Side Effects Of Insulin Therapy And Hypoglycemia Treatment
Antidiabetic therapyÂ isÂ mandatory in type 1 diabetes mellitus (insulin) and necessary in type 2 diabetes, whichÂ can be treated with aÂ correct indicatedÂ diet by the physicianÂ andÂ fully respected by the patient (oral medication or insulin). InsulinÂ has anÂ absolute indication for type 1 diabetes, type 2 diabetes complicated with ketoacidosis orÂ pregnancy. Relative indications of insulin may be permanent: type 2 diabetes requiring insulinÂ or temporary in case of infection,Â myocardial infarction, during surgery.
Insulin does not cause addiction, which means that its administration in type 2 diabetes may be interrupted if the disease permits it.
Generally any drug canÂ cause adverse effects.Â It is also the case of insulinÂ that possesses a number of adverse effects that any patient with diabetesÂ should to be aware of.
Insulin side effects
Hypoglycemia is the most common and most serious side effect ofÂ insulin, very serious, sometimes fatal.Â It is defined by blood sugar levels under 65 mg % (3.6 mmol / l). Hypoglycemia may occur after any type of insulin and results in brain damage by lowering oxygen consumption of theÂ brain,Â more seriousÂ the lowerÂ blood sugar levels are. Sometimes, after years of illness, intellectual capacity greatly decreases atÂ a relatively young age (around 50 years) due to destruction of neurons, a condition calledÂ hypoglycemicÂ encephalopathy.
Factors that favor the occurrence of hypoglycemia due to insulin are very varied.
- Insulin overdose, most commonly in the intensive treatment
- Not eating – the omission of a meal, after insulin was injected (eg, patient falls asleep)
- TheÂ long interval between the injectionÂ andÂ the carbohydrate meal orÂ mealsÂ containing aÂ smallÂ quantity ofÂ carbohydrates.
- Injecting insulin into a blood vessel
- More physical activity than usual, without precautions against hypoglycemia.
- The presence of vomiting and diarrhea.
- Alcohol intake
Clinical manifestations of hypoglycemia are extremely varied, depending on blood sugar levelsÂ and individual factors, some patientsÂ handling hypoglycemiaÂ better than others.
In mild and moderate forms:
- Epigastric pain
- Extreme hunger sensation
- Mouth tingling
- Unusual fatigueÂ which isÂ rapidly installed
- Headaches,Â especially frontal and scheduled
- DiplopiaÂ (double vision)
- Mild agitation, disorientation
In severe forms (in addition to mild and moderate form)
- Loss of consciousnessÂ (coma) and seizures, bilateral Babinski sign.
If not recognized early, hypoglycemic comaÂ can lead toÂ severe brain damage andÂ even brain death. It is important to state that some patients lose warning signs of hypoglycemia (hypoglycemia awareness), hypoglycemiaÂ is asymptomatic and isÂ installed withoutÂ any warningÂ signs leading to coma very rapidly. Some patientsÂ remain asymptomatic at extremely low blood sugar levels (below 30 mg%), while others show signs of mild and moderate hypoglycemiaÂ at close toÂ normalÂ blood sugar levels.
Treatment of mild to moderate hypoglycemia: the ingestion of sugar, as such, or sweetened tea, syrups, sweet drinks. This measure is urgent, as rapid progression to coma is very probable. Therefore, all diabetics must have sugar on hand at any time of day, glucose (tablets), or soft candy.
Hypoglycemic coma. 1-2 mgÂ of glucagon is administered (in the muscle). GlucagonÂ increases blood sugar levelÂ byÂ releasing glucose depositsÂ from theÂ liver.Â IfÂ glucagon is not available,Â 33% hypertonic glucose is injected intravenously until the patient recovers (sometimes more than 300ml). Because it is an emergency, treatment isÂ started immediately afterÂ diagnosis,Â including family members (immediately after they called 112 / 911). IfÂ Â you can notÂ differentiateÂ hyperglycaemic comaÂ from hypoglycemic coma (inÂ absenceÂ of blood glucose testing),the comaÂ is treated as a hypoglycaemic coma. Glucose administration does not harm in case of hyperglycemia, but saves the patientÂ inÂ the case of hypoglycaemic coma.
Other InsulinÂ Side Effects
- Allergy: human insulin is theoretically free of this risk, which in practice can be observed, however, extremely rare
- Insulin resistance, a condition defined by a higher necessary perÂ dayÂ (more than 1.5-2 units / kg or 200 units per day).
- Lipodystrophy (fat redistribution), atrophic and hypertrophic form, modifying the local reabsorption of insulin.
- Local abscess (very common among insulin side effects)
- Injection site pain
- Visual disturbances atÂ the start of treatment (reversible within a couple ofÂ weeks)
- Insulin edema (rare in women who use high doses)