Hypoglycemic coma | First aid | Treatment | Hyperglycemic coma | Causes of hyperglycemic coma | Types of coma | Treatment of hyperglycemic coma | The consequences of coma
Coma in diabetes is one of the most serious complications of the disease. It develops as a result of metabolic disorders or total or partial insulin deficiency. We will distinguish between hypoglycemic and hyperglycemic coma.
Hypoglycemic coma in diabetes
It occurs with a sharp decrease in the concentration of glucose in the blood (up to 2-1 mmol / l). Risk factors:
- not following a therapeutic diet;
- insulin overdose;
- hormonal tumor (insulinoma);
- intense physical activity.
Hypoglycemic coma manifests itself very rapidly. The first symptoms – within half an hour after the action of a provoking factor.
Signs of impending hypoglycemic coma:
- severe hunger;
- general weakness;
- excessive sweating;
- wet pale skin;
- tense muscles;
- strong tendon reflexes, convulsions;
- dilated pupils;
- mental inadequacy, hallucinations;
- loss of consciousness (blood pressure, respiration and pulse remain within normal limits).
First aid for coma
When the first signs of hypoglycemic coma appear in a patient with diabetes mellitus, it is necessary to perform the following actions:
- give glucose in any form (sweet tea, candy, sugar); if the victim is not able to independently take glucose, you need to unclench his teeth and put something sweet under the tongue;
- to shelter the patient, keep them safe;
- call an ambulance.
!!! A dangerous mistake is the classification of hypoglycemic coma as hyperglycemic. If insulin is administered as a result of a false assessment, the patient may die. Therefore, in clinical practice, it is difficult to determine who is hypoglycemic.
Treatment
The patient is immediately injected with an intravenous glucose solution. According to blood test results, adrenaline, ascorbic acid, glucagon, hydrocortisone are used. To prevent cerebral edema, an intravenous infusion of mannitol (20%) and mechanical ventilation is performed in hyperventilation mode.
Hyperglycemic coma in diabetes
It develops gradually over a period of one and a half to two weeks. Blood glucose levels rise. Sometimes concentration reaches 55 mmol / l.
Clinical signs:
- lethargy and drowsiness;
- headache and tinnitus;
- loss of consciousness;
- dry skin and mucous membranes, moderate pallor or hyperemia;
- smell of acetone from the mouth;
- sunken eyeballs;
- rapid pulse;
- low blood pressure;
- cramps, excessive reflex activity;
- polyuria;
- changes in respirations.
Causes of hyperglycemic coma
- not following an appropriate diet (excessive consumption of fatty and carbohydrate foods);
- insufficient dose of insulin.
Types of coma in diabetes
- ketoacidotic;
- hyperosmolar non-ketoacidotic;
- lactic acid.
A state of hyperglycemic coma requires immediate medical attention. Therefore, you do not need to do anything on your own.
Treatment
Short-acting insulin is promptly administered to the patient, since this form is easier to control. Most often, drugs are administered intravenously using drip dispensers under the control of blood glucose levels. Speed - 6-10 units / hour.
The first dose of insulin (depending on the level of hyperglycemia) is increased to 20 units. Subsequently, the amount is reduced so that the glucose concentration decreases gradually, by 3-4 mmol per hour. Correction is carried out until the glucose level is 8-10 mmol / L.
The consequences of coma in diabetes
If symptoms and the initial signs of coma are seen in time, then impaired consciousness can be avoided. Otherwise, a coma leads to cerebral edema. The patient may die. The number of deaths – 10% of the total number of coma patients.