If a diabetic patient is in a coma, please measure blood sugar in time

This is the 3844th article of Da Yi Xiao Hu

Doctor Liu was on duty in the emergency room yesterday and received a comatose old man. His family said that the patient had been coughing for the past two days, and felt short of breath and thirsty at noon. They thought he had a cold and would be fine after a good sleep. At night, the family heard the old man snoring loudly but couldn't wake him up. The family thought the patient had a "stroke" and was a little anxious. They rushed him to the hospital for treatment. When their blood sugar was tested, it was "HIGH" (too high to be measured), so Doctor Liu quickly gave him insulin to lower his blood sugar, gave him plenty of fluids, and completed related tests.

Before I was done, another unconscious old lady came to the emergency department. Her family members complained that she had eaten some unclean food in the past two days, had diarrhea several times a day, and had a poor appetite. She suddenly couldn't be woken up tonight. Every time he saw a comatose patient, Dr. Liu had a habit of asking the nurses to measure the blood sugar at the end of her finger during routine examinations. The old lady's blood sugar result was 1.6mmol/L, and Dr. Liu quickly asked the nurse to give her an intravenous injection of high sugar. Under Dr. Liu's timely treatment, the old lady woke up after a while, and the old man also slowly woke up after treatment. Through another communication with the patient after he woke up, everyone understood that the old man had some lung infection in the past few days. Usually, diabetes was controlled by subcutaneous insulin injection every day. During this period, blood sugar was not monitored. Unexpectedly, the blood sugar was so high when it was measured; and the old lady also had a history of diabetes, and usually controlled blood sugar by subcutaneous insulin injection. She had diarrhea in recent days and ate less, but she still injected insulin at the original dose every day, which led to hypoglycemia coma.

Common causes and triggers of coma caused by diabetes

If diabetic patients do not take proper care of themselves or have poor blood sugar control (too high or too low) in their daily lives, they may experience coma, such as ketoacidosis coma caused by high blood sugar, non-ketotic hyperosmolar coma, and diabetic hypoglycemia coma caused by low blood sugar.

1. Diabetic ketoacidosis is a syndrome in which the patient, under the influence of certain factors, has insufficient insulin secretion, leading to hyperglycemia, hyperketosis, dehydration, ketonuria, metabolic acidosis, electrolyte imbalance, etc. Severe metabolic disorders lead to the accumulation of a large number of ketone bodies in the patient's body.

Causes

Acute infection, improper treatment, uncontrolled diet, gastrointestinal diseases, etc. are the triggering factors of diabetic ketoacidosis.

symptom

Patients will have worsening symptoms of diabetes (such as polyuria and thirst), gastrointestinal symptoms (such as nausea, vomiting, loss of appetite), increased respiratory rate, rotten apple smell in the breath, shock, dehydration, impaired consciousness and other symptoms. In severe cases, patients will go into a coma.

2. Diabetic non-ketotic hyperosmolar coma is caused by the body's stress, which leads to a relative lack of insulin in the body, inappropriate secretion of insulin counter-regulatory hormones (such as glucagon) and increased release of glycogen, resulting in severe hyperglycemia. This disease is more common in the elderly, with an average age of onset of over 60 years old, and is more common in summer.

Causes

① Stress and infection: Stress reactions such as cerebrovascular accident, acute pancreatitis, surgery, respiratory tract infection and urinary tract infection are most likely to cause diabetic non-ketotic hyperosmolar coma.

② Insufficient drinking water: This is more common in the elderly, especially in summer when the body sweats more. However, since the thirst center of the elderly is not sensitive, insufficient drinking water can easily lead to blood concentration and increased plasma osmotic pressure. In addition, patients who cannot take care of themselves or are in a coma often have insufficient drinking water.

③ Excessive water loss: such as high fever, severe vomiting, diarrhea or inappropriate use of diuretics, dehydrating agents, etc.

④ Excessive sugar intake: Patients who do not know that they have diabetes drink large amounts of sweetened beverages or eat high-sugar foods, causing their blood sugar to rise significantly.

⑤ Drug factors: Glucocorticoids, beta-blockers and some diuretics can cause increased blood sugar. Insulin pump users may also develop this disease if their insulin pump malfunctions (such as catheter blockage) are not discovered in time.

symptom

Polyuria, polydipsia, and water loss without obvious ketosis gradually worsen with the progression of the disease. Various mental and neurological symptoms appear one after another, and the patient will quickly enter a coma or semi-coma state.

3. Diabetic hypoglycemia coma: Hypoglycemia can be diagnosed when the fasting blood glucose concentration of an adult is lower than 2.8mmol/L or the blood glucose value of a diabetic patient is ≤3.9mmol/L. Severe hypoglycemia can cause coma.

Causes

Excessive insulin dosage or oral hypoglycemic drug dosage leads to less food intake; increased exercise but no corresponding increase in food intake; reduced food intake but no appropriate reduction in hypoglycemic drug intake.

symptom

Hunger and fatigue, dizziness and headache, cold sweat, palpitations and shortness of breath, tachycardia, blurred vision, trembling all over the body, and even mental confusion, abnormal behavior, drowsiness and coma.

Prevention of coma caused by diabetes

① Strengthen diabetes knowledge education and health check-ups, early detection and early treatment, and regular blood sugar tests for people over 50 years old. Patients diagnosed with diabetes should take regular medication, control their diet, increase exercise, and strictly control their blood sugar levels.

② Control various inducing factors, actively treat various infections, pay attention to whether there is dehydration during hemodialysis, peritoneal dialysis, and mannitol dehydration treatments, and monitor blood sugar and urine sugar in time.

③ Pay attention to the use of inducing drugs, such as diuretics, glucocorticoids, propranolol (Inderal), etc.

④Change bad living habits and avoid staying up late, smoking and drinking.

⑤ Condition monitoring: Monitor blood sugar regularly. If early symptoms such as diabetic ketoacidosis, non-ketotic hyperosmolar coma, and diabetic hypoglycemia appear, measure blood sugar in time.

⑥ If the blood sugar level is too high or too low, timely treatment and follow-up are required. If the patient is conscious and can swallow, the most effective way to treat hypoglycemic coma is to let the patient drink sweet water or eat candy, sweet cakes, etc. In addition to hypoglycemia, coma caused by diabetes can also be caused by a significant increase in blood sugar. Therefore, when the cause of coma is unclear, do not feed the patient with sugar water casually to avoid aggravating the condition. Moreover, feeding sugar water to an unconscious patient can easily cause choking or even suffocation.

⑦ If the patient has lost consciousness, lay the patient flat with his head to one side, loosen his collar, ensure that the airway is open, clear vomitus, and prevent suffocation due to accidental aspiration.

⑧When a diabetic patient falls into a coma, if not rescued in time, his life may be in danger. You should call "120" and go to the hospital for medical treatment.

Author: Shanghai Fifth People's Hospital Affiliated to Fudan University

Dr. Cheung Hok Man