Seizure, known medically as ictus, broadly describes an episode of uncontrolled behavior or movement in a patient’s body. Seizures are generally considered a symptom of an underlying condition, and typically originate from abnormal electrical activity in the brain. A vast and diverse array of medical conditions may induce seizures, ranging from head trauma to drug withdrawal. The only common factor that seizure-causing conditions have is their capacity to interfere with the normal functioning of the electrical impulses that communicate within the brain as well as to other parts of the body.

When seizures occur as a symptom of diabetes, they are referred to as diabetic seizures (DS). Like with seizures generally, there can be a tremendous degree of variability in the severity and nature of DS symptoms. Nevertheless, it is generally true that understanding the medical origins of a serious occurrence like a seizure enables patients and their medical practitioners to better address the prospect of future occurrences. Fortunately, in the case of DS, the factors that can induce seizures in a diabetic patient are relatively well understood and can be addressed to some extent with effective treatment.

Causes

It is important to clarify that diabetic seizures are not something that every diabetic patient will experience. However, certain consequences of diabetes, especially when not treated effectively, can increase the likelihood that a seizure will occur. This section will detail some of the ways in which diabetes can create favorable conditions for seizure.

The most common cause of diabetic seizures is hypoglycemia, or low blood sugar. This may surprise some people who are familiar with diabetes, as high blood sugar is often associated with the more severe diabetes complications. However, because circulating glucose is needed as fuel for cells throughout the many tissues and organs of the body, hypoglycemia can deprive cells of the fuel they need to function properly. This can ultimately cause organs, including the brain, to malfunction, and can cause the brain to behave erratically and uncontrollably for a period of time.

Hypoglycemia can also cause seizures indirectly if it develops into a severe complication known as diabetic ketoacidosis (DKA). This condition is dangerous in itself, irrespective of whether seizures are present. When a diabetic is unable to use glucose for fuel, either due to low blood sugar levels or an inability to use circulating glucose for lack of insulin or insulin resistance, the body resorts to other means for energy. Specifically, it will begin breaking down fats into usable energy in a process that produces ketones as a by-product. As these ketones build up, they can increase the acidity of the blood, which can lead to a range of serious medical complications. Seizures may result; however, the condition can cause many other life-threatening complications. Patients experiencing DKA require urgent attention, whether or not they are seizing.

While far less common, the opposite situation, hyperglycemia, can also induce seizures. Seizures due to nonketotic hyperglycemia are extremely serious, as is the condition of nonketotic hyperglycemia itself. This condition can arise as a complication of diabetes, particularly type 2, and occurs when severely high levels of blood sugar cause extreme dehydration and disruption of electrolytic balances. This impairment can prevent organs throughout the body from functioning normally, including the brain. While the condition is not common, seizures among those experiencing nonketotic hyperglycemia are relatively prevalent, occurring in roughly 25% of patients.

It is important to stress that a diabetic person may experience a seizure that is totally unrelated to their diabetic condition. As we already mentioned, seizures can be induced as a result of many other conditions, including serious conditions like epilepsy. It is best not to presume that a seizure is the result of diabetes and rather seek the medical opinion of a doctor. Otherwise, patients who incorrectly treat the wrong cause of the seizures risk future recurrences and potentially life-threatening complications.

Symptoms

The symptoms of a seizure can vary widely, depending on the cause and the circumstances present in the individual. Though you may have some expectation of what to look for based on depictions of seizures in media, keep in mind that seizures are not always so obvious and can be very subtle in how they manifest.

If a patient experiences repeated DS episodes, they may gain a better sense of what to expect in their particular case. Communicating this to others around you may be a helpful strategy to ensure others are equipped to recognize and assist when you are experiencing an occurrence.

Warning signs

The onset of diabetic seizures can often be precipitated by subtle warning signs. These are often much less severe than the symptoms of a full-blown seizure and may not clearly indicate that anything is grossly wrong. However, understanding and recognizing the warning signs one typically experiences immediately prior to an episode can enable them to take some action to prepare and minimize the harm potentially associated with diabetic seizures.

The following are common warning signs associated with DS, however, please note that each patient’s experience will vary. The list below should not be seen as exhaustive or applicable to everyone. Warning signs may include:

  • Changes in mood or cognition, such as irritability or confusion;
  • A dizzy or lightheaded sensation;
  • Trembling or shaking;
  • A sense of sudden fatigue or muscle weakness;
  • Numbness and tingling in the extremities.

