What Is Hypoglycemia?
Last week, I had the opportunity to speak with KPRC2 Houston about a case that has shocked even seasoned physicians. Sarah Hartsfield is now on trial for allegedly murdering her husband by giving him a fatal dose of insulin—a chilling example of how a lifesaving drug can be misused with deadly consequences.
Watch the full interview here: KPRC2 Houston Interview
As an endocrinologist, I treat people with diabetes every day—and I know how frightening and misunderstood hypoglycemia can be. This case highlights the urgent need to educate the public on what hypoglycemia is, what to eat during a low, how insulin works, and how we as clinicians must rise to the challenge of keeping people safe.
What Is Hypoglycemia?
Hypoglycemia, or low blood sugar, occurs when blood glucose drops below 70 mg/dL. For people living with diabetes—especially those on insulin or sulfonylureas—it can happen suddenly, at any time, and can be life-threatening.
Hypoglycemia symptoms include:
Mild to moderate (hyperadrenergic): shakiness, palpitations, anxiety, sweating, tremor, hunger
Severe (neuroglycopenic symptoms): confusion, slurred speech, behavioral changes, seizures, and loss of consciousness
Yes, hypoglycemia can cause seizures, coma, and death when left untreated.
What to Eat for Hypoglycemia: The Rule of 15s
The American Diabetes Association recommends the Rule of 15:
Consume 15 grams of fast-acting carbohydrate (like juice, glucose tablets, or soda—not chocolate or peanut butter, which slow absorption).
Wait 15 minutes, then recheck blood glucose.
If still low, repeat until above 70 mg/dL.
Follow up with a small meal or snack to prevent recurrence.
In cases of severe hypoglycemia, where the person is unconscious or unable to swallow, glucagon should be administered immediately. Never try to feed someone who cannot swallow.
How Insulin Works—And Why It Must Be Used Safely
Insulin is a powerful hormone that lowers blood sugar by moving glucose into cells. It's life-sustaining—but dangerous when misused or misunderstood.
In the Hartsfield case, Joseph Hartsfield died from what was ultimately found to be a toxic level of insulin. One heartbreaking detail from the investigation: he was so terrified of hypoglycemia that he sometimes avoided taking insulin.
Unfortunately, this fear is not uncommon—and it’s something we at Complete Medicine work closely with our patients to overcome.
Fear of Hypoglycemia Is Real—and We Take It Seriously
At Complete Medicine, we’ve seen many patients like Joseph who are paralyzed by the fear of low blood sugar. Some are afraid to take even a small dose of insulin. That fear can spiral—causing dangerously high sugars, diabetes burnout, and avoidance of treatment.
We don’t believe the answer is to simply "try harder" or to send someone home with more handouts. Oftentimes doctors think their patients are taking their insulin as prescribed, and react to high blood sugar and A1c by increasing insulin dose, which only compounds the problem. Higher insulin dose, higher risk of low blood sugar
We believe it’s our responsibility, as endocrinologists, to walk beside our patients through these difficult moments. I have personally sat on the phone with patients as they injected insulin, step by step, supporting them through fear so they could regain control and confidence in managing their diabetes.
This is what it takes sometimes. Because hypoglycemia is terrifying—and for good reason.
Why Our Model Is Different
The traditional healthcare system is not designed to provide the time, access, or support that people with diabetes need—especially when facing complex challenges like insulin adjustment or hypoglycemia unawareness.
That’s why we created a different kind of practice. At Complete Medicine, we give patients:
Longer, unhurried visits
Direct access to their physician
Ongoing education and support
Help adjusting insulin safely and confidently
Advanced tools like CGMs and hybrid closed-loop pumps
We work hard to get doses right, identify patterns of low blood sugar, and educate patients on what to eat during a hypoglycemic episode—so they can live fully and safely with diabetes.
Preventing Severe Hypoglycemia with Technology
We often recommend continuous glucose monitoring (CGM) and hybrid closed-loop insulin systems to reduce both fear and risk:
CGMs, like Dexcom and FreeStyle Libre, track blood sugar in real-time and send alerts before levels drop too low.
Closed-loop insulin pumps automatically adjust insulin delivery to reduce highs and lows—even while sleeping.
For patients with hypoglycemia unawareness, these tools can be life-changing.
Final Thoughts
This tragic case is a reminder that insulin safety is not just about math—it’s about people. People who feel fear, frustration, and fatigue. People who deserve the kind of care that helps them feel empowered, informed, and protected.
If you or someone you love is living with diabetes and struggling with fear of insulin or hypoglycemia, please know: you are not alone—and you deserve better support.
We’re here to help. Learn more about our personalized, doctor-led care at sacomplete.com
