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• Hypoglycemia ("insulin shock") - This complication occurs if the blood glucose levels fall below normal and can be caused by insufficient intake of food, exercise, or alcohol intake. This occurs most commonly in persons using insulin and those who are attempting to achieve tight control of glucose levels. At the extreme, repeated episodes of hypoglycemia (glucose < 65mg/dL) can lead to permanent brain damage (hypoglycemia encephalopathy) or death. Symptoms of hypoglycemia include:

  • Sweating
  • Trembling
  • Headache
  • Hunger
  • Rapid heartbeat
  • Mood changes
  • Neurologic symptoms
  • Confusion and disorientation
  • Weakness
  • Combativeness
  • Coma (rare)
  • Seizures (rare)
  • Death (rare)

These symptoms should be promptly treated with juice, glucose tablets, glucose gel or another source of quick-acting carbohydrate, which should carried and available at all times. Severe hypoglycemia can be treated with glucagon, which may be injected intramuscularly or intravenously

• Lipohypertrophy - This refers to the development of benign "tumor-like" swelling of fatty tissue at the sites of subcutaneous insulin injections. It is estimated that the prevalence of clinically significant lipohypertrophy is around 20% to 30% in patients with type 1 diabetes and 4% in patients with type 2 diabetes. Lipohypertrophy seems to be due to a cellular response of fat cells to the local effects of injected insulin. Suggested risk factors for lipohypertrophy include frequent injection at the same site, type of insulin, number of injections a day, total daily dose of insulin, reuse of needles, and use of pen devices rather than syringes. Injection into lipohypertrophied injection sites can lead to problems with glycemic control because of delay in insulin absorption. The lipohypertrophied areas can be unsightly, and the only available treatment for the condition is liposuction, although not injecting into the sites may reduce their size over time.

Interactions of Other Drugs with Insulin

Many drugs can interfere with the effectiveness of insulin and may require closer monitoring or changes in drug regimen.

Drugs that can decrease the effectiveness of insulin include:

• Corticosteroids
• Oral contraceptives
• Diltiazem,
• Epinephrine
• Niacin
• Thiazide diuretics

Drugs that can increase the effectiveness of insulin include:

• Alcohol
• Alpha-adrenergic blockers
• Nonselective beta blockers
• Clofibrate (lipid lowering medication)
• MAO inhibitors (anti-depressants)
• Pentamidine
• Salicylate
• Tetracycline
• Anabolic steroids