During the occurrence

As we mentioned previously, there is no exhaustive list of what to expect when experiencing diabetic seizures. However, certain symptoms are more common than others, and having a rough sense of what one might expect can help patients and those they interact with to be stay vigilant.

In the most familiar cases, DS episodes can be accompanied by jerky, uncontrollable, or repetitive body movements. The patient may also slip out of consciousness or not be fully aware. To outside observers, this can present as a patient staring into space, being unresponsive, or failing to understand or communicate properly with others.

Patients may also experience DS episodes at night, in which case they may be awoken by the occurrence. Seizures experienced while sleeping may cause a patient to awake with a sense of confusion, a painful headache, or covered in sweat.

Prevention and Coping Strategies

If you experience diabetic seizures, it is critically important that you consult with your doctor regarding how to prevent future occurrences. Each person may experience seizures for different reasons, and the approach taken to treat the DS episodes may vary greatly depending on each patient’s medical circumstances.

Generally, diabetic seizure prevention involves ensuring effective and consistent treatment of the underlying diabetes. Since most DS episodes are a result of complications arising from poorly managed diabetes, such as low blood sugar or ketoacidosis, preventing these conditions through effective regulation of insulin and blood sugar levels is likely a solid approach. If you do not already have an effective diabetes management plan in place, it is therefore important that you consult a doctor to develop one for you.

If you are already managing your diabetes, then prevention of diabetic seizures may involve adjusting or improving your management strategies in subtle ways. For instance, you may need to identify habits or practices that tend to disrupt healthy blood sugar management. For example, skipping meals or fasting for long periods of time between meals can allow your blood sugar to creep into hypoglycemic territory if you are not careful. Regularly monitoring you blood sugar is also a good way to note how you react to meals and can help you identify patterns of behavior that may elicit an unsafe drop in blood sugar.

Other habits that may seem productive for managing diabetes can actually be harmful in some cases. Take exercise as an example. Generally, exercising regularly is an important part of staying healthy, irrespective of diabetes, but can specifically help diabetics manage their blood sugar. However, the devil is in the details; some forms of exercise can actually burn too much energy, depleting your blood sugar levels and potentially bringing you outside of a healthy range. It may be worth working with a professional to develop a diabetes-friendly exercise regimen.

Other advisable preventive measures include wearing a medical alert ID on your person if you are diabetic or prone to diabetic seizures. This allows first responders to identify important medical information about you that may assist them in administering the most appropriate care for your circumstances, especially if you are unconscious or unaccompanied by someone who knows about your condition.

Treatment

Just as there is no single cause or manifestation of DS, there is also no one-size-fits-all approach to treating a DS occurrence. In each case, the best course of treatment will depend on the acute symptoms of the occurrence and whether they require some immediate action to prevent further harm, as well as the underlying cause for the occurrence.

There are two general goals when attempting to assist someone you suspect is experiencing a DS episode. The first is to prevent the person from sustaining an injury due to their uncontrolled movements or loss of consciousness, while the second is to ameliorate the conditions causing the seizure.

With respect to the first goal, doing this safely can be tricky. Restraining a seizing person can seem like a helpful thing to do, but restricting their movement can while their muscles are seizing can actually cause greater injury. The CDC’s Seizure First Aid guidelines instead advise bystanders to cushion the head with something soft, like a towel, to prevent a head injury, and clear the surrounding area of anything that may cause the patient harm. The guidelines also advise that bystanders should ease the patient to the floor in case they lose consciousness or fall, loosen any clothing around their neck as well as eyeglasses or anything that might harm them while moving erratically, and to turn the person on their side, if possible. If a seizure lasts more than 5 minutes, the guidelines advise bystanders to call 911. We must note that the CDC offers these guidelines for epileptic seizures and cannot confirm that they are applicable to DS episodes universally.

With respect to the second goal, this is also a tricky subject. Some guidelines strictly advise that bystanders should not, under any circumstances, offer the seizing individual anything to eat or drink until they fully return to consciousness and alertness. Others suggest that offering a seizing diabetic something sweet to drink may help ease any hypoglycemia that might be the cause of the seizure. We cannot advise what the correct course of action is, but we encourage individuals to seek trusted resources for education on administering first aid to patients experiencing a DS episode, especially if they have a diabetic person in their lives.