Blood glucose is an important indicator of human he alth. With a sharp decrease in sugar, hypoglycemic shock can occur. Often, patients do not notice the harbingers of this life-threatening condition. During hypoglycemia, a person's well-being is rapidly deteriorating, and the patient falls into a coma. How to prevent this state? And how to provide first aid to the patient? We will consider these issues in the article.
Description of pathology
What is hypoglycemic shock? This is a severe reaction of the body to a drop in the concentration of glucose in the blood and an increase in the level of the hormone insulin. In this dangerous condition, first of all, the central nervous system suffers. After all, glucose is a source of energy for neurons. With a deficiency of this substance, brain tissue experiences an acute lack of oxygen.
Hypoxia is accompanied by the death of neurons. The more nerve cells die, the more pronouncedsigns of pathology. When glucose levels fall to extremely low levels, the patient falls into a coma. Doctors call this condition insulin or hypoglycemic shock. If urgent help is not provided to the patient, then a coma can be fatal.
Etiology of diabetes
What causes hypoglycemic shock? In most cases, this condition occurs in diabetics due to an overdose of insulin.
In diabetes, the pancreas produces very little insulin. Therefore, this hormone can enter the body only from the outside. Such patients are prescribed replacement therapy with insulin preparations for life. What can cause a hormone overdose? Endocrinologists identify the following causes of hypoglycemic shock in diabetics:
- Injecting too much insulin. An overdose is most often noted when using an oversized syringe. In this case, it is very difficult for the patient to collect the exact amount of solution. Therefore, doctors recommend using syringes that are equal in volume to a single dose of insulin.
- Intramuscular injection of insulin. It is important to remember that this hormone can only be administered under the skin or intravenously. Sometimes insulin is accidentally injected into a muscle when using a needle that is too long.
- No food after treatment. For some forms of diabetes, doctors prescribe medications with short-acting insulin. These drugs are administered strictly before meals. Some time after the injection, the patient must eat. Long absence of foodcan cause glucose levels to drop.
- Physical activity immediately after the injection. Doctors recommend giving the body a little rest after an insulin shot. This is especially true for patients taking short-acting drugs. During heavy muscular work and sports activities, glucose is consumed very intensively. If insulin was injected shortly before exercise, this can lead to a sharp drop in sugar.
- Massage of the injection site. Doctors do not recommend massaging the insulin injection site. This increases blood circulation and can cause an increase in the concentration of the hormone in the blood.
- Decrease in the production of antibodies to insulin. In the human body, special IAA antibodies are produced. They inhibit the action of insulin. In diabetics, these immunoglobulins are formed in increased quantities. However, with alcohol, obesity and pregnancy, antibody production decreases. This leads to an excessive action of insulin on the body and a sharp drop in glucose levels.
- Incorrect treatment of ketoacidosis. With untimely administration of insulin or with its insufficient dosage, the patient will increase the level of sugar and ketone bodies in the blood plasma. This condition is called ketoacidosis and is very life-threatening. In this case, doctors adjust the treatment regimen and prescribe higher doses of insulin to patients. This increases the risk of drug overdose. Therefore, therapy should be carried out under strict control of blood sugar concentration.
- Taking sulfonamides. The use of these drugs increasesplasma insulin concentration and can cause hypoglycemia.
Other causes of hypoglycemia
Can there be hypoglycemic shock without diabetes? A sharp decrease in glucose can also be observed in he althy people. It can be caused by the following reasons:
- Starvation and malnutrition. Often, hypoglycemia occurs during overly strict diets and long breaks between meals. In this case, a deficiency of carbohydrates is formed in the body, as a result of which a hypoglycemic shock occurs. However, this phenomenon is quite rare.
- Physical activity. Intensive training requires a large expenditure of energy, which the body takes from glucose reserves. As a result, a person's blood sugar levels may drop. Athletes often experience hypoglycemic shock during competitions. Some bodybuilders use insulin to increase muscle mass. Under no circumstances should this be done. Taking the hormone inappropriately can lead to the development of severe hypoglycemia.
- Taking certain medications. The use of antipyretics, sulfonamides, and antimalarials can lead to a decrease in sugar.
Hypoglycemia can be caused by alcohol abuse. Often, a state of shock due to a drop in glucose levels is noted in patients with chronic alcoholism.
Hypoglycemic shockmay occur as a complication of the following diseases and conditions of the body:
- liver and kidney disease;
- enzyme disorders;
- pancreatic tumors;
- endocrine disorders;
- operations on the digestive tract.
In infants, hypoglycemia develops with prematurity and congenital heart pathologies. Hypoxia during the prenatal period may be the cause of low glucose levels in a newborn.
Stages
Doctors identify the following stages in the development of hypoglycemia:
- Cortical stage. The patient becomes irritable and feels a strong sense of hunger. Such symptoms are caused by the death of neurons in the cerebral cortex.
- Stage of vegetative reactions. Cells of the subcortical regions die in the brain. This is accompanied by pronounced pathological manifestations of the autonomic nervous system: frequent heartbeat, increased sweating, trembling of the limbs, headaches. The patient continues to experience excruciating hunger.
- Subcortical stage. The patient continues to destroy nerve cells under the cerebral cortex. This is accompanied by a mental disorder. There are delusions and hallucinations. The patient becomes aggressive and may behave inappropriately.
