Diabetics can suffer not only from too high blood sugar, but also from too low. If the level is extremely low and unconsciousness occurs for this reason, experts speak of hypoglycemic shock (colloquially: hypoglycemia). This can be life-threatening.
What is hypoglycemic shock?
In diabetics, blood glucose levels can fluctuate wildly for a variety of reasons. If the level drops below 40 to 50 mg/dl, there is acute danger. Such a case occurs when there is too much insulin in the blood. Since the brain needs glucose to maintain vital functions, such a condition can become extremely dangerous. If the patient becomes unconscious, this is a coma. But hypoglycemia already announces itself in advance:
The affected person is pale, sweats, has ravenous appetite, may have seizures, trembles, is restless and possibly mentally striking, which can manifest itself in agitation, confusion or hallucinations. The pulse rate accelerates and blood pressure is elevated. If hypoglycemic shock occurs, action must be taken even more quickly than in diabetic coma.
Causes
The question is: What causes hypoglycemia to be so dangerous? One possibility is that a diabetic has overdosed his or her blood sugar-lowering medication or insulin. Hypoglycemic shock can also occur if those affected eat too little (especially carbohydrates) or exercise too much without adjusting their insulin or medication doses. For this reason, optimal dose adjustment is elementary. Excessive alcohol consumption, on the other hand, can also become critical for people without diabetes. Since the liver is busy breaking down alcohol, it may not be able to produce enough glucose (dextrose) and the brain suffers a deficiency. Hypoglycemia also then occurs. However, excessive consumption of foods with a high glycemic index, which trigger a strong release of insulin, can also cause blood glucose levels to drop rapidly as a result.
Symptoms, complaints, and signs
Hypoglycemic shock is characterized by the sudden onset of coma. It is a life-threatening condition that requires immediate treatment. Treatment consists of the administration of glucose in the form of dextrose or, if the patient is unconscious, in the form of an IV. In addition to coma, there is a tendency to convulsions and increased reflexes. In addition, there is profuse sweating and moist and pale skin. In addition, palpitations often occur. However, unlike diabetic coma, the symptom of complete dehydration is absent. Since coma in hypoglycemic shock is otherwise indistinguishable from diabetic coma, the only way to distinguish between the two disease states is by the presenting signs. Laboratory tests reveal very low blood glucose levels. In addition, hypoglycemic shock announces itself by various symptoms that occur even with moderate hypoglycemia. It is true that these are symptoms that can also occur in other diseases. However, in the context of diabetes, they provide valuable clues that unconsciousness may be imminent. These signs include sudden restlessness, food cravings, difficulty concentrating, dizziness, nervousness, visual disturbances, panic, trembling or palpitations. In addition, there are perceptual disturbances, difficulty speaking, tingling, cold sweats, weak knees and a furry taste in the mouth. After glucose is administered, the symptoms immediately resolve.
Diagnosis and course
Life-threatening hypoglycemia can persist for hours and days. Therein lies the clinical problem. It first announces itself by symptoms of the autonomic nervous system and the central nervous system. The first signs are ravenous appetite, sweating, nausea, trembling, vomiting, headache, lack of concentration, increased irritability and confusion. If blood glucose levels drop even further, primitive expressions such as smacking, grimacing and grasping may occur. Subsequently, speech disorders, double vision, seizures, paralysis, and respiratory and circulatory problems occur. Finally, hypoglycemic shock occurs in the form of unconsciousness. The affected person falls into a coma. The progression of symptoms is very rapid. For this reason, diabetics must monitor themselves closely.Already at the first signs, the blood glucose level must be controlled.
Complications
As a rule, a number of different complaints and symptoms occur during this shock. The affected person primarily suffers from vomiting and severe nausea. A general feeling of illness occurs and the patient usually feels tired and exhausted. Physical exertion or sporting activities are no longer possible, so that the quality of life is severely restricted. Furthermore, there is trembling all over the body and sweating. It is also not uncommon for the affected person to suffer from impaired coordination and concentration. In the further course, the patient may also lose consciousness if the symptoms are severe. If the shock is not treated, death usually occurs as well. If unconsciousness occurs, the patient may be injured if he or she falls. Treatment of shock is usually by importing glucose and leads relatively quickly to a positive course of the disease. No further complications occur if treatment is given quickly and early. However, the patient may suffocate if he loses consciousness and no other person provides assistance.
When should you go to the doctor?
