A critical decrease in sugar levels, just like its increase, inevitably leads to disruption of the functioning of the body and the emergence of various pathologies. A noticeable lack of glucose in the blood eventually finds expression through a hypoglycemic coma - a condition caused by the reaction of the brain to a strong drop or lack of sugar in the body. This pathology develops rapidly: from minor symptoms of hypoglycemia to its extreme manifestation.
Hypoglycemic coma in the medical registry
The International Classification of Diseases, which is used by doctors to make a diagnosis and select medicines, is abbreviated as the ICD. The ICD refers hypoglycemic coma to the heading of diabetes mellitus (E10 - E14), which is divided into subheadings depending on the presence of complications, one of which is coma itself, as well as ketoacidosis, damage to internal organs, organs of vision and the nervous system.
The main reason for the development of pathology
Loss of consciousness and falling into a coma does not happen at lightning speed and always has various reasons. There are many reasons for hypoglycemic coma, but the most important of them is an acute shortage of glucose in the blood, which nourishes the cells of the brain and other vital organs. This eventually leads to an exacerbation of such a disease as hypoglycemia, a severe form of which is a coma.
What causes a lack of sugar?
The following actions can lead to a critical lack of blood sugar:
Excessive input of the hormone insulin into the body
The main task of this hormone is to neutralize excess glucose in the blood in people with diabetes. Severely exceeding the acceptable insulin threshold can lead to low glucose levels and subsequent coma.
Drinking alcohol
Alcohol inhibits the synthesis of glucose in the liver and the transport of sugar into the blood, as the liver can hardly cope with the double load that has piled up (alcohol removal and glucose production). The more alcohol you drink, the more likely you are to develop hypoglycemia.
Not following a special diet
Insulin injections must be accompanied by a meal rich in carbohydrates. The lack of carbohydrates against the background, for example, of unusual physical activity is a common prerequisite for the progression of an unhe althy hypoglycemic state and, as a result, the cause of hypoglycemic coma.
Incorrect work of the pancreas
As you know, the pancreas is the source of insulin production in the body, which, as a result of chemical interactions, lowers the level of glucose in the blood. However, if too much insulin is produced and its amount exceeds the amount of glucose produced, then hypoglycemia and subsequent coma may develop.
Symptomatics of the pathological condition
Before falling into a coma, a patient suffering from hypoglycemia goes through several stages, which, when flowing from one to another, are characterized by an increase in negative manifestations and a worsening of possible consequences. During these stages, the main symptoms of hypoglycemic coma can be considered, ranging from harmless to fatal.
General malaise. It manifests itself in the form of headaches, profuse cold sweat, pallor of the skin, feelings of hunger and sometimes low body temperature. It is also possible the appearance of behavior that is unusual for the patient in the usual state: excessive irritability, unreasonable fun or apathy.
Manifestation of hypoglycemia. The patient's condition gradually worsens, the symptoms become more dangerous. The midbrain is involved in the development of hypoglycemia. The pulse quickens and develops into tachycardia, blood pressure increases to dangerous values, a person may be disturbed by nausea and vomiting. This stage is characterized by convulsions of the arms and legs, similar in appearance to epilepticfit.
Coma stage
At this stage, the last and most dangerous form of hypoglycemia manifests itself - a coma, the patient loses consciousness. The pulse and blood pressure gradually drop to acceptable values, convulsions disappear, and breathing evens out. The pupils are slightly dilated and retain the ability to respond to light.
Decrease in all key indicators (pressure, body temperature) continues. It can also be considered a symptom of hypoglycemic coma. At this time, the patient's muscles lose their tone, some reflexes stop working. In the future, sweating increases and the regularity of the pulse disappears: from slowing down to a new increase. A deep coma is dangerous because during it cerebral edema can develop with all the ensuing consequences.
What not to do
Emergency care for hypoglycemic coma should be provided as early as possible, every minute of delay increases the risk of serious complications. First of all, it is worth noting that in no case should you inject the patient with a dose of insulin that he carries with him. This has a positive effect only in the case of hyperglycemia (exceeding the permissible level of glucose in the blood), which cannot be distinguished from hypoglycemia with the naked eye.
After calling an ambulance, it is necessary to help the patient with improvised means. Actions for hypoglycemic coma should be swift, but deliberate. It is not necessary to give the patient any drugs, and even more so to inject substances such as adrenaline, if there is no self-confidence. It makes sense to proceed to such manipulations only if the ambulance gets too long and the patient's pupils have lost their reaction to light.
Things to do
If the patient is depressed, but still retains the ability to speak and somehow move, then you need to put him on his side or bring him to a sitting position. Next, be sure to pour into his mouth a drink containing a large dose of sugar (juice, sweet tea, syrup).
Ideally, a special glucose solution. In extreme cases, give a piece of refined sugar. If there is nothing from the list presented at hand, then you can hit him on the cheek or pinch him hard. Simply put, cause a tangible pain impulse. It will help bring the patient out of a mild coma.
