Does this sound like insulin/hypoglycemic shock to you?

In My Humble Opinion
1

My friend, a theater manager, just told me a story about something that happened in her movie theater this weekend. Nothing about it is matching up with any experience I’ve ever had or anything I’ve ever heard, so I appeal to you, the Teeming Millions.

This is the story as my friend related it to me.

Halfway through an evening show, a woman, her sister, and her sister’s daughter come out of the theater they were in. They are all diabetics. The woman’s sister (S) tells the employees in the box office that she needs to call 911 because her sister is a diabetic and she needs help. They call 911 for her, and she gives all the pertinent information. S is relatively calm then, but as things go on she is becomes increasingly hysterical. She keeps protesting that her sister needs A Shot and everything will be all right. The niece (N) is calm throughout this, and tries to keep her mother calm, but doesn’t have much success.

Meanwhile, the woman (W) is huddled in a corner of the lobby, with her knees pulled up to her chest and screaming – my friend described it as “screaming in pain.” She entered the lobby under her own steam and was lucid enough to tell my friend that the supposed low blood sugar came up on her fast, but rapidly became uncooperative. She has her jaw clenched shut, and won’t unlock it to drink any Coke. N tries to get her to drink some by forcing her lips open and pouring it in her mouth, but she spits it back out and refuses to swallow it. W is pretty much screaming whenever she can throughout this entire process. Whenever anyone touches her, she screams more loudly.

The paramedics arrive after about ten minutes (during which period the cops and the fire department have already shown up), and S flies at them, screaming that her sister needs A Shot, won’t they give her A Shot and make it better! She becomes such an annoyance and impediment that a police officer tells her to “shut the hell up or leave.” She shuts up. The paramedics don’t give W a shot of anything during the entire time they’re there. They bundle her up on a stretcher and take her away in the ambulance.

There are a couple of things about this that are just plain strange to me as a diabetic:

  1. All three of them are diabetics, and they all seem to know what’s going on and what needs to be done. But none of them are carrying any glucagon (what I’m assuming The Shot is) and none of them make any moves to check W’s blood sugar. I’m assuming this has happened before – why aren’t any of them prepared to handle it?

  2. I have never, in all my 17 years as a diabetic, had a low blood sugar that involved “screaming in pain”, and I’ve never heard of another diabetic doing it either. It certainly isn’t on any of the common symptoms lists. Would this fit under “irritability”? It seems rather extreme compared to the irritability I experience, which is more like PMS than anything else – crying jags and bitchiness.

  3. The women never elaborate as to what The Shot is. That’s just weird to me. Glucagon is a shot, yes, but not one that I would call A Shot.

  4. The fetal position and clenched muscles of W. All of the diabetics I know, myself included, lose muscle control when very low. I’m not talking “Oh! I have wet myself!” but more being unable hold a glass or walk without falling over.

So, what say you diabetics and doctors of the SDMB? Does this sound like insulin shock or not? I realize it might be hard to tell from what I’ve given you, but it doesn’t sound like anything I’ve ever heard of before related to insulin shock. It’s just so over-the-top and dramatic, and that’s really not my friend’s storytelling style.

2

Doesn’t sound anything like the insulin shocks that I’ve witnessed. Both people that I saw go into hypoglycemic shock (several times each) were at first clumsy, then slack and unresponsive.

Obviously, I’m not a doctor and my own experiences don’t preclude the possibility of this being as they described it, but to me, it sounds more like a panic attack. I seem to remember reading somewhere that low blood sugar can trigger a panic attack in diabetics that are prone to them, but I can’t for the life of me remember where I read it or even if it’s accurate.

3

Hypoglycemia means low blood sugar. It is also called insulin shock or insulin reaction. Low blood sugar happens when there is too much insulin, too little food, or too much exercise. Alcohol such as beer, wine or liquor can also cause hypoglycemia.

Low blood sugar is more common in people taking insulin than in those who use pills to manage their diabetes. It rarely happens when diabetes is diet-controlled. It sometimes happens in persons without diabetes, but this is very uncommon. The longer insulin is used, the higher the chance of getting low blood sugar.

Early signs of hypoglycemia are:

  • shakiness,
  • sweating,
  • hunger,
  • dizziness,
  • blurry vision, and
  • being unable to concentrate.

Later signs of low blood sugar are:

  • headache,
  • confusion,
  • mood changes, and
  • coma or seizure.

Medical Encyclopedia: Hypoglycemia

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000386.htm

Alternative names
Insulin shock; Low blood sugar

Definition

Hypoglycemia occurs when your blood sugar, called glucose, is abnormally low. The term insulin shock is used to describe severe hypoglycemia that results in unconsciousness.

