Diabetes complications

Emergency measures for hypoglycemic coma

Normalization of blood glucose levels is the main task facing the patient with diabetes mellitus. Sharp fluctuations in glucose values ​​not only worsen the patient’s condition, but can also cause dangerous complications.

One of the consequences of uncontrolled diabetes is hypoglycemic coma, which occurs when the level of sugar decreases. This condition is characterized by lightning-like development and, if the assistance is not provided in time, can be a cause of death.

Pathogenesis and causes of the pathological condition

Low glucose concentrations with high insulin levels (insulin shock) can cause hypoglycemic coma. This condition is characterized by a special reaction of the organism, in which the work of the higher nervous system is disturbed and brain neurons are affected. Prolonged glucose deficiency causes oxygen and carbohydrate starvation. The result of such a process is the death of the parts or parts of the brain.

Insulin coma is characterized by a drop in glucose level below 3.0 mmol / l. At such a moment a person experiences various discomfort. The condition develops rapidly, worsening with every minute. In most cases, coma occurs in insulin-dependent patients. Her appearance is due to the wrong tactics of treatment of the disease, as well as a lack of understanding of the rules for performing injections.

Main reasons:

  • insulin overdose, when the patient injected the wrong amount of drug or applied the wrong type of product (for example, a U40 syringe instead of a U100);
  • the drug is injected intramuscularly, not subcutaneously;
  • the diet was not observed, and the snacks that were put in time were skipped;
  • long intervals between meals;
  • change of diet and nutrition;
  • a short-acting hormone injection was performed without a subsequent snack;
  • performing additional physical activity without first consuming carbohydrates;
  • lack of glycemic control before calculating the dose of the hormone, resulting in the body receives more drug than required;
  • rush of blood to the area of ​​the injection due to perfect massaging movements;
  • drinking alcohol;
  • pregnancy, especially in the first months, when the need for insulin is reduced;
  • liver obesity;
  • the patient is in a state of ketoacidosis;
  • taking certain medications, for example, the use by older people of drugs from the sulfonamide group against the background of chronic lesions of the liver, heart or kidneys;
  • disorders of the digestive system.

Hypoglycemia can also occur in a newborn who was born earlier than normal, or if he has congenital heart disease.

Symptoms

Clinic hypoglycemia depends on the speed of its manifestation.

The first signs are:

  • feeling of hunger;
  • weakness;
  • sweating;
  • dizziness;
  • drowsiness;
  • feeling of fear without a cause;
  • headache;
  • pallor of the skin.

In the absence of measures to relieve the early symptoms of hypoglycemia, an acute form of the condition occurs, which is accompanied by the following symptoms:

  • tachycardia;
  • paresthesia;
  • labored breathing;
  • tremor;
  • convulsions;
  • arousal (psychomotor);
  • clouding of consciousness.

With prolonged disregard for these symptoms, coma inevitably occurs.

It has the following manifestations:

  • the unnaturalness of the pale covers;
  • dilated pupils;
  • rapid pulse;
  • slight increase in blood pressure;
  • lowering body temperature;
  • development of a symptom of Kernig;
  • increase of tendon and periosteal reflexes;
  • loss of consciousness.

The appearance of such signs should be a reason for the immediate reception of carbohydrates and seeking medical help.

Emergency help - algorithm of actions

Patients with diabetes should definitely tell their relatives about the features of therapy, as well as about the possible dangerous consequences. It is necessary for the surrounding people to take the necessary measures to eliminate the manifestations of hypoglycemic coma.

First aid includes the following actions:

  1. Lay the patient to the side to prevent asphyxiation due to vomit entering the airway. Due to this situation, it is possible to avoid sticking of the language.
  2. Release the oral cavity from food (if necessary).
  3. Cover the patient with several warm blankets.
  4. Constantly monitor the pulse and respiratory movements of the patient. In their absence, you need to urgently begin to perform a heart massage and artificial respiration (if necessary).
  5. If the swallowing functions are preserved in the patient, you need to make him drink a sweet drink. As an alternative, sweets or any sweets will not work, as they will take longer to digest. In addition, in the process of eating a muffin or chocolate, the patient's condition may worsen, he may faint or choke.
  6. In the absence of carbohydrates at hand and maintaining pain sensitivity in humans, the release of catecholamines (adrenaline, serotonin, and dopamine) should be enhanced by slapping or pinching.
  7. First aid to an unconscious person should consist in taking measures to raise the level of sugar. In the presence of a syringe with glucagon, it should be administered to the patient subcutaneously (in a volume of 1 ml) or by the intravenous route. Then you need to call an ambulance.

