Hypoglycemic state, when the sugar (glucose) content in a person's blood decreases, can be in every person, especially those who suffer from diseases of the exocrine pancreas. Hypoglycemic coma, in which emergency care is very important in the shortest possible time, is almost always the lot of diabetics. Those who suffer most often are those who have a fairly “decent” experience of type 1 (insulin-dependent) diabetes.
What is the danger of hypoglycemic coma? Damage to the nervous system, more specifically, cerebral edema. The fact is that almost half of the glucose that enters the body is used by the brain. If a hypoglycemic coma occurs, emergency care is delayed, the brain does not have enough energy, it cannot work at “full strength”, that is, it turns on “sleep mode”. Staying in this mode for a long time exacerbates the situation, since blood without glucose can retain less water in itself (osmotic pressuredecreases), this "excess" fluid goes to the tissues, primarily to the brain tissue. And if in a he althy person, in response to a decrease in glucose levels, more insulin antagonist hormones are produced compensatory, aimed at the release of the necessary glucose from its depot in the liver, then in diabetics this regulation is disturbed.
In addition, in diabetes mellitus, not only “simple” insulin is prescribed, but also a prolonged one that has a long-term effect. With an overdose or certain actions that lead to a decrease in blood sugar concentration, a hypoglycemic state can occur in a dream, not be recognized in time by a person and develop into a coma.
Why does hypoglycemic coma occur? Emergency care and symptoms
Not only diabetes is the cause of hypoglycemia, however - this is the most common situation. In other cases, a person may feel the initial manifestations of a decrease in sugar levels and take action (eat), but in the case of a long “experience” of the disease, this may not happen, and it will come to coma. It is coma that occurs when the glucose level drops below 2.5 mmol / liter (the lower limit of the norm is 3.3 mmol / liter, for many diabetics the “usual level” is 7-8 mmol / liter, and everything below it is already causes sensations of hypoglycemia).
In a patient with diabetes, hypoglycemic coma can occur due to:
- deliberate or accidental overdose of insulin;
- an overdose of a hypoglycemic tablet;
- fasting or eating a small amount of food 30-40 minutes after an insulin injection;
- when a person injected himself with the previously calculated dose, but before that he had increased physical activity;
- in violation of the schedule of insulin injections. Here it must be said that a person suffering from diabetes, if he is admitted to the hospital, should not take insulin “as before” without determining the glycemic profile: a more or less severe illness “breaks compensation”, and insulin doses must be determined every day, after the attending physician finds out the level of sugar in the blood;
- after drinking alcohol: ethyl alcohol reduces the activity of those enzymes that are responsible for the production of additional, if necessary, glucose. That is, alcohol "blocks the road" to protective mechanisms.
Other causes of hypoglycemia:
- prolonged fasting, especially when a person works hard physically;
- deliberate injection of insulin by a he althy person to himself or another person;
- pancreatic necrosis, acute pancreatitis and hepatitis;
- the presence of a tumor in the body that produces insulin.
Before the development of a coma itself, the following symptoms may be observed for some time (up to several hours):
- inappropriate behavior (often - aggression);
- weakness, fatigue;
- hand shake;
- trembling all over;
- feeling very hungry.
At the same time, most oftena person is covered with a cold sticky sweat, he becomes pale, his pulse is palpable. Then the person can calm down, lie down to rest, and from the side it is noticeable that the release of cold sweat continues, and the dream is restless, the person often cries out, expresses delusional wishes. If you try to wake him up, he may initially react, but usually without opening his eyes and not recognizing those around him. This is a beginning hypoglycemic coma. Urgent care must be provided now.
Therefore, if you notice inadequacy, aggressiveness and disorientation in a person who has diabetes (even if he periodically answers that he is fine), but you do not have a glucometer at hand, provide assistance as in a hypoglycemic state: a lot of sugar in the blood does not pose such a danger to life as a state when it is low. It is in a hypoglycemic state (coma) that minutes count, while a coma caused by high sugar levels is unlikely to lead to death and disability if help is provided after 30-40 minutes.
Help for hypoglycemic coma
Consists in the introduction of glucose solution intravenously. It is best if the house has a glucometer. If you know the technique of intravenous injection, then when signs of hypoglycemia appear, you can inject undiluted 40% glucose in an amount of 20-40 ml. Then do not exit the vein. Glucagon can be injected intramuscularly (if available).
Have someone else call an ambulance (hospitalization will be required, especially if there was an overdose of prolongedinsulin).
If consciousness has not recovered, make another 20 ml of the same glucose, enter 1 ampoule of "Prednisolone" or "Dexamethasone" intravenously, diluting it in 10 ml of isotonic sodium chloride. If this is done without monitoring the sugar level on a glucometer, do nothing else until the ambulance arrives.
First aid for hypoglycemic coma, if relatives do not know the technique of intravenous injections, and there is no glucagon in the house (this is a rather expensive drug), is as follows:
- put the patient on his side, watching the breath so that it does not stop;
- open the window, the window to get more oxygen;
- if possible, put a couple of small (one at a time) pieces of refined sugar under the tongue, while making sure that this sugar is not swallowed, as an unconscious patient can, moving his jaws, block his airways with such a piece.
You can’t give a drink to a patient in a coma: in this way you will only pour this liquid into the lungs, then it will be very difficult and sometimes even impossible to cure such consequences.
If you managed to catch a person when he is still conscious, but inadequate and excited, try to give him sweet sparkling water, warm water with sugar or honey, just a candy or a spoonful of honey. It is imperative to call an ambulance, even if you stopped this dangerous condition yourself with such carbohydrates.