Causes, incidence, and risk factors

Hypoglycemia results when your body’s glucose is used up too rapidly, when glucose is released into the bloodstream too slowly, or when too much insulin is released into the bloodstream. Insulin is a hormone that reduces blood glucose. It is produced by the pancreas in response to increased glucose levels in the blood.

Hypoglycemia is relatively common in diabetics. It occurs when too much insulin or oral antidiabetic medication is taken, not enough food is eaten, or from a sudden increase in the amount of exercise without an increase in food intake.

Relative hypoglycemia, where a newborn’s blood glucose is low, is fairly common. Severe hypoglycemia may occur in an infant born to a woman with diabetes or gestational (caused by pregnancy) diabetes. In these cases, the child is referred to as an IDM (infant of diabetic mother).

If, during the pregnancy, the mother’s blood sugar is persistently high, the fetus’ pancreas assists in controlling the excess blood sugar by producing extra insulin. When the infant is born, it no longer gets the mother’s glucose, but still produces large amounts of insulin, which drives the infant’s blood sugar down to dangerous levels. This is a medical emergency that may result in seizures and damage to the baby’s nervous system if not treated.

Sometimes the cause of hypoglycemia is unknown (idiopathic). In these cases, people who are not diabetic and who do not have another known cause of hypoglycemia experience these symptoms.

Hypoglycemia can occur because of an insulin-secreting tumor of the pancreas, liver disease, or as a response to the ingestion of alcohol. It can occur in adults, infants, and children, and affects approximately 1 out of every 1,000 people.

Symptoms

* Fatigue
* General discomfort, uneasiness, or ill feeling (malaise)
* Nervousness
* Irritability, or even aggression
* Trembling
* Headache
* Hunger
* Cold sweats
* Rapid heart rate
* Blurry or double vision
* Confusion
* Convulsions
* Coma

Additional symptoms that may be associated with this disease:

* Excessive sweating
* Sleeping difficulty
* Paleness

*** Muscle pain**
* Memory loss
* Palpitations, or feeling your heartbeat (heartbeat sensations)
* Hallucinations
* Fainting
* Different size pupils
* Dizziness
* Decreased consciousness

Signs and tests

* Serum glucose, or sugar level in the blood, is low.
* If the person is self-checking blood glucose levels, readings will be low (less than 50 mg/dl).

This disease may also alter the results of the following tests:

* Glucose tolerance test
* CSF collection
* Blood glucose monitoring

Treatment

A snack or drink containing sugar will raise the blood glucose level, and you should see an immediate improvement in symptoms.

Infants of diabetic mothers that develop low blood sugars are treated with glucose solutions given into the vein to maintain the blood sugar at normal levels. The glucose is slowly reduced over the next 24 - 48 hours while the infant begins to regulate its blood sugar at normal levels.

Unconsciousness or inability to swallow may occur if the person’s blood sugar levels are very low. This is called insulin shock, and emergency medical treatment is needed. An injection of glucose solution or the hormone glucagon will be given immediately.

In the longer term, you may need to modify your diet so that you get glucose into your body more evenly throughout the day. This may prevent further hypoglycemic episodes. Small, frequent meals with complex carbohydrates, fiber, and fat and avoiding simple sugars, alcohol, and fruit juice may be recommended. You should also eat meals at regular intervals, and balance extra exercise with extra food.

If hypoglycemia is caused by an insulinoma (insulin-secreting tumor), surgery to remove the tumor is the best treatment.

Expectations (prognosis)

Severe hypoglycemia can often be avoided by recognizing the early warning signs of the condition and treating yourself rapidly and appropriately. Untreated hypoglycemia can progress to unconsciousness and if the brain is exposed to reduced glucose for a long period of time, there may be permanent damage.

Complications

* Loss of consciousness
* Coma

In the infant

* Seizure
* Permanent damage to the nervous system

Calling your health care provider

Go to the emergency room immediately or call a local emergency number, such as 911, if early signs of hypoglycemia do not improve after you’ve eaten a snack containing sugar. If a diabetic, or other person known to experience hypoglycemia, becomes unresponsive or you can’t wake them, you should also call an emergency number.

Prevention

Diabetics should follow their doctors’ advice regarding diet, medications, and exercise.

Pregnant diabetic women should maintain careful control of their blood sugar. Gestational diabetes, or diabetes that occurs during pregnancy, is diagnosed by repeat testing of expectant mothers. Upon delivery, routine blood sugar levels are taken from the infant until blood sugar levels are normal.

People who are known to experience hypoglycemia should keep a snack or drink containing sugar available at all times to take as soon as symptoms appear. If symptoms do not improve in 15 minutes, additional food should be eaten. A glucagon kit is available by prescription for episodes of hypoglycemia that respond poorly to other types of treatment.