It is much more difficult to provide emergency care for hypoglycemic coma when a person is in its severe stage, since his swallowing reflex disappears, which is dangerous by choking. In this case, it is necessary to put a person under the tongue either a special gel containing glucose, or thick honey. Fortunately, even in a deep coma, a person is able to absorb substances through the space under the tongue.
Diagnostics
After the patient is taken by ambulance to the hospital, the next stage begins - the diagnosis of hypoglycemic coma. It begins with determining the overall picture of the state of he alth: doctors are talking with the patient or his family about various diseases that could cause the development of a pathological condition, as well asfind out what symptoms the patient experienced before falling into a coma. This stage is called the collection of anamnesis - the necessary information about the patient's illness, on the basis of which further treatment will be built.
Laboratory tests are also mandatory, the main of which is a blood test for glucose. As a rule, in the majority of incoming patients, this content is very small and differs greatly from the norm. Caregivers also examine and evaluate the severity of the external manifestations of hypoglycemic coma: dry and pale skin, excessive sweating, pupillary response, tremors of the limbs, and so on.
However, to make a correct diagnosis, studying only external signs is never enough. Therefore, when determining the course of treatment, computed tomography, EEG and MRI are also used.
Medical care for mild coma
When all the required measures were taken, the patient was provided with timely medical assistance, the necessary tests were taken, patients who survived a severe form of coma are placed in a hospital for treatment.
Usually, the symptoms of hypoglycemia and its consequences are removed quite quickly and simply by injecting a dose of glucose into the body, due to which blood sugar levels normalize. To do this, it is enough to either enter the desired solution intravenously, or eat or drink something sugar-containing. After that, you should organize a meal rich in carbohydrates.
However, if the hypoglycemia did not go smoothly, but resulted in a severe hypoglycemicwho, then the patient needs to be placed in a hospital. As a rule, the pathological condition of the patient is brought back to normal with the help of regular injections of glucose solution.
Medical care for deep coma
In more serious cases, when a person cannot get out of a coma even with a sufficient level of glucose in the body, therapy becomes more complicated and the list of drugs used is replenished with Glucagon, Prednisolone, Mannitol, and procedures are also carried out aimed at to maintain the tone of the heart and blood vessels. The longer the coma lasts, the more the central nervous system changes and the higher the risk of a stroke or heart attack.
However, in most cases, the patient gets back on his feet in a few days. Once the sugar level reaches normal, the treatment of hypoglycemic coma can be considered successful. In the future, the patient must follow a strict diet, do not forget about meals and control their sugar levels, as well as take drugs prescribed by a doctor.
Possible consequences of a coma
The severity of the consequences of hypoglycemic coma depends on the quality of the first aid provided and the quality of the care offered in the medical institution. Much depends on how long the patient has been in a coma. If this condition was short-lived, then the risk of complications is minimal. As soon as the glucose level returns to normal, the symptoms and consequences of hypoglycemic coma soon disappear.
However, as it wasmentioned above, a long coma leads to irreversible changes in the structure of the brain, leads to muscle atrophy and a decrease in the tone of the work of internal organs and blood vessels. It should be noted that with prolonged coma, a decrease in vascular tone is not one of the most serious consequences. A much greater concern is cerebral edema.
Possible Complications
Cerebral edema can have a different character. This may be swelling of blood vessels, gray matter or brain stem. The latter is the most dangerous, as it disrupts the vital functions of the body: respiration, blood circulation, and others.
However, edema is one of the most serious complications of hypoglycemic coma, not because of its edematous nature, but because of the subsequent increase in venous pressure and decrease in cerebral pressure, which ultimately results in either a stroke or a deadly meningitis. In fact, cerebral edema poses a life and death issue for the patient, which only a competent doctor in a fully equipped clinic is able to solve.
General conclusion
Hypoglycemic coma is the final stage in the development of such a pathological condition as hypoglycemia. The reason for the formation of a negative pathology in diabetics is a critical decrease in blood sugar levels due to an inadvertent increase in the injected dose of insulin or non-compliance with a carbohydrate diet.
Hypoglycemia itself, with proper and timely treatment, is not dangerous, all symptoms and possible complications disappear after the glucose level inbody returns to normal. However, if the ambulance drove too long to the patient or the first aid was incorrectly provided, then there is a real threat to the he althy life of a person - a hypoglycemic coma. In most cases, it requires hospital treatment and a further recovery period at home, as well as regular prophylaxis.
Coma is dangerous primarily due to the likelihood of developing such complications as cerebral edema, which can at least lead to a protracted coma and atrophy of blood vessels and muscles, and at most result in a stroke and inevitable death. Therefore, doctors always try to prevent the development of hypoglycemia to a situation where a person falls into a coma. This process is called “cupping.”
