Emergency Conditions

Hypoglycemia. Intensive insulin or treatments that produce insulin, such as sulfonylureas, increase the risk of hypoglycemia (or insulin shock), which occurs if blood glucose levels fall below normal. Hypoglycemia may also be caused by insufficient intake of food, exercise, or alcohol intake. Usually the condition is manageable, but occasionally, it can be severe or even life threatening, particularly if the patient fails to recognize the symptoms. Mild symptoms usually occur at moderately low and easily correctable levels of blood glucose; they include sweating, trembling, hunger, and rapid heartbeat.

Severely low blood glucose levels can precipitate neurologic symptoms -- confusion, weakness, disorientation, combativeness, and in rare and worst cases, coma, seizure, and death. Patients who experience repeated episodes of hypoglycemia may become insensitive to symptoms; even a single recent episode of hypoglycemia may make it more difficult to detect the next episode. By rigorously avoiding low blood glucose, such patients can regain the ability to sense the symptoms. Most experts recommend that patients monitor blood levels as often as possiblefour times or more per day.

This is particularly important for patients who have a history of experiencing no symptoms of hypoglycemia before mental changes occur. Experts have been concerned that the increased incidence of hypoglycemia accompanying strict blood glucose control could cause mental deterioration over time, but a six-year study has found no evidence of this in adolescents and adults. (The effect on young children, however, is not known).

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