4

In my experience, hypoglycemia presents with a “thousand yard stare,” people look right through you, appear to be paying attention but don’t respond to questions or instructions. That and cold clammy skin in a known diabetic would have me reaching for the glucagon without an accucheck if I didn’t think I could get an IV, but IV dextrose would be my first choice and you can almost always check a sugar when you start one.
Larry

5

Miss Purl McKnittington- I wouldn’t worry about them saying “a shot” instead of glucagon. I know people who have had 3 heart attacks, and when you ask them what medications they take it’s “the heart pills, you know, the white ones”.

The muscle rigidity could be a diabetic seizure. Perhaps it wasn’t a hypo at all, it could be a kidney stone, a seizure, even small bowel ischaemia or something completely unrelated to her diabetes. Maybe there was an element of drug or alcohol abuse.

Perhaps the adrenalin surge of her sister being unwell caused S to become slightly hypo herself, explaining her behaviour.

Possibly the paramedics didn’t have a glucometer, or weren’t happy to give glucagon without the hypo being confirmed by a doctor. Different hospitals have different policies on when to give glucagon and who should give it.

6

Why would she spit out the soda instead of swallowing it though? :confused:

7

It’s also possible they weren’t paramedics, just EMTs, especially if it’s just a volunteer service (Miss Purl McKnittington didn’t say eithe way, so it is possible they are.) EMTs can only adminster a very, VERY, short list of drugs, and even then they almost always have to radio a hospital to get a doctor’s permission. The ambluance I ride with only has a few doses of epipen (a specific brand of epinephrine/adrenaline) for anaphylatic shock, and a few doses of albuterol for severe asthma attacks. They also have activated charcoal and ipecac. For hypoglycemia, we just give an oral glucose gel. We have no glucometer on board (though I think it might be in the budget for this year). Since we don’t carry insulin or glucagon, there’s no real need, other than just to confirm that that’s what it is before we get to the hospital (the more info you can give an ER before you get there, the better.) If we suspect someone has low blood sugar, we can give glucaose gel and it’s not like anything bad will happen if they don’t have low blood sugar.

8

This is just what I was going to say. It depends on the level of training of the medics. I’m an EMT with a volunteer company, and we do have glucometers and the oral glucose gel, but I’m not allowed to give insulin at my level of training. If it came out that the person was having a diabetic emergency, checking her blood sugar would be my first thought, but if she was screaming whenever someone came near or touched her, I don’t know how I’d accomplish it.
Perhaps they got her in the ambulance (strapped down on the gurney) and then checked it.

9

Hmm, the panic attack theory sounds promising. I could understand how a low blood sugar could trigger one.

I’m still kind of surprised that the women – all three of them diabetics – were so unprepared and inarticulate. I don’t leave the house without at least my glucometer and some glucose tablets or one of those tubes of cake decorator’s gel (because it’s cheaper than the glucose gel.) And The Shot thing was just kind of weird. I suppose I shouldn’t underestimate people’s ability to be uninformed about their own health.

Thanks for the input, everyone.

10

IMO it sounds like low BS compounded by other things–some mental perhaps.

I have never heard or seen a hypoglycemic pt clench their jaws shut, though.
I am wondering if there wasn’t a hidden second issue going on–be it physiological or psychological.

It all sounds more exciting that the movie, at any rate.

11

I’ve treated hundreds of patients in hypoglycemic states and they generally get spacey and slack-jawed and poorly responsive until they seize.

What the OP describes certainly doesn’t sound like any typical or near-typical hypoglycemic reaction.

Of course if the patient was on insulin or an oral hypoglycemic agent (like glyburide or other sulfonylureas) it sure would have been nice to know the blood sugar ASAP.

12

You’d be amazed. People with asthma call their inhalers “puffers” or “blowers” or “sucker thingys.” It’s not like ‘inhaler’ is a big technical term.

13

I think the difference between asthma and heart conditions (with a very limited knowledge of the specific treatments for these conditions on my part, mind you), vis a vis the vagueness of calling for “the shot,” is that for diabetes a shot of insulin and a shot of glucagon are drastically different things. Family members, especially with their own personal experience with diabetes, would or should be familiar enough to be specific.

I have experience only with my son in terms of hypoglycemic events, but the description in the OP is completely inconsistent with them. I would suspect, just based on the description of the OP, that other issues were afoot.

14

I’m hypoglycemic and when my sugar drops I do eventually reach a point of muscle rigidity combined with lack of coordination. It doesn’t last long (10 minutes maybe) and it is often accompanied by a muscular “discomfort.” After the rigidity passes my muscles more or less become slack and heavy.

As for what happened to the lady at the theatre, I have no idea.

15

Maybe the movie just sucked?

16

I"ve seen one of my friends become confused, violent, and screaming because she had severe hypoglycemia once. Her blood sugar was so low, I don’t think it registered on the meter. After some orange juice (it took two of us to make her drink it) she became coherent and her blood sugar only registered fifty something.