A critical decrease in sugar level, just like its increase, inevitably leads to impaired functioning of the body and the emergence of various pathologies. A tangible 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 diagnose and select medications, is abbreviated as ICD. The ICD hypoglycemic coma belongs to the rubric 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 the 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 with lightning speed and always has various reasons. There are many causes of hypoglycemic coma, but the main one is an acute shortage of glucose in the blood, which nourishes the brain cells and other vital organs. This ultimately leads to an exacerbation of a disease such 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 intake of the hormone insulin.
The main objective of this hormone is to neutralize the excess glucose in the blood in people with diabetes. Strong excess of the permissible threshold of insulin can lead to a decrease in glucose levels and subsequent coma.
- The use of alcoholic beverages.
Alcohol inhibits the synthesis of glucose in the liver and the transport of sugar into the blood, since the liver can hardly cope with the double load (alcohol withdrawal and glucose production). The greater the amount of alcohol consumed, the higher the likelihood of developing hypoglycemia.
- Failure to follow a special diet.
Insulin injections must be accompanied by the consumption of carbohydrate-rich foods. A lack of carbohydrates amid, for example, unusual physical exertion is a common prerequisite for the progression of an unhealthy hypoglycemic state and, as a result, the cause of hypoglycemic coma.
As you know, the pancreas is a source of insulin production in the body, which as a result of chemical interactions reduces 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.
Symptoms of a 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 worsening of possible consequences. During these stages, you can consider the main symptoms of hypoglycemic coma, from harmless to fatal.
General malaise. It manifests itself in the form of headaches, profuse cold sweat, pallor of the skin, a feeling of hunger and sometimes a lowered body temperature. It is also possible the appearance of behavior unusual for the patient in the usual state: excessive irritability, unreasonable fun or apathy.
The manifestation of hypoglycemia. The patient's condition is gradually worsening, the symptoms are becoming more dangerous. The midbrain is drawn into the process of developing hypoglycemia. The pulse quickens and develops into tachycardia, blood pressure rises to dangerous values, a person may be disturbed by nausea and vomiting. For this stage, convulsions of the arms and legs are characteristic, in appearance similar to an epileptic seizure.
Coma stage
At this stage, the last and most dangerous form of hypoglycemia is manifested - a coma, the patient loses consciousness. The pulse and blood pressure gradually fall to acceptable values, cramps go away, and breathing is evened out. The pupils are slightly dilated and retain the ability to respond to light.
The decrease in all the main 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 intensifies and the measured pulse disappears: from slowing down to a new heart rate. A deep coma is dangerous because during it it can develop cerebral edema with all the ensuing consequences.
What can not be done
Emergency care for hypoglycemic coma should be given 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 the patient inject the dose of insulin that he carries with him. This has a positive effect only in case of hyperglycemia (exceeding the permissible level of glucose in the blood), which cannot be distinguished with the naked eye from hypoglycemia.
After calling an ambulance, it is necessary to help the patient with improvised means. Actions with a hypoglycemic coma should be rapid, but deliberate. You should not give the patient any medications, and even more so inject substances such as adrenaline, if there is no self-confidence. It makes sense to proceed to such manipulations only if the ambulance takes too long and the patient’s pupils have lost reaction to the light.
What should be done
If the patient is depressed, but still retains the ability to talk and at least somehow move, then you need to put him on his side or bring him into a sitting position. Next, you must definitely pour a drink containing a large dose of sugar (juice, sweet tea, syrup) into his mouth.
Ideally, a special glucose solution. In extreme cases - give a piece of refined sugar. If you don’t have anything from the list at hand, you can hit it on the cheek or pinch it badly. Simply put, cause a tangible pain impulse. It will help to remove the patient from a light coma.
It is much more difficult to provide emergency care for a hypoglycemic coma when a person is in its severe stage, because his swallowing reflex disappears, which is dangerous because of 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 to the hospital by ambulance, the next stage begins - the diagnosis of hypoglycemic coma. It begins with a definition of the general picture of the state of health: the doctors talk with the patient or his family about various diseases that could cause the development of a pathological condition, and also find out what symptoms the patient experienced before falling into a coma. This stage is called collecting an 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 very different from the norm. The treating staff also studies and evaluates the severity of the external manifestations of the hypoglycemic coma: dryness and pallor of the skin, excessive sweating, the reaction of the pupils, tremor of the extremities and so on.
However, to make a correct diagnosis, studying only external signs is never enough. Therefore, in determining the course of treatment, computed tomography, EEG and MRI are also used.
Medical help for a mild coma
When all the necessary measures have been taken, the patient was provided with timely medical care, the necessary tests were taken, patients who have experienced severe coma are placed in a hospital for treatment.
Usually, the symptoms of hypoglycemia and its consequences are removed quite quickly and simply by introducing a dose of glucose into the body, due to which the blood sugar level is normalized. To do this, it is enough either to inject the desired solution intravenously, or to eat or drink something sugar-containing. After this, you should organize a meal rich in carbohydrates.
However, if hypoglycemia did not go smoothly, but resulted in a severe hypoglycemic coma, then the patient needs to be hospitalized. As a rule, the patient's pathological condition is brought back to normal with regular injections of a 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, the therapy is complicated and the list of drugs used is replenished with Glucagon, Prednisolone, Mannitol, and procedures are carried out aimed at maintaining heart tone and vessels. The longer the coma lasts, the more the central nervous system changes and the higher the risk of stroke or heart attack.
However, in most cases, the patient rises to his feet in a few days. Once the sugar level reaches normal, treatment for hypoglycemic coma can be considered successful. In the future, the patient must follow a strict diet, do not forget about meals and control his sugar level, as well as take medications prescribed by a doctor.
Possible consequences of a coma
The severity of the effects of hypoglycemic coma depends on the quality of the first aid provided and the quality of the assistance offered at the hospital. 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 the hypoglycemic coma will soon disappear.
However, as mentioned 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 is worth noting that with prolonged coma, a decrease in vascular tone is not one of the most serious consequences. Much greater concern is caused by cerebral edema.
Possible complications
Cerebral edema can be of a different nature. This may be edema of blood vessels, gray matter or brain stem. The latter is the most dangerous, since it violates the vital functions of the body: respiration, blood circulation and others.
However, edema is one of the most serious complications of a hypoglycemic coma not because of its edematous nature, but because of an increase in venous pressure and a decrease in cerebral pressure following the edema, which ultimately results in either a stroke or a deadly meningitis. In fact, cerebral edema poses the patient a question of life and death, which only a competent doctor can solve in a fully equipped clinic.
General conclusion
Hypoglycemic coma is the final stage of development of such a pathological condition as hypoglycemia. The reason for the formation of negative pathology in diabetics is a critical decrease in blood sugar due to an inadvertent increase in the injected dose of insulin or a failure to follow a carbohydrate diet.
With proper and timely treatment, hypoglycemia itself is not dangerous, all symptoms and possible complications disappear after the glucose level in the body returns to normal. However, if the ambulance went to the patient for too long or the first aid was provided incorrectly, a real threat to a person’s healthy life appears - hypoglycemic coma. In most cases, it requires inpatient treatment and a further period of recovery at home, as well as regular prevention.
Coma is dangerous primarily because of the likelihood of developing such a complication as cerebral edema, which can at least lead to a protracted coma and atrophy of blood vessels and muscles, and at the very least result in a stroke and inevitable death. Therefore, doctors always try to prevent the development of hypoglycemia in a situation where a person falls into a coma. This process is called “stopping."