What is a diabetic seizure?

A diabetic seizure, also known as insulin shock or hypoglycemia, is a serious health condition that can occur in people with diabetes. It happens when blood sugar (glucose) levels drop dangerously low. Low blood sugar causes the brain and body to malfunction, leading to seizure activity. Diabetic seizures require emergency medical treatment to prevent complications and even death.

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What causes diabetic seizures?

There are a few key causes of severely low blood sugar that can lead to diabetic seizures:

Taking too much insulin – This is the most common cause. The insulin dose was higher than needed to balance out the available glucose in the bloodstream.
Delaying or missing a meal – Meals provide carbohydrates that are broken down into glucose. When a meal is delayed or missed after taking insulin, glucose levels can plummet.
Getting more physical activity than normal – Exercise uses up glucose for energy. With insulin in the system, this can rapidly lower blood sugar.

Drinking alcohol – Alcohol interferes with the liver’s ability to release glucose into the bloodstream, increasing hypoglycemia risk.
Taking certain medications – Some pills, like sulfonylureas for type 2 diabetes or insulin secretagogues, can cause low blood sugar.

These triggers all have the same result – insulin in the bloodstream without enough glucose available for it to act on. This causes glucose to be rapidly pulled from the blood and dropped to dangerously low levels. The threshold for diabetic seizure is typically considered blood sugar of 50 mg/dL or less.

What are the symptoms of diabetic seizures?

Recognizing the early symptoms of plummeting blood sugar is crucial for diabetics to prevent a full-blown seizure. Symptoms usually appear when glucose drops below 70 mg/dL and may include:

Sweating
Trembling or shakiness

Rapid heartbeat
Anxiety or irritability
Dizziness

Tingling or numbness in the lips or tongue
Blurred vision
Weakness

Fatigue
Confusion
Difficulty speaking

These symptoms are the body’s attempt to alert that glucose is too low. The problem occurs when hypoglycemia is not treated in time before more severe symptoms set in. As blood sugar continues dropping, symptoms worsen and expand to include:

Difficulty concentrating or confusion
Weakness or coordination problems

Slurred speech
Irritability or personality changes
Headache

Blurred or double vision
Loss of consciousness
Seizures

Once glucose falls below 50 mg/dL, seizure activity and loss of consciousness are likely. Prompt treatment is vital at this stage.

What are the types of diabetic seizures?

There are a few types of seizure activity that can stem from severe hypoglycemia. These include:

Generalized tonic-clonic seizure – Also called a grand mal seizure, this causes stiffening and jerking of the muscles. There is usually a short cry at the start as air is forced out of the lungs, followed by violent muscle contractions and loss of consciousness.

Absence seizure – This involves a brief, sudden lapse of consciousness or staring spell. The person may lose muscle tone and appear dazed for up to 10 seconds.
Focal aware seizure – Remaining conscious, the person experiences unusual sensations, emotions, or movements. These signals are generated in one area of the brain.
Focal impaired awareness seizure – Consciousness is altered, appearing as staring or rhythmic blinking. Automatic behaviors like lip smacking may occur.

Generalized tonic-clonic seizures are most frequently associated with severely low blood sugar. The seizure may last for several minutes with profound unconsciousness. Any seizure requires emergency medical care.

Who is at risk for diabetic seizures?

Anyone with diabetes dependent on medications that lower blood sugar can potentially experience a seizure with hypoglycemia. Certain groups have increased risk factors:

People with type 1 diabetes – They lack the ability to produce insulin and rely fully on injected or pumped insulin.

People with hypoglycemia unawareness – A condition where they no longer experience early warning symptoms of low blood sugar.
People on insulin or sulfonylureas – These medications directly cause blood sugar to drop.
People with gastroparesis – This condition causes delayed stomach emptying leading to inconsistent absorption of oral diabetes medication.

People who drink alcohol – Alcohol impacts glucose levels and masks hypoglycemia symptoms.
People who exercise vigorously – High-intensity and endurance exercise can rapidly lower blood sugar.
People who skip meals or follow unstable diets – Inconsistent carbohydrate intake makes managing insulin dosing difficult.