Mild hypoglycemic shock usually resolves on its own as soon as a small meal with enough carbohydrates is eaten. Severe hypoglycemia, on the other hand, always requires medical attention. If the person is still conscious, glucose or an appropriate emergency medication can be administered. The measures must be repeated at 15-minute intervals until the blood glucose level is stable again or a doctor arrives. In the event of unconsciousness, the emergency medical services must be called immediately. Until specialist help is available, the affected person must be given the necessary agent (e.g. glucagon or glucose) intravenously. Hypoglycemic shock must always be discussed with the physician in charge. The medical history is necessary to determine the cause of the hypoglycemia and to adjust the therapy accordingly. In addition, if necessary, the physician can prescribe a stronger medication to prevent future attacks. It is also possible that impaired hypoglycemia awareness is causative, which must be identified and treated with medication.
Treatment and therapy
If hypoglycemic shock is imminent, countermeasures should be taken immediately. If the blood glucose level turns out to be too low, the affected person must take glucose immediately. One possibility is to clamp one to four tablets of glucose between the teeth and cheek. The glucose dissolves slowly and thus enters the bloodstream. The patient who is still conscious can also eat other carbohydrate-rich foods that raise blood sugar levels quickly. Sugary drinks such as fruit juices are also an option. Light drinks, on the other hand, should be avoided because they lead to even more insulin release, further lowering blood sugar levels. If these measures are not enough, then an intravenous glucose infusion is indicated. This applies if the patient is already unconscious, because then the swallowing reflex no longer works and thus aspiration can occur. It is also possible for the emergency physician or ambulance service to administer glucagon intramuscularly, optionally into the subcutaneous fat tissue. However, the latter does not work in cases of excessive alcohol consumption. If hypoglycemia occurs, an emergency physician should be notified immediately. Glucose infusions or intramuscular delivery of glucagon should be performed only by specialists.
Prevention
To prevent threatening hypoglycemia from occurring in the first place, the best prevention is to adjust insulin and medication regimens precisely to the body’s needs. This is true when a patient eats less and exercises more as part of a diet or eats less and exercises more in everyday activities. Both the type and amount of food eaten and exercise are factors a patient should keep in mind. Both too little food and too much food or food with a high glycemic index are not good options for sufferers. A diabetic should therefore constantly monitor his blood glucose level in order to be able to intervene quickly before the blood glucose level drops too low. He should also be very careful when administering insulin or medication.For fear of the consequences of diabetes, many sufferers tend to inject more than necessary. The exact dose adjustment of insulin or medication is therefore best done by a doctor.
Aftercare
Hypoglycemic shock is associated with type 2 diabetes mellitus, and follow-up care is closely linked to lifelong medical care. For patients, this means attending regular follow-up appointments with their physician after medication has been discontinued. Here, blood values are checked in order to monitor developments. Patients can also measure their values themselves and strengthen their health through certain changes in their lifestyle habits. Changing to a balanced diet is a very important point in this context. Appropriate training, i.e. participation in a nutrition course, may help. With more health awareness and a nutritionist, diabetes patients succeed in eating more vitamins and less fat. This gradually leads to a better body image. In addition to nutritional counseling, which should be renewed occasionally, other appointments are also scheduled. The ophthalmologist should be visited once a year, and the podiatrist also detects any deterioration at an early stage. In this way, it is possible to prevent diabetes from causing vision problems or problems with the feet. The disease itself can neither be stopped nor cured, but its progression can be slowed down. The right lifestyle, which patients should discuss with their doctors and a nutritionist, helps.
What you can do yourself
In most cases of mild hypoglycemia, it is sufficient for the affected person to consume plenty of glucose and carbohydrates. A glass of lemonade or some crackers will balance the blood sugar level and relieve the discomfort. Hypoglycemic shock must be treated by a doctor in any case. An emergency doctor is urgently required. Insulin must not be injected in this situation. If the affected person is conscious, he should sit down, put his legs up and drink sufficient water (at least one liter per hour). Physical exertion should be avoided for the time being. In addition, blood glucose levels should be checked every two hours. If the blood glucose level has not normalized after six hours, the patient must be taken to hospital. In the event of unconsciousness or vomiting, first aid must be administered immediately until the emergency physician arrives. The diabetic must be placed in the stable lateral position and any dentures that are not fixed must be removed. Glucagon should be injected if available. After hospitalization, the affected person must take it easy for several days. In addition, the cause of hypoglycemic shock should be determined so that further complications can be avoided in the future.
