Blood glucose is an important indicator of human health. 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 rapidly deteriorates, and the patient falls into a coma. How to prevent this condition? And how to provide first aid to the patient? We will consider these issues in the article.
Pathology Description
What is hypoglycemic shock? This is a severe reaction of the body to a drop in blood glucose concentration and an increase in the level of the hormone insulin. In this dangerous condition, the central nervous system is primarily affected. After all, glucose is a source of energy for neurons. With a deficiency of this substance, brain tissues experience an acute lack of oxygen.
Hypoxia is accompanied by the death of neurons. The more nerve cells die, the more pronounced signs of pathology. When glucose drops to extremely low levels, the patient falls into a coma. Doctors call this condition insulin or hypoglycemic shock. If you do not urgently help the patient, then a coma can lead to death.
Etiology for 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 drugs for life. What can cause an overdose of the hormone? Endocrinologists identify the following causes of hypoglycemic shock in diabetics:
- The introduction of excessive amounts of insulin. An overdose is most often noted when using an oversized syringe. In this case, the patient is very difficult to dial the exact amount of solution. Therefore, doctors recommend the use of syringes that are equal in volume to a single dose of insulin.
- Intramuscular injection of insulin. It is important to remember that this hormone is allowed to be administered only under the skin or intravenously. Sometimes insulin accidentally enters the muscle when using a needle that is too long.
- Lack of food after administration of the drug. In some forms of diabetes, doctors prescribe short-acting insulin medications. These drugs are administered strictly before meals. Some time after the injection, the patient must eat. A long lack of food can cause a drop in glucose levels.
- Exercise immediately after injection. Doctors recommend giving the body a little rest after an injection of insulin. This is especially true for patients taking short-acting drugs. During hard muscle work and sports, glucose is consumed very intensively. If insulin was injected shortly before exercise, this can lead to a sharp drop in sugar.
- Massage the area of drug administration. Doctors do not recommend massaging the injection site of insulin. This enhances blood circulation and can cause an increase in the concentration of the hormone in the blood.
- Decrease in 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 an increased amount. However, with alcohol, obesity, and pregnancy, antibody production is reduced. This leads to an excessive effect of insulin on the body and a sharp drop in glucose levels.
- Improper treatment of ketoacidosis. With the untimely administration of insulin or with an insufficient dosage, the patient will increase the level of sugar and ketone bodies in the blood plasma. This condition is called ketoacidosis; it poses a great danger to life. In this case, doctors adjust the treatment regimen and prescribe higher doses of insulin to patients. At the same time, the risk of overdose of the drug increases. Therefore, therapy should be carried out under strict control of blood sugar concentration.
- Reception of sulfonamides. The use of such drugs increases the concentration of insulin in the plasma and can cause hypoglycemia.
Other causes of hypoglycemia
Can there be hypoglycemic shock without diabetes? A sharp decrease in glucose can be observed in healthy people. It can be triggered by the following reasons:
- Fasting and malnutrition. Often hypoglycemia occurs during the observance of excessively strict diets and long breaks between meals. In this case, a deficiency of carbohydrates forms in the body, resulting in hypoglycemic shock. However, this phenomenon occurs quite rarely.
- Physical activity. Intensive training requires a large expenditure of energy, which the body takes from glucose stores. As a result, a person may have a drop in blood sugar. Often there is hypoglycemic shock in athletes during competitions. Some bodybuilders use insulin to increase muscle mass. In no case should this be done. Inappropriate use of the hormone can lead to severe hypoglycemia.
- Taking some medications. The use of antipyretic drugs, sulfonamides, as well as antimalarials can lead to a decrease in sugar.
The cause of hypoglycemia can be alcohol abuse. Often a shock condition due to a drop in glucose levels is observed in patients with chronic alcoholism.
Hypoglycemic shock can occur as a complication of the following diseases and conditions of the body:
- liver and kidney diseases;
- enzyme production 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 the newborn.
Stages
Doctors distinguish the following stages of hypoglycemia:
- Cortical stage. The patient becomes irritable and feels a strong feeling of hunger. Such symptoms are caused by the death of neurons in the cerebral cortex.
- Stage of vegetative reactions. In the brain, cells of the subcortical departments die. This is accompanied by severe pathological manifestations of the autonomic nervous system: frequent palpitations, increased sweating, trembling limbs, headaches. The patient continues to experience excruciating hunger.
- Subcortical stage. The patient continues to break down nerve cells under the cerebral cortex. This is accompanied by a mental disorder. Delusions and hallucinations appear. The patient becomes aggressive and may behave inappropriately.
