Glucose is one of the main substrates that ensures the functioning of brain tissue. In the presence of diabetes, a person is faced with problems with the amount of glucose in the blood. Failures occur in the body, against which there may be complications.
In diabetes mellitus, in addition to the complications of the course of the process, one should be afraid of two conditions - hyperglycemia and hypoglycemia. Such conditions often occur with the wrong behavior of the patient. Consider what mistakes patients make, how to determine the state of hypoglycemia and how to provide first aid in this condition.
Hypoglycemia. Reasons for the development of hypoglycemic coma
Hypoglycemia is characterized by a plasma glucose concentration of less than 2.8 mmol/l if clinical manifestations are present, and less than 2.2 regardless of the presence of the manifestation.
Hypoglycemia can be mild, in which the patient feels the symptoms and is able to eliminate them himself, and severe hypoglycemia, which is accompanied by impaired consciousness, the patient needs medical attention.
Causes of hypoglycemia:
I. Associated with hypoglycemic therapy.
- Overdose of insulin and other hypoglycemic drugs:
- Patient error (additional intake of hypoglycemic drugs, incorrect choice of insulin dose, additional intake of drugs, self-increasing the dose);
- doctor inaccuracy in prescribing (high insulin dosage or low glycemic targets);
- malfunction syringe – a pen or glucometer that shows high readings when measuring blood glucose;
- deliberate overdose for the purpose of manipulating or committing suicide.
- Altered elimination of insulin or sugar-lowering drugs (delayed elimination, incorrect injection technique).
- Hypersensitivity to the drug (with prolonged physical exertion or in the postpartum period).
II. Causes related to diet change
- skip a meal or lack of carbohydrates in the diet;
- deliberate starvation or intention to reduce body weight without reducing the dose of the drug;
- slow movement of food from the stomach in neuropathies;
- reception of alcoholic beverages;
- short-term exercise without carbohydrate intake before and after exercise.
III. Associated with increased muscle activity.
Pathogenesis of hypoglycemia development. Symptoms of hypoglycemia
Glycogenolysis and gluconeogenesis are mechanisms aimed at maintaining glucose balance. Inhibition of utilization by insulin-dependent tissues also belongs to these mechanisms. These processes are activated by contrainsular hormones (growth hormone, cortisone, glucagon, catecholamines).
When the glucose level approaches 3.8, the secretion of these hormones increases. The autonomic nervous system also responds to a decrease in glucose with the presence of neurogenic symptoms, and at glucose levels below 2.7, symptoms of a deficient supply of glucose to the brain tissue (neuroglycopenic symptoms) are observed. So, with a sharp development of the state of hypoglycemia, these symptoms are observed simultaneously.
Clinical presentation of hypoglycemia:
- Neurogenic symptoms – cholinergic – paresthesia, hunger, increased sweating, adrenergic – pallor, tremors, palpitations, anxiety, nightmares.
- Neuroglycopenic symptoms – increased fatigue, weakness, decreased concentration, speech and visual disturbances, behavioral changes, impaired consciousness, convulsions, dizziness.
With a long course of diabetes mellitus, these symptoms may be present in patients with a glycemia of 5-7 mmol / l. This is false hypoglycemia.
Treatment of hypoglycemia in different settings. Help with hypoglycemic coma
Non-drug treatment is to take 2 carbs, which is about 4 teaspoons of sugar dissolved in water or tea, or drink a glass of sweet fruit juice. One bread unit raises blood glucose levels by 2.2 mmol/l.
In case of impaired consciousness, drug treatment is indicated. To avoid the development of aspiration in hypoglycemic coma, eliminate hypoglycemia by intravenous administration of 40% glucose 40-100 ml. Prior to the arrival of the medical team, intramuscular or subcutaneous administration of 1 mg of glucagon is recommended.
Consciousness is restored within 5-10 minutes, if not renewed – the procedure is repeated. With the successful removal of a person from a hypoglycemic coma, the intake of rapidly digestible carbohydrates is recommended. It is important to know that glucagon will have no effect if the hypoglycemia is caused by alcohol intake or insulin overdose.
In any case, if a person who has a history of diabetes mellitus is in a coma, resuscitation should be started with the intake of glucose into his body. Even if it is a hyperglycemic coma, then the sugar level, which is very high, will rise even more, and this will not affect the state in any way.
But if a person is in a hypoglycemic coma, then in this way you can quickly help him. Usually in such states it is not necessary to spend time thinking about the cause of the coma. We need to act.
In situations where, after carrying out the measures described above, a person does not regain consciousness, he should be immediately hospitalized in the intensive care unit to remove the patient from a hypoglycemic coma.
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