First aid for hypo and hyperglycemic coma. Indications for emergency hospitalization

The main goal of diabetes therapy is to stabilize glycemia. Any deviation of the glucose value from the norm negatively affects the patient’s condition and can lead to dangerous complications.

Long-term insulin deficiency in the body increases the risk of hyperglycemic coma. This state represents serious threat for the life of the patient, since it is often accompanied by loss of consciousness. That is why it is important for people around to know the first symptoms of this complication and the algorithm of actions for emergency care of the patient.

Why does coma develop?

Hyperglycemic coma occurs due to high level sugar that persists for a long period.

The pathogenesis of this condition is due to insulin deficiency and impaired glucose utilization, resulting in the following processes in the body:

ketone bodies are synthesized;
develops fatty infiltration liver;
lipolysis is enhanced due to the high content of glucagon.

Coma classification:

Ketoacidotic. Its development is most often characteristic of insulin-dependent patients and is accompanied by growth ketone bodies.
Hyperosmolar– occurs in patients with the second type of disease. In this state, the body suffers from dehydration and critically high glucose levels.
Lactic acidosis– this type of coma is characterized by the accumulation of lactic acid in the blood with a moderate increase in glycemia.

The etiology of the pathological condition lies in decompensation of diabetes, incorrectly selected treatment tactics or untimely detection of the disease.

The appearance of coma can be triggered by the following factors:

non-compliance with the injection schedule;
discrepancy between the amount of drug administered and carbohydrates consumed;
violation of diet;
changing insulin;
using frozen or expired hormone;
taking some medicines(diuretics, Prednisolone);
pregnancy;
infections;
diseases of the pancreas;
surgical interventions;
stress;
mental trauma.

It is important to understand that any inflammatory process occurring in the body contributes to an increase in insulin consumption. Patients do not always take this fact into account when calculating the dosage, as a result of which a deficiency of the hormone occurs in the body.

When should you sound the alarm?

It is important to understand in what situations the patient needs urgent help. To do this, it is enough to know the signs of coma caused by hyperglycemia. Clinic upon occurrence similar complication differs depending on the stage of its development.

There are 2 periods:

precoma;
coma with loss of consciousness.

First manifestations:

malaise;
weakness;
rapid onset of fatigue;
strong thirst;
dry skin and itching;
loss of appetite.

In the absence of measures to relieve the listed symptoms clinical picture intensifies, the following symptoms occur:

fog;
rare breathing;
lack of reaction to events happening around;
eyeballs may become soft;
drop in blood pressure and heart rate;
pale skin;
the formation of dark spots on the oral mucosa.

The main symptom indicating the development of coma is the level of glycemia. The value of this indicator at the time of measurement can exceed 20 mmol/l, reaching in some cases 40 mmol/l.

First aid

First aid includes the following:

Call emergency medical assistance.
Place the person on their side. This body position minimizes the risk of vomit moving into the Airways, as well as tongue retraction.
Ensure influx fresh air, release the patient from tight clothes, unbutton your collar or remove your scarf.
Measure your blood pressure using a tonometer.
Monitor your pulse, recording all indicators before the doctors arrive.
Cover the patient with a warm blanket if he or she is chilly.
If the swallowing reflex is preserved, the person should be given water to drink.
An insulin-dependent patient should receive an insulin injection according to the recommended dosages. If a person is able to help himself, then he needs to monitor the process of administering the drug. Otherwise, this must be done by a relative located next to him.
Perform artificial respiration and external massage hearts if necessary.

What not to do:

leave the patient alone in case of coma;
interfere with the patient during insulin injections, regarding these actions as inadequate;
Deny medical care, even if the person’s well-being improves.

To help the patient's relatives, it is important to distinguish hypo- from hyperglycemic coma. Otherwise, erroneous actions will not only not alleviate the patient’s condition, but may also lead to irreversible consequences, up to and including death.

If you are not sure that the coma is caused by high sugar levels, the person should be given something to drink sweet water, and in case of loss of consciousness, administer intravenous glucose solution. Despite the fact that his glycemia may already be too high, in such a situation, until the ambulance arrives, this will be the only right decision.

Differential diagnosis

The type of hyperglycemic coma can be determined based on biochemical and general analyzes blood, as well as urine tests.

Laboratory signs of coma:

significant excess of glucose and lactic acid levels;
presence of ketone bodies (in urine);
increased hematocrit and hemoglobin, indicating dehydration;
decreased potassium levels and increased sodium levels in the blood.

In out-of-hospital settings, a blood sugar test is used using a glucometer. Based on the results obtained, the doctor chooses a tactic for providing assistance.

Video material about comas with diabetes:

Resuscitation actions

Indications for resuscitation measures are:

lack of breathing or pulse;
heart failure;
blue discoloration of the skin surface;
absence of any reaction of the pupils when light hits them.

If you have these symptoms, you should not wait for the ambulance to arrive.

The patient's relatives should begin to act independently according to the following recommendations:

Place the patient on a hard surface.
Open access to the chest, freeing it from clothing.
Tilt the patient's head back and place one hand on his forehead, and extend the other lower jaw forward to ensure airway patency.
Remove food debris from the mouth (if necessary).