- Death of neurons in the upper parts of the medulla oblongata. This stage is accompanied by the appearance of seizures. The patient then slips into a superficial coma.
- Death of cells in the lower part of the medulla oblongata. This part of the central nervous system is responsible for vital functionsorganism. At this stage, respiratory and cardiac depression develops. The patient sinks into a deep coma that pumps fatally.
It is important to remember that all stages of hypoglycemic shock develop very quickly. Only a few minutes pass between the initial manifestations of pathology (feeling of hunger, irritability) and a coma. Therefore, very little time is left for patient care.
Initial signs
Early signs of hypoglycemia are often difficult to recognize. In the initial stages, the patient develops cerebral hypoxia. This is accompanied by a feeling of fatigue, as well as headaches that are not relieved by analgesics. This condition is a precursor to insulin shock and is called hypoglycemic aura.
When glucose falls below 2.8 mmol/l, the following manifestations of hypoglycemia occur:
- coldness and sweating of hands and feet;
- nausea;
- weakness;
- dizziness;
- numbness in the nose and lips.
If the patient is not treated at this stage, his condition is rapidly deteriorating.
Detailed symptoms
In the later stages of the pathology, severe symptoms of hypoglycemic shock develop:
- unbearable feeling of hunger;
- breathing difficulties;
- double vision and blurred vision;
- trembling hands and feet;
- tachycardia;
- drop in blood pressure and body temperature;
- sharpweakness;
- dyscoordination.
The late stages of hypoglycemia end with an attack of convulsions, loss of consciousness and the development of a coma. This poses a great danger to the life of the patient.
Complications
As already mentioned, hypoglycemic coma without treatment leads to death. But even with timely therapy, this condition can affect a person’s he alth for a long time. After all, hypoglycemia is accompanied by the death of a large number of neurons.
Coma can cause the following pathologies:
- Edema of the brain. Such a complication leads to irreversible pathological changes in the tissues of the central nervous system.
- Encephalopathy. This disease is accompanied by impaired blood supply and nutrition of the brain. It leads to mental disorders, memory impairment and dementia. This consequence of hypoglycemia is more common in older patients.
- Mental retardation. Hypoglycemia in childhood can cause mental retardation. Violation of the development of intelligence occurs due to prolonged hypoxia of the brain.
First aid
First aid for hypoglycemic shock should be provided immediately. After all, the patient's condition can deteriorate significantly in a matter of minutes. If the patient is conscious, then it is necessary to lay or seat him. Then give the patient a sugary food or drink as soon as possible:
- sweet tea or juice;
- honey;
- a few pieces of sugar;
- jam;
- chocolate;
- candy.
After 10-15 minutes, you need to measure the sugar level with a glucometer. If it still remains low, then the sweet product is repeated. If the patient suffers from diabetes, then after feeling better, you should visit an endocrinologist.
If the patient has lost consciousness, it is urgent to call an ambulance. Before the arrival of the doctors, the patient must be laid on his side. Intramuscularly, 2 ml of the drug "Glucagon" should be injected - this agent increases the level of glucose.
Diagnosis
It is very important to differentiate between diabetic coma and hypoglycemic shock. This can be done with a blood glucose test. With a diabetic coma, the sugar level rises sharply, and with hypoglycemia it decreases. At home, this test can be done using a glucometer.
In he althy people, the normal concentration of glucose in the blood is from 3.3 to 5.5 mmol/l. The first signs of hypoglycemia occur when blood sugar drops below 3 mmol/L.
It should be remembered that a sharp jump in the concentration of glucose down most often leads to a state of shock. In diabetics, the sugar level is elevated, it can reach up to 10-20 mmol / l. In this case, signs of hypoglycemia may occur even at rates of 4-8 mmol / l.
Treatment
Bmild cases, the patient's condition improves after first aid. If hypoglycemia occurs frequently, then the doctor reviews the patient's treatment regimen and, if necessary, reduces the dosage of insulin. Also, the endocrinologist gives recommendations to the patient about nutrition and lifestyle.
In severe cases, hypoglycemic shock is treated in a hospital. The patient is given a glucose solution in the form of droppers or intravenous injections. At the same time, doctors constantly monitor the level of sugar in the blood. If the patient does not come out of a coma for a long time, then corticosteroid hormones are prescribed, which increase the concentration of glucose in the body.
Forecast
Among patients with diabetes, the mortality rate from hypoglycemic coma is about 4%. The lethal outcome most often occurs due to untimely assistance to the patient.
In mild cases, a sharp drop in sugar levels does not give any consequences. In the first time after an attack of hypoglycemia, the patient may feel a little weak and dizzy. Then his condition is completely normal.
Severe hypoglycemic coma can lead to cerebral edema and encephalopathy. In this case, persistent neurological disorders may persist in patients. These complications are more common in children and the elderly.
Prevention
How to prevent a drop in blood sugar and the development of coma? To prevent this dangerous condition, the following recommendations of endocrinologists must be observed:
- Measure your blood sugar regularly with a home glucometer.
- Do not overdose on insulin and other antidiabetic drugs.
- Avoid fasting and long breaks between meals.
- Patients with diabetes should always have sugar cubes, chocolate or sweets with them.
- Exercising should be avoided after administration of short-acting insulin preparations.
These measures will help to control the level of glucose in time and prevent its critical decline.
