Coma
Insulin Coma
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Insulin coma refers to a medical emergency that renders a person with diabetes unconscious because his or her blood glucose level is too low or too high. If the glucose level is too low, the person has hypoglycemia and if the level is too high, the person has hyperglycemia and may develop ketoacidosis. Patients with diabetes mellitus type 1 are susceptible to this condition.
Causes for this condition vary; in the case of a hyperglycemia, it could be due to too much food too quickly or forgetting to inject oneself with insulin, while in the case of a hypoglycemia it could be due to a lack of food, too much exercise for current conditions, or to an insulin overdose. While no particular amount of sugar in the blood is generally recognized as the starting point to an attack of this kind, blood glucose levels higher than 500 mg/dL (28 mmol/L) indicate risk of hyperglycemic insulin coma, and blood glucose levels lower than 50 mg/dL (3 mmol/L) risk hypoglycemic insulin coma.
In both cases, the coma is caused by brain cell malfunction. In the case of hypoglycemia, there simply isn't enough glucose in the blood, leaving brain cells without enough glucose to satisfy their metabolic needs. In the case of hyperglycemia, while glucose is plentiful, indeed too plentiful, the consequences of so much blood glucose produce chemistry abnormalities which cause brain cells to malfunction. These include cell dehydration due to osmotic pressure, electrolyte balance problems both inside brain cells and in the blood, and in some cases acidosis.
• If available, a blood glucose reading should be taken immediately. Because the symptoms of hypo- and hyperglycemia are similar, it’s difficult to tell which condition is causing the coma. Never give insulin unless you are certain that the patient is not hypoglycemic. Mistakes with insulin can be fatal.
• If the patient is conscious and suffering from hypoglycemia, administer sugar (fruit or orange juice, glucose or white sugar dissolved in juice or water), glucose tablets or gel, sugary drinks (not diet drinks), etc. Artificial sweetners will not work. Avoid fatty, oily, or protein rich foods if possible, for digestion and absorption will be delayed. A chocolate bar is not as good as a sugary tea, for instance. If suffering from hyperglycemia, do not feed the patient. Push water while conscious instead. And get the patient to medical treatment promptly.
• If the patient is unconscious and suffering from hypoglycemia, glucose gel may be rubbed on the lips and gums in the hopes that it will be absorbed through the mucous membranes. Even a hard sugar candy might help, placed between cheek and gum. To avoid choking, no other food or drink should be given to an unconscious person.
• If a blood test isn’t possible, administering sugars to a person suffering hypoglycemia will improve their condition within fifteen minutes. If improvement doesn’t occur, the cause was not hypoglycemia. (Note: Giving sugar to a hyperglycemic patient is far less dangerous than giving insulin to a hypoglycemic patient.) If sugar does not cause improvement, the insulin coma most likely resulted from hyperglycemia, a critical situation requiring immmediate medical treatment. Failure to receive treatment may result in ketoacidosis and death.