QUESTION:
My sister injected a large overdose of insulin, had a seizure and died. I need to know whether she suffered pain.
Quick Answer
I am very sorry for your loss. No one can know with certainty what your sister consciously experienced. Severe insulin-induced hypoglycemia usually causes progressive confusion, impaired awareness, seizure and unconsciousness. During a generalized convulsive seizure, consciousness is ordinarily lost, so the movements may look frightening without meaning that the person is consciously feeling them. She may have experienced distressing low-glucose symptoms before losing awareness, but it is also possible that awareness declined quickly. It would not be medically honest to promise that she felt no discomfort or to assume that she suffered throughout.
Answer by Dr. Albana Greca, MD, MMedSc
Hello,
Please accept my sincere condolences. Questions about a loved one’s final moments are common after a sudden death, especially when the family witnessed a seizure or did not receive a clear explanation.
Insulin moves glucose out of the bloodstream. An excessive dose can make glucose fall dangerously low and may continue acting for many hours, depending on the insulin type, dose, injection site and kidney function.
As glucose falls, the body first releases stress hormones. A person may experience:
Severe hypoglycemia can then progress to seizure, unconsciousness, coma, abnormal heart rhythm, brain injury and death. Read our low blood glucose guide.
Not necessarily. A generalized tonic-clonic seizure may involve stiffening, jerking, changes in breathing, jaw clenching or other dramatic movements. These are involuntary electrical and muscular events.
Consciousness is generally lost during this type of seizure, and people who recover usually do not remember the convulsive phase. The appearance of violent movement therefore does not prove conscious pain or awareness.
Someone who survives a seizure may later have muscle soreness, headache, tongue injury or confusion. That does not tell us what a person experienced while unconscious or during a fatal event.
Before severe brain dysfunction develops, hypoglycemia can feel frightening or uncomfortable. Some people notice shaking, sweating, palpitations, hunger, anxiety, weakness or confusion. Others—especially those with repeated low readings—have impaired awareness and may develop confusion or unconsciousness with little warning.
We cannot reconstruct how long your sister remained aware, which symptoms she had, or how quickly the glucose fell. The insulin preparation, dose, whether she had eaten, alcohol use, previous hypoglycemia and medical response all influence the course.
The most medically reasonable reassurance is this: once severe hypoglycemia caused loss of consciousness and a generalized seizure, her awareness was probably greatly reduced or absent. The seizure’s frightening appearance should not be interpreted as proof that she was consciously suffering throughout it.
The original answer stated that hypoglycemia was the only process involved. Severe hypoglycemia is the central problem, but it can trigger several fatal complications, including prolonged seizure, dangerous heart rhythms, breathing problems, aspiration or irreversible brain injury.
Only the emergency records, hospital notes, death certificate, toxicology report or autopsy can clarify the likely medical mechanism. These records cannot determine subjective pain with certainty.
It would be inaccurate to describe every fatal insulin overdose as peacefully “falling asleep.” Some people have warning symptoms, agitation or confusion before unconsciousness. It would be equally inaccurate to assume that convulsions mean the person was consciously experiencing severe pain.
The honest answer lies between those claims: discomfort before loss of awareness is possible, but awareness during a generalized convulsive seizure is usually absent.
An insulin overdose is an immediate emergency.
Call emergency services immediately. Give fast-acting carbohydrate only if the person is awake and can swallow safely. If the person is confused, having a seizure or unconscious, give nothing by mouth. Use glucagon if available, place the person on their side, protect them from injury and remain with them until help arrives.
Even after glucose improves, hospital observation may be necessary because long-acting or very large insulin doses can cause recurrent hypoglycemia. Review our insulin safety guide and high and low glucose emergency guide.
A medical explanation cannot remove the grief or provide complete certainty about another person’s internal experience. It may help to speak with the treating hospital, coroner or medical examiner and ask someone to explain the records in plain language.
Sudden or traumatic bereavement may also bring recurring images, guilt, insomnia, anxiety or an intense need to reconstruct every moment. Support from a grief counselor, physician, faith leader or bereavement group can be valuable. Seeking this support does not mean you are failing to cope.
This educational answer cannot determine an individual person’s awareness or cause of death and does not replace review of the official medical records.
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