Taking too much fast-acting insulin leads to dangerously low blood sugar, a condition known as hypoglycemia. This rapid-acting medication quickly moves glucose from the bloodstream into the body’s cells, meaning an excess dose causes a swift drop in blood sugar levels. Immediate and informed action is necessary to prevent life-threatening complications like seizures, coma, or death. Because fast-acting insulin begins working quickly, usually within 15 to 30 minutes, there is a narrow window to intervene. Understanding the correct protocol for different levels of low blood sugar is paramount for anyone who uses this medication.
Recognizing the Signs of Hypoglycemia
The signs of low blood sugar are categorized by severity, and recognizing the differences is crucial for determining the correct response. Mild to moderate hypoglycemia occurs when blood glucose falls below 70 mg/dL, presenting with noticeable physical and cognitive symptoms. Initial warning signs include feeling shaky or jittery, increased anxiety, excessive sweating, or clammy skin. Individuals might also experience a rapid heartbeat, intense hunger, dizziness, or a mild headache.
As blood sugar continues to drop, symptoms progress to confusion, difficulty concentrating, or irritability. Severe hypoglycemia is defined by a blood glucose level below 54 mg/dL and is marked by the inability to self-treat due to mental or physical impairment. Signs of this medical emergency include slurred speech, loss of coordination, seizures, or a complete loss of consciousness. Immediate recognition of these severe symptoms signals the need for external assistance and emergency treatment.
Immediate Steps for Mild to Moderate Hypoglycemia
When blood sugar is low but the individual is conscious and able to swallow safely, the primary treatment strategy is the “Rule of 15.” This method involves consuming 15 grams of a fast-acting carbohydrate, waiting 15 minutes, and then retesting the blood glucose level. The goal is to raise the blood sugar quickly without causing an overshoot into hyperglycemia. Select pure, fast-release carbohydrates that lack fat or protein, as these slow down glucose absorption.
Examples of suitable 15-gram carbohydrate sources include three to four glucose tablets, four ounces (half a cup) of fruit juice or regular soda, or a tablespoon of sugar, honey, or corn syrup. After consuming the carbohydrate, the 15-minute wait allows time for the simple sugars to enter the circulation. If the retest shows the blood glucose remains below 70 mg/dL, repeat the process of consuming 15 grams of carbohydrate and waiting another 15 minutes.
Once the blood sugar is back in the safe range (above 70 mg/dL), consume a small snack containing a longer-acting carbohydrate, such as crackers or fruit, if the next meal is more than an hour away. This secondary step helps stabilize the blood sugar and prevent another dip, which is important after an insulin overdose. This protocol is only for individuals who are fully alert, as giving food or liquid to someone confused or unable to swallow presents a significant choking hazard.
Handling Severe Hypoglycemic Emergencies
A severe hypoglycemic emergency occurs when the person is too confused, disoriented, or unconscious to safely consume oral carbohydrates. Immediate medical assistance is necessary, and the caregiver must call emergency services right away. While waiting for help, the life-saving protocol involves administering emergency glucagon, a hormone that signals the liver to release its stored glucose into the bloodstream.
Glucagon is available as an injection kit requiring mixing or in newer, ready-to-use forms like pre-mixed pens or a needle-free nasal spray. The medication is typically given into the thigh, arm, or stomach. If using a traditional kit, the powder must be dissolved with the accompanying liquid before injection, but newer devices simplify this process.
After administering glucagon, the individual must be immediately turned onto their side, known as the recovery position. Glucagon commonly causes nausea and vomiting, and this positioning prevents choking. Glucagon should take effect within 10 to 15 minutes, and the person should regain consciousness or become alert enough to swallow. Even if the person wakes up, emergency medical services are still required to ensure continued care and safe recovery.
Post-Emergency Monitoring and Prevention
After a hypoglycemic episode, especially one caused by an insulin overdose, continuous blood sugar monitoring is required for several hours. Checking glucose levels every one to two hours is necessary to ensure stability and catch any potential secondary drops. Once the crisis has passed, the individual must contact their healthcare provider immediately to discuss the incident and review the cause of the overdose.
A healthcare team can help adjust the medication regimen to prevent future events, as a large overdose may require a change in dosing or insulin type. Prevention strategies focus on minimizing common causes of accidental overdose, such as miscalculating carbohydrates or injecting the wrong type of insulin. Individuals should always double-check the dosage units on their pens or syringes and never mix up fast-acting and long-acting insulin products. Consistent meal timing and careful storage of supplies also help ensure correct medication delivery.