What causes coma in diabetes mellitus?
Diabetes mellitus refers to endocrine diseases. It can be of two types. Diabetes mellitus of the first type is insulin-dependent, and type 2 diabetes is insulin-independent.
Coma in diabetes mellitus is one of the most serious complications of this disease. The condition can arise due to insulin insufficiency, as well as metabolic disorders. The main types of com with diabetes mellitus are distinguished in the number of two pieces:
Hypoglycemic coma in diabetes mellitus
This condition can develop in a patient if a sharp decrease in glucose level occurs in his blood. The indicator falls below 2-1 mmol / l. Coma occurs with an overdose of insulin, a violation of diet or hormonal tumors.
Glucose is the main source for brain energy. The human nervous system consumes about 20% of the glucose that circulates in the human blood. The brain can not store glucose, which many other body systems are capable of. Therefore, if glucose is not supplied to the brain cells within a maximum of seven minutes, irreversible changes occur in the brain. With hypoglycemia, the blood glucose level drops sharply. Especially this applies to brain cells.
This condition manifests itself as a loss of consciousness, motor and psychomotor disorders. The patient does not exclude hallucinations and tonic convulsions. Skin and mucous membranes abruptly acquire a white color, become moist, sweat appears, tachycardia is observed.
This is important! When the patient is in this condition, it is very important not to confuse hypoglycemic and hyperglycemic coma. Doctors advise always to use one rule: if you accurately determine the type of coma is difficult, then it must first be regarded as hypoglycemic.
After determining the type of coma, it is necessary to administer 80ml of 40% glucose solution to the patient. If possible, you need to measure the glucose in your blood. It should be within 8-10 mmol / l. Introduce a person who is in the state of this coma, you can also hydrocortisone, ascorbic acid, glucagon, adrenaline. The choice of the drug depends on the specific indications.
To avoid complications such as cerebral edema after or as a result of a coma, it is necessary to introduce a ventilator in the hyperventilation mode, as well as intravenous infusions of 20% mannitol.
Hyperglycemic coma in diabetes mellitus
Sometimes the concentration of glucose in the blood rises and reaches 55 mmol / l. Then this kind of coma arises in a person with diabetes mellitus. This condition is characterized by loss of consciousness, dry skin and mucous membranes. Sometimes you can smell bad breath. The eye apples of the patient become sunken and soft, the pulse becomes faster. Cramps are possible, as well as increased reflex activity.
There are three types of this coma:
- Hyperosmolar non-ketoacidotic;
When diagnosing a particular type of coma, an important role is played not only by clinical data, but also by laboratory studies. For example, with hyperglycemic coma, not only does blood sugar rise, but hyperosmolar syndrome also develops. In the extracellular space, the fluid moves from the cells. Therefore, there are signs of cellular dehydration that lead to neurologic symptoms. Also, the level of sugar in the urine rises. The index can reach 250 mmol / l.
As a result of coma, the body is lost up to twelve liters of fluid. Together with it, the body derives potassium and sodium, magnesium, calcium. As a result of these processes, hypoelectroliteemia develops. Ketone bodies in the blood go off scale, their number increases to ten times. Especially in a large number of them can be found in the urine.
That's interesting! Coma in diabetes mellitus: the consequences can be severe, and the condition lasts for a long time. The longest case recorded in modern medicine: a man has been lying in a diabetic coma for over forty years.
To quickly remove a person from the state of this coma, you must enter the patient's insulin. It is best if you have "controlled" insulin at hand. The most effective is a drip introduction. The amount of glucose in the blood should be constantly monitored. As a rule, it is necessary to introduce such an amount of insulin that the blood glucose content decreases by 3-4 mmol / hour every hour. As a result, the sugar level should be at the level of 8-10 mmol / l.
The patient also needs to give more fluid, inject sodium. The rate of fluid injection into the body directly depends on the state of the cardiovascular system of the patient, on the proper functioning of the kidneys. It is best to introduce one or two liters of liquid in the first hour, in the second and third of the tea - a liter, and in each subsequent hour - 250 milliliters. The total volume of fluid that must be administered to the patient within 24 hours is 4-7 liters.
This is important! If a person with diabetes mellitus suddenly lost consciousness at a dentist's reception, the first thing to do is to presume a state of hypoglycemia. Carry out all necessary measures and immediately call an ambulance.
If a diabetic patient knows how to behave and monitor his health correctly, then coma states can be avoided with great probability. Be careful and do not allow extremes!