Insulin Shock vs. Diabetic Coma

Medically Reviewed by Michael Dansinger, MD on December 03, 2020

All day long, your blood sugar levels go up and down, depending on when you eat and any medications you take. These changes are normal. But if you have diabetes, it’s possible for your sugar levels to go outside their normal range, which can be dangerous.

Insulin shock means you have very low blood sugar levels. Diabetic coma is when you pass out due to either high or low blood sugar. These two diabetic emergencies can happen if you don’t keep your glucose and insulin levels under control. Though they have different symptoms and causes, both need medical treatment right away. It’s important to know what to do if they happen to you or a loved one.

What Is Insulin Shock?

“Insulin shock” is a common term for low blood sugar, or hypoglycemia. It may also be called an insulin reaction.

The exact blood sugar level that leads to symptoms varies, but is generally less than 70 mg/dL. A low blood sugar level triggers your body to release the hormone epinephrine, also called adrenaline. That causes the early symptoms of insulin shock, which can come on quickly. (Learn more about low blood sugar levels.)

If you don’t treat your dropping blood sugar ASAP, your brain will stop getting glucose and your symptoms will get worse. If levels stay low for too long, you can have a seizure or go into a diabetic coma.

What Is a Diabetic Coma?

This means you lose consciousness when your sugar gets very low, as in hypoglycemia, or very high, called hyperglycemia. You are alive in a diabetic coma, but you can’t wake up or respond to sights, sounds, or other stimulation.

When Do They Happen?

You’re most likely to get hypoglycemia if you skip a meal after injecting insulin or if you take too much insulin.

Diabetic comas happen when you don’t take steps to fix blood sugar that’s too high or too low. While your levels drop when you don’t eat for a while or get too much insulin, they might go up if you miss a dose of insulin or other diabetes medication, don’t follow your diet plan, or exercise less than usual. Infections, hormone imbalances, and severe illnesses can also raise blood sugar in people with diabetes. High blood sugar usually comes on more slowly than low blood sugar.

A few other things make diabetic comas more likely, including:

Who Do They Affect?

Anyone with diabetes can have these two emergencies, since everyone with the disease can have abnormal swings in their blood sugar levels.

Insulin shock is common for people with type 1 diabetes but can also happen in people with type 2 who take insulin.

For people with type 2, a diabetic coma may be caused by either hypoglycemia or very high blood sugar, called diabetic hyperosmolar syndrome. That’s when your body tries to get rid of extra sugar by passing it into your urine. Over days or weeks, this can cause life-threatening dehydration and, eventually, a coma.

If you have type 1 diabetes, it is more likely that you’d have a diabetic coma because of hypoglycemia or diabetic ketoacidosis, when your body starts using fatty acids instead of sugar for fuel.


The most common symptoms of hypoglycemia, or insulin shock, are:

You may have those symptoms before a diabetic coma, too. Or you may show signs of hyperglycemia, such as:

But if you’ve had diabetes for a long time, it’s possible to fall into a coma without these signs.

Treatments for Insulin Shock

The American Diabetes Association teaches the “15-15 Rule” for treating hypoglycemia: Have 15 grams of carbohydrates to raise your blood sugar and then check your levels again after 15 minutes. This approach helps to slowly raise levels so they don’t shoot up too high. You can get these small amounts of carbohydrates in:

  • Glucose tablets or gel tubes
  • 4 ounces (1/2 cup) of regular, non-diet soda
  • 1 tablespoon of sugar, honey, or corn syrup
  • 8 ounces of nonfat or 1% milk

If your levels remain dangerously low, you may need to use injectable glucagon to raise them. Your doctor may have prescribed you a glucagon kit. Follow the instructions on injecting it into your buttock, arm, or thigh. And tell your family, friends, and co-workers how to give it to you if you’re ever unable to do it yourself.

Treatments for Diabetic Coma

If you go into a diabetic coma, you need emergency medical help. Let your loved ones, friends, and co-workers know that if you pass out, they need to call 911 right away and let first responders know you have diabetes.

The type of treatment for a diabetic coma depends on whether your blood sugar level is too high or too low and the exact reason for the level. If it’s too high, you may get IV fluids and potassium, sodium, or phosphate to treat dehydration, insulin to help your tissues absorb sugar, and treatment for any underlying infection. If your blood sugar is too low, you may get a glucagon injection or dextrose.

Show Sources


American Diabetes Association: “Hypoglycemia.”

Mayo Clinic: “Diabetic Coma.”

KidsHealth: “What is Hypoglycemia?”

Medscape: “Hypoglycemia.”

Medline Plus: “Hyperglycemia.”

Mayo Clinic: "Diabetic hyperosmolar syndrome."

Cleveland Clinic: “Diabetic Coma.”

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