Insulin and Hypoglycemia

Insulin is a high-alert medication because a dose that is appropriate in one circumstance can become dangerous when food intake, activity, kidney function, or insulin sensitivity changes. Hypoglycemia is the most immediate medication-related threat: the brain depends on a continuous glucose supply, while excess insulin continues lowering plasma glucose even when the person is no longer eating. The bedside priority is not simply to obtain a number. First determine whether the person is conscious, able to protect the airway, and able to swallow safely. A person who is sweaty and trembling but answering appropriately needs a different intervention from a person with the same glucose reading who is confused, seizing, or unable to swallow. A low glucose value is also not the whole definition of severe hypoglycemia. Diabetes Canada’s current classification uses the clinical effect and the assistance required, so a person who needs another individual to provide treatment has Level 3 hypoglycemia regardless of the measured glucose.