- The death of neurons in the upper parts of the medulla oblongata. This stage is accompanied by the appearance of seizures. Then the patient falls into a shallow coma.
- Cell death in the lower part of the medulla oblongata. This section of the central nervous system is responsible for the vital functions of the body. At this stage, respiratory depression and cardiac activity develops. The patient is plunged into a deep coma, which is lethally pumped.
It is important to remember that all stages of hypoglycemic shock develop very quickly. Between the initial manifestations of pathology (hunger, irritability) and coma only a few minutes pass. Therefore, there is very little time left to assist the patient.
Initial signs
Early signs of hypoglycemia are often difficult to recognize. In the initial stages, the patient develops hypoxia of the brain. This is accompanied by a feeling of fatigue, as well as headaches that cannot be stopped by analgesics. This condition is a precursor to insulin shock, it is called a hypoglycemic aura.
When glucose falls below 2.8 mmol / L, the following manifestations of hypoglycemia occur:
- cooling and sweating of hands and feet;
- nausea;
- weakness;
- dizziness;
- numbness in the nose and lips.
If you do not help the patient at this stage, then his condition is rapidly deteriorating.
Detailed symptoms
In the later stages of the pathology, pronounced symptoms of hypoglycemic shock develop:
- unbearable feeling of hunger;
- difficulty breathing
- double vision and visual impairment;
- trembling hands and feet;
- tachycardia;
- drop in blood pressure and body temperature;
- sharp weakness;
- motor coordination disorder.
The late stages of hypoglycemia end with an attack of seizures, loss of consciousness and the development of a coma. This poses a great danger to the patient's life.
Complications
As already mentioned, hypoglycemic coma without treatment leads to death. But even with timely therapy, this condition can affect a person’s health status for a long time. After all, hypoglycemia is accompanied by the death of a large number of neurons.
A coma can cause the development of the following pathologies:
- Cerebral edema. Such a complication leads to irreversible pathological changes in the tissues of the central nervous system.
- Encephalopathy This disease is accompanied by a violation of the blood supply and nutrition of the brain. It leads to mental disorders, memory impairment and dementia. This consequence of hypoglycemia often develops in elderly patients.
- Impaired mental function. Hypoglycemia in childhood can cause mental retardation. A 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 you need to give the patient a sugar-containing 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 with a glucometer. If it still remains low, then the reception of the sweet product is repeated. If the patient suffers from diabetes mellitus, then after improving well-being, an endocrinologist should be visited.
If the patient has lost consciousness, it is urgent to call an ambulance team. Before the arrival of doctors, the patient should be put on his side. Intramuscularly, 2 ml of the drug Glucagon should be administered - this drug increases the level of glucose.
Diagnostics
It is very important to conduct a differential diagnosis of 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 study can be done using a glucometer.
In healthy 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 sugar falls below 3 mmol / L.
It should be remembered that a sharp jump in glucose concentration down most often leads to a shock state. In diabetics, the sugar level is elevated, it can reach 10-20 mmol / L. In this case, signs of hypoglycemia can occur even at rates of 4-8 mmol / L.
Treatment
In mild cases, the patient's condition improves after first aid. If hypoglycemia occurs frequently, the doctor reviews the patient's treatment regimen and, if necessary, reduces the dosage of insulin. The endocrinologist also gives recommendations to the patient about nutrition and lifestyle.
In severe cases, treatment of hypoglycemic shock is carried out 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 blood sugar. 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, mortality from hypoglycemic coma is about 4%. A fatal outcome most often occurs due to untimely assistance to the patient.
In mild cases, a sharp drop in sugar level has no effect. For the first time after an attack of hypoglycemia, the patient may feel slight weakness and dizziness. Then his condition is completely normalized.
Severe hypoglycemic coma can lead to cerebral edema and encephalopathy. In this case, patients may persist persistent neurological disorders. Such complications are more likely to occur in children and the elderly.
Prevention
How to prevent a drop in blood sugar and coma? In order to prevent this dangerous condition, it is necessary to observe the following recommendations of endocrinologists:
- Regularly measure your blood sugar with your home blood glucose meter.
- Avoid an overdose of insulin and other sugar-lowering drugs.
- Avoid fasting and long breaks between meals.
- Patients with diabetes should always have sugar cubes, chocolate bar or sweets with them.
- After the administration of drugs with short-acting insulin, it is necessary to avoid physical exertion.
These measures will help in time to control the level of glucose and prevent its critical decline.