It is important to be able to distinguish the symptoms of a hypoglycemic state from a hyperglycemic coma. In the first variant, the patient should be given glucose, and in the second, insulin. Misuse of the drug increases the risk of death.

In order to avoid the onset of a life-threatening condition, the patient should first take a small amount of carbohydrates to prevent a further drop in glycemia, and then measure the level of glucose with a glucometer. After receiving the test results, it is necessary to take measures appropriate to the level of the indicator (to prick insulin or inject glucose), and then wait for the doctors to arrive.

Differential diagnostics

Insulin coma is diagnosed in patients with diabetes, as well as having disorders in the pancreas. The main laboratory test is blood sampling to measure glucose levels.

Coma is characterized by a decrease of less than 2 mmol / l. For patients who constantly had hyperglycemia, a drop in the level of sugar to 6 mmol / l is also considered a pathological condition. In such cases, determining the cause of the coma may be difficult. Glycemia rate for a patient with diabetes is 7 mmol / l.

Being unconscious also complicates diagnosis. There is no time to conduct a blood test, therefore a doctor can distinguish hyperglycemia from hypoglycemia only by focusing on external manifestations (dryness, skin color, moist palms, cramps). Any delay can cost the patient life.

Video material about the causes of coma in diabetes:

Inpatient treatment

Assistance in the hospital environment includes the following activities:

  1. Intravenous 40 or 60 ml of glucose solution having a concentration of 40%.
  2. In the absence of the effect of the injection, a dropper is put in to the patient in order to deliver 5% glucose solution until consciousness returns to him.
  3. In deep coma, 200 mg of hydrocortisone is additionally administered to the patient.
  4. In some cases, it may be necessary to perform a subcutaneous injection of epinephrine in the amount of 1 ml of solution (with 0.1% concentration) or ephedrine chloride.
  5. If the patient has poor veins, then subcutaneous glucose is used as an alternative to intravenous injections or the use of an enema in a volume of 500 ml.
  6. To improve cardiac activity, caffeine, camphor, or similar preparations may be required.

Signs of the effectiveness of the actions taken by the specialist:

  • restoration of consciousness in the patient;
  • the disappearance of all symptoms;
  • normalization of glucose.

If the patient’s condition does not improve after 4 hours from the time of intravenous glucose injection, the risk of developing such complications as brain swelling becomes much higher. The consequence of this condition can be not only disability, but also death.

Consequences and prognosis

The consequences for a person who has suffered a hypoglycemic coma may vary. This is due to the duration of the negative impact of carbohydrate deficiency on the state of the cells and the work of the internal organs.

Complications:

  • swelling of the brain;
  • irreversible disorders in the central nervous system (central nervous system);
  • development of encephalopathy due to damage to brain cells;
  • blood supply failure;
  • the onset of oxygen starvation of neurons;
  • the death of nervous tissue, leading to the degradation of the individual;
  • children who have suffered a coma often become mentally retarded.

A mild form of insulin shock can lead to a short-term functional disorder of the nervous system. Immediate therapeutic measures can quickly restore glucose levels and eliminate manifestations of hypoglycemia.

In this case, the signs of this condition do not leave any trace on the further development of the patient. Severe comatose forms, inadequate therapeutic measures lead to serious consequences, including the development of stroke and brain edema.

Video material on hypoglycemia:

Preventive measures

The appearance of insulin shock is due to the onset of hypoglycemia. To prevent a sharp drop in glucose, you should carefully observe the treatment regimen, as well as carry out preventive measures.

Key recommendations:

  • monitor the blood glucose index - it is enough to monitor the glucose value before and after meals, as well as unscheduled snacks;
  • monitor urine reaction;
  • monitor the condition before and after the injection of insulin;
  • correctly select the dose of insulin prescribed by the doctor;
  • do not leave the house without sweets;
  • not to increase independently the dosages of hypoglycemic drugs;
  • follow the doctor’s diet and diet;
  • check the blood glucose index each time before performing physical exertion;
  • tell other people about all the complications associated with the disease, and teach them how to behave when a hypoglycemic condition occurs.

All people, especially in adulthood, it is important to periodically be examined by a doctor to identify diabetes in the early stages of its development. This will help prevent the development of many complications, including hypoglycemia, even among those who are unaware of the progression of the disease.

Watch the video: "Management of Diabetic Ketoacidosis" by Michael Agus, MD for OPENPediatrics (September 2019).