Diabetic Seizure

Overview

A diabetic seizure is a seizure (sometimes called a fit) that happens because of a problem with blood sugar in someone who has diabetes. Most often it is caused by blood sugar dropping too low. Doctors call this hypoglycemia (say: hy-po-gly-SEE-mee-ah). The brain runs almost completely on glucose (sugar), so when levels fall very low the brain cannot work properly. This can lead to confusion, strange behaviour, jerking movements, passing out, or a full seizure. Less often, a seizure can happen when blood sugar is extremely high, particularly in people with type 1 diabetes who become very unwell. A diabetic seizure is a medical emergency and needs help straight away, but most people recover fully once their blood sugar is treated.

Low blood sugar is common in people who take insulin, and many will have at least one serious episode. Actual seizures are much less common and happen in a smaller group of people, usually after a very low reading. Because more people now live with diabetes and use insulin, doctors are working harder to prevent these events with better monitoring and education.

Anyone with diabetes can be affected, but the risk is highest in people who take insulin or certain diabetes tablets, people who have had diabetes for many years, children and young people with type 1 diabetes, and older adults. Risk also rises with heavy drinking, missed meals, unusual exercise, kidney problems, and some other illnesses.

Symptoms

Common symptoms

• Early warning signs of low blood sugar: shaking, sweating, a pounding heart, hunger, dizziness, and feeling irritable or anxious
• Confusion, difficulty speaking clearly, slurred speech, or behaving oddly
• Blurred vision, weakness, or trouble concentrating
• Suddenly feeling very sleepy or hard to wake
• Jerking or stiffening of the body, loss of consciousness, or a full seizure
• Afterwards: headache, tiredness, sore muscles, and not remembering what happened

Symptoms in children

• A first seizure can sometimes be the first sign of type 1 diabetes in a child
• Staring spells, body jerking, or suddenly going floppy
• Being very sleepy, clingy, or hard to rouse, especially in the morning
• Bedwetting or night sweats from low blood sugar overnight
• Early warning signs may be missed because a young child cannot describe them

Symptoms in older adults

• Confusion or odd behaviour that is mistaken for dementia or just getting older
• Falls, especially with no clear reason
• Feeling faint, weak, or unsteady
• Fewer or no early warning signs of low blood sugar
• Low blood sugar overnight causing nightmares, sweating, or a headache on waking

Causes

Main causes

• Too much insulin or too strong an effect from diabetes tablets compared with the food eaten or activity done
• Skipping or delaying meals, or eating less than usual
• Unusual or extra physical activity without adjusting food or medicine
• Drinking alcohol, especially on an empty stomach, because alcohol blocks the body's normal sugar-raising response
• Being ill, or having kidney or liver problems that change how medicines work
• Very high blood sugar in severe illness, which is a much rarer cause of seizures
• Other causes of seizures that have nothing to do with diabetes, such as epilepsy, infection, or a head injury, which doctors will check for

Risk factors

• Using insulin, or taking certain diabetes tablets that can lower sugar
• Having had diabetes for many years, or having lost the early warning signs of low blood sugar
• Tight blood sugar control without much support or monitoring
• Being a young child or an older adult
• Drinking a lot of alcohol
• Kidney disease, or an illness with vomiting or diarrhoea
• Living alone, or having memory problems that make it hard to manage medicines safely

When to see a doctor

See a doctor urgently if:

• You have had any seizure or near-seizure, even if you feel fine now
• Your blood sugar has dropped very low more than once in a short time
• You no longer notice the warning signs of a low blood sugar
• A child or older adult in your care is having low blood sugars often
• Your blood sugar is high and you are being sick or feel very unwell

Book a routine appointment if:

• You want to review your diabetes medicines, meal pattern, or monitoring plan
• You would like training on what to do in an emergency, including for family and friends
• You are worried about low blood sugars at night, at work, or while driving
• You feel anxious about having another low blood sugar or seizure

Diagnosis

Doctors usually diagnose a diabetic seizure by putting together the story of what happened, the blood sugar reading at the time or soon after, and a review of your diabetes medicines and daily routine. They will also want to rule out other causes of seizures, such as epilepsy, infection, a head injury, or problems with heart rhythm. The blood sugar level, either from a finger-prick test or a sensor, is the most important clue.

Tests that may be done

• A blood sugar check at the time of the event, if possible, or as soon as you are found
• A review of your glucose meter, sensor, or app history
• An HbA1c blood test, which shows your average blood sugar over about three months
• Blood tests to check kidney, liver, and hormone function, and to look for infection
• A heart tracing (ECG), because some heart problems can cause fainting that looks like a seizure
• A brain scan or brain wave test in some cases, to rule out other causes of seizures

What to expect at your appointment

You will likely be asked detailed questions about the day it happened: what you ate, your medicines, activity, alcohol, and sleep. Bring any glucose records and the medicines you take, including any you buy over the counter. Your diabetes team will then work with you on a plan to lower the chance of it happening again. You may be asked not to drive until your doctor says it is safe, so plan for that.

