type, injection site or method of administration) may affect glycemic control and predispose to hypoglycemia Hypoglycemia is the most common adverse reaction associated with insulin-containing products, including SOLIQUA 100/33 Hypoglycemia may occur as a result of an excess of insulin relative to food intake, energy expenditure, or both.

The question about low insulin does not have a direct answer in the provided drug labels. However, the labels discuss hypoglycemia, which is a condition that can occur when there is too much insulin relative to food intake or energy expenditure.

• Hypoglycemia can be treated with oral glucose for mild episodes, and adjustments in drug dosage, meal patterns, or exercise may be needed.
• More severe episodes may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous glucose.
• Low insulin is not directly addressed, but it can be inferred that if a patient is experiencing high blood glucose, their insulin dose may need to be adjusted under close medical supervision 2, 3.

From the Research

Low Insulin Management

To manage low insulin levels, several strategies can be employed:

• Frequent monitoring of blood sugars with home blood glucose tests and sometimes continuous glucose monitoring (CGM) to identify hypoglycemia, especially in cases of hypoglycemia unawareness 4
• Prompt measured hypoglycemia treatment, attempts to reduce glycemic variability, balancing basal and meal insulin therapy, and a pattern therapy approach 4
• Use of a physiological mimicry with insulin analogues in a flexible manner 4
• Consideration of individualized therapy and glycemia goals to minimize the risk of hypoglycemia 4

Insulin Therapy

Different types of insulin can be used to manage low insulin levels:

• Insulin glargine and detemir are two commonly prescribed basal insulin analogues for the management of diabetes 5
• Insulin lispro protamine has been shown to be effective in reducing glycaemic variability and improving glycaemic control in people with type 1 diabetes 6
• The choice of insulin therapy should be based on individual patient needs and characteristics, such as the presence of hypoglycemia unawareness or a history of severe hypoglycemia 7

Hypoglycemia Management

To manage hypoglycemia, the following strategies can be employed:

• Treatment with 15-16g of carbohydrates, with repeat treatment if hypoglycemia persists after 15 minutes 8
• Optimization of insulin doses and carbohydrate intake, as well as a short warm-up before or after physical activity sessions to avoid hypoglycemia 7
• Consideration of continuous glucose monitoring (CGM) for individuals with increased risk of hypoglycemia, impaired hypoglycemia awareness, or a history of severe hypoglycemia 7