Children and adolescents on insulin therapy are also at increased risk as it can be more challenging to balance diet and activity with insulin dosing in the young. Elderly adults may progress to hypoglycemia unawareness over time, losing protective warning signs of low blood sugar.

What are complications from diabetic seizures?

Diabetic seizures require urgent treatment. Even a single seizure can lead to short-term or long-term complications:

Injury – The intense muscle contractions may cause falls or collisions that result in cuts, bruises, head trauma, or broken bones.

Status epilepticus – A seizure lasting more than 5 minutes or recurring frequently without regaining consciousness. This is a life-threatening emergency requiring hospital intensive care.
Hypoxic brain damage – Lack of glucose causes oxygen deprivation to the brain which can lead to cognitive dysfunction, personality changes, or memory loss if severe.
Aspiration – Vomiting or saliva may be aspirated into the lungs during the seizure, causing pneumonia.

Sudden cardiac death – Severe hypoglycemia can trigger abnormal heart rhythms and even cardiac arrest.
Permanent hypoglycemia unawareness – Recurrent severe hypoglycemia destroys early warning symptoms for future episodes.

Those who experience recurring diabetic seizures have a higher mortality risk over time. Prompt emergency treatment is vital not just for survival but also reducing the risk of short and long-term complications after seizures occur.

How are diabetic seizures treated?

The main goals of treating diabetic seizures are to safely restore normal blood glucose, stop the seizure activity, and prevent complications. Steps include:

Call emergency medical services – Seizures require ambulance transport to the emergency room.
Position the person on their side – This prevents choking on vomit or saliva.

Give glucagon injection if prescribed – This hormone rapidly raises blood glucose and stops seizure activity.
Do not put anything in the mouth – Do not attempt to give food or fluids, which may cause choking.
Administer oxygen – If available, give supplemental oxygen to support breathing.

Treat any injuries – If there has been trauma, stop serious bleeding and immobilize any fractures.
Check glucose level – First responders will check blood sugar and establish IV access.
Give intravenous dextrose – Once in emergency care, rapid dextrose infusion is used to normalize glucose levels.

Thiamine supplementation – Glucose metabolism requires thiamine. Those deficient may also require thiamine before carbohydrate loading.

After the seizure emergency has resolved, further care focuses on identifying what factors precipitated the hypoglycemic episode. This helps prevent future occurrences through medication adjustments, dietary changes, glucose monitoring, and adjusting physical activity routines.

How can diabetic seizures be prevented?

The risk of seizures with diabetes involves both preventing hypoglycemia and responding promptly when blood sugar drops occur. Key prevention strategies include:

Checking glucose levels – Regular self-monitoring ensures levels stay in the target range of 70-180 mg/dL.
Following dietary recommendations – Eating consistent amounts of carbohydrates balanced with insulin or other medications.
Carrying quick-sugar sources – Having glucose tablets or candy on hand to immediately boost low glucose levels.

Wearing medical alert jewelry – This identifies diabetes in case of an emergency situation of severe hypoglycemia.
Measuring blood ketones – When glucose is low, ketones may rise signalling the need for insulin adjustment.
Reducing alcohol – Drinking alcohol lowers glucose levels and impairs judgment around treatment.

Planning activity and insulin – Adjusting insulin dosing in anticipation of increased physical activity.

For those with frequent hypoglycemic episodes, healthcare providers may recommend adjusting diabetes medication dosing. New technologies like continuous glucose monitors and insulin pumps can help stabilize blood sugar levels.

Takeaway on diabetic seizures

Diabetic seizures are caused by severely low blood sugar below 50 mg/dL.

Rapid treatment with intravenous dextrose stops seizures and prevents complications.
High-risk groups include type 1 diabetics, those with hypoglycemia unawareness, alcohol users, and insulin deficient individuals.
Prevention focuses on frequent blood sugar testing, balanced diet, quick-sugar sources, and adjusting physical activity.

All seizures require emergency medical evaluation to identify causes and prevent future episodes through diabetes management adjustments.

Living with diabetes involves constant diligence to maintain glucose balance and avoid extremes that can lead to seizures and other complications. Monitoring blood sugar levels, following nutritional guidelines, adjusting medications, and managing activity help reduce hypoglycemia risk. Seeking immediate treatment when blood sugar drops too low is critical for both short-term recovery and long-term health.