Treatment

Treatment has two parts: getting through the emergency safely, and then changing your diabetes plan so it is less likely to happen again. During a seizure, the priority is to keep the person safe and call for help. Afterwards, the person needs their blood sugar raised, usually with a prescribed emergency medicine that can be given by injection or nasal spray, or with fast-acting sugar once they are fully awake and can swallow safely. Longer term, treatment is about the right balance of food, activity, and diabetes medicines.

Self-care at home

• Always carry fast-acting sugar with you, such as glucose tablets or a sugary drink, and know how much your team advises
• Wear or carry medical ID saying you have diabetes
• Make sure family, friends, and colleagues know what to do, and where your emergency kit is kept
• Check your blood sugar more often during illness, after alcohol, and around exercise
• Follow your sick-day plan, which your diabetes team should give you in writing
• Keep a record of low blood sugars, including the time of day and what you were doing, and share it with your team
• Eat regular meals and avoid drinking heavily on an empty stomach

Medical treatments

Your diabetes team will look at why the seizure happened and adjust your plan. That may mean changing the type, timing, or amount of your diabetes medicines, changing when you eat, or using a different insulin routine. Many people are offered a continuous glucose monitor, which is a small sensor worn on the skin that checks sugar levels all the time and can sound an alarm before levels get dangerously low. You may also be offered structured education to help you recognise and treat low blood sugar, and extra training for the people you live with. If the seizure was not caused by low blood sugar, or if tests show another cause, your doctor will discuss the right treatment for that.

When is surgery considered?

Surgery is not used to treat diabetic seizures.

Living with this condition

Most days with diabetes are ordinary days. Living safely with the risk of low blood sugar means building a few habits: carrying sugar, checking levels before driving and before bed, keeping your emergency kit stocked and in date, and making sure the people around you know what to do. It also helps to know your own patterns, such as whether your lows happen in the afternoon after exercise, or at night after a big meal and a glass of wine.

Lifestyle tips

• Keep to a regular meal pattern, and take snacks for exercise or long journeys
• Be careful with alcohol: eat when you drink, and check your sugar before bed afterwards
• Check your blood sugar before driving, and follow your country's rules about driving with diabetes
• Tell your employer and trusted friends about your diabetes and what to do in an emergency
• Keep an emergency kit with you and check the expiry dates regularly
• Have a plan for illness, and know how to get help quickly
• Get enough sleep, and tell your team if you have night-time lows

Diet and exercise

You do not need a special diet, but regular meals with slow-release carbohydrates, fruit, vegetables, and enough fibre help keep blood sugar steady. Exercise is very good for you, but it can lower blood sugar for many hours afterwards, so check your levels before, during, and after activity, and ask your team about adjusting food or medicine. Drink water, and take fast-acting sugar with you when you are active.

Mental health and emotional wellbeing

It is completely normal to feel shaken after a seizure. Many people become anxious about having another one, worry about being alone, or lose confidence about going out. Some people avoid exercise or driving, or feel embarrassed and stop telling people they have diabetes. These feelings are common and treatable, and talking about them with your diabetes team or a counsellor helps. If you are feeling hopeless, very anxious, or having thoughts of harming yourself, please reach out for crisis support in your area straight away. You do not have to cope alone.

Prevention

Often, yes. Most diabetic seizures are caused by severe low blood sugar, which can be reduced with the right balance of food, activity, and medicines, and with better monitoring. Ask your team about a continuous glucose monitor with a low-glucose alarm, about reviewing your medicines, and about education on recognising and treating low blood sugar early. Having an emergency plan and a kit that others know how to use also reduces the risk of harm.

Vaccines

There is no vaccine for diabetic seizures. Staying up to date with routine vaccinations matters for everyone with diabetes, because infections can upset blood sugar control. Ask your pharmacist or doctor which vaccinations are recommended for you.

Screening programmes

There is no screening test for diabetic seizures specifically. What helps is regular diabetes review: checking your average blood sugar, asking about night-time lows, reviewing your medicines, and checking your kidney function. If you have had a seizure, your doctor may arrange tests such as a heart tracing or brain scan to rule out other causes.

Complications

If left untreated

• Injury from falling, especially head injury
• Breathing problems if someone vomits during a seizure
• Brain injury from very prolonged low blood sugar, which is rare but serious
• Confusion and exhaustion afterwards, which can last hours
• Loss of consciousness or coma
• In very rare cases, death, which is why calling emergency services matters

Long-term outlook

The outlook is good for most people. Most seizures stop within a few minutes, and once blood sugar is treated, people usually recover fully within hours. The most important thing you can do is to treat low blood sugar early, have a written plan, and review your diabetes care with your team so the risk of it happening again is lower. Many people live full, active lives with diabetes after an episode like this.

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