When performing artificial respiration, it is necessary to firmly touch your lips with the patient’s mouth, having first placed a napkin or a piece of clean cloth on it. Then you need to take deep exhalations, closing the patient’s nose in advance. The effectiveness of the actions taken is determined by raising at this moment chest. The number of breaths per minute can be up to 18 times.

To perform chest compressions, your hands should be placed on lower third the patient's sternum, located on the left side of him. The basis of the procedure is energetic pushes made towards the spine. At this moment, the surface of the sternum should shift by a distance of 5 cm in adults and 2 cm in children. You need to perform about 60 presses per minute. When combining such actions with artificial respiration, each breath should alternate with 5 compressions on the chest area.

The described steps should be repeated until the doctors arrive.

Video lesson on resuscitation measures:

Medical measures:

In case of ketoacidosis coma, it is necessary to administer insulin (first in a stream manner, and then in a drip method with dilution in a glucose solution to prevent hypoglycemia). Additionally, sodium bicarbonate, glycosides and other agents are used to maintain heart function.
In case of hyperosmolar coma, infusion drugs are prescribed to replenish fluid in the body, and insulin is administered intravenously by drip.
Lactic acidosis is eliminated by using the antiseptic Methylene Blue, Trisamine, sodium bicarbonate solution, and insulin.

The actions of specialists depend on the type of coma and are performed in a hospital setting.

How to prevent a threat to life?

Treatment of diabetes requires mandatory compliance medical recommendations. Otherwise, the risk of developing various complications and the onset of coma increases.

It is possible to prevent such consequences using simple rules:

Follow a diet and do not abuse carbohydrates.
Monitor glycemic levels.
Perform all injections of the drug in a timely manner according to the dosages prescribed by the doctor.
Carefully study the reasons diabetic complications to eliminate provoking factors as much as possible.
Periodically undergo medical examinations to identify the hidden form of the disease (especially during pregnancy).
Switch to another type of insulin only in a hospital setting and under the supervision of a doctor.
Treat any infectious diseases.

It is important to understand that knowledge about the rules of providing care to patients at the time of the onset of coma is needed not only by the patient, but also by his relatives. This will avoid life-threatening states.

Everyone should know the rules of first aid for diabetics. It happens that patients lose consciousness or contact with them is limited, so they cannot instruct them on what to do. In the meantime, you need to act quickly because there is a threat to life.

In case of hyperglycemia ( high sugar in the blood) you should always call an ambulance, because the patient may lose vision, get renal failure or circulation problems, as well as ketoacidosis, leading to coma and death.

Symptoms of a sharp increase in blood glucose levels are as follows:

increased thirst,
headache,
frequent urination.

The most characteristic symptoms are impaired concentration, slurred speech, loss of consciousness, as well as the smell of acetone from the breath, dry skin and rapid pulse.

Many diabetics cannot count on the right help, because stranger considers these symptoms alcohol intoxication. Before you refuse to help someone because they are drunk, you should know that they may be sick. In addition, intoxication also kills and is not a sufficient reason to leave the patient without help.

As a rule, after calling an ambulance, a conscious patient with hyperglycemia should be given salt water. If unconscious, lay in a safe side position and wait for doctors.
The problem is that a diabetic is sometimes not sure whether hyperglycemia or hypoglycemia has occurred, i.e. a sharp drop in blood sugar. Then you need to give something sweet...

Hyperglycemia, otherwise increased content blood sugar is a condition that occurs in patients with type 1 or type 2 diabetes mellitus. Due to insufficient amounts of insulin, which is normally produced by certain cells of the pancreas, starvation of the body's cells may occur. This is due to poor glucose absorption. As a result, incomplete oxidation of fatty acids occurs, and ketone bodies (acetone) are produced and accumulated.

Therefore, the natural metabolism in the body is disrupted, which has a negative effect on the cardiovascular and nervous system. Conventionally, hyperglycemia is divided into 3 degrees of severity: mild, medium degree severity and severity. At mild degree blood sugar level is no more than 10 mmol/l, with moderate - from 10 to 16 mmol/l, with severe - more than 16 mmol/l.

Hyperglycemia can lead to diabetic acidosis, which is very dangerous for a person if first aid is not provided in time. Therefore, it is necessary to know the signs of hyperglycemia both for the patient himself and for his loved ones in order to provide timely help.

Causes

missing a dose hypoglycemic agent or insulin injections,
violation of the prescribed diet (sweets, overeating),
reduction of the required level physical activity,
some infectious diseases,
stress,
taking certain medications
profuse blood loss.

Signs

weakness;
dry mouth;
hunger;
blurred vision;
frequent urination;
irritability,
nausea, sometimes vomiting;
smell of acetone from the mouth;
abdominal pain;
headache;
weight loss;
elevated blood sugar.

The precomatose state is characterized constant nausea, the appearance of vomiting, and with general weakness, vision and consciousness deteriorate. Breathing becomes more frequent, and a strong pungent odor of acetone comes from the mouth; hands and feet become cold.

How to provide first aid?

First of all, you need to measure your blood sugar. When the level exceeds 14 mmol/l, patients who have diabetes Type 1 or 2, but taking insulin, you need to inject insulin short acting no more than 2 units and ensure plenty of fluids. You need to measure your sugar level every 2-3 hours and administer 2 units of insulin until full recovery indicators. If blood sugar does not drop, then an ambulance should be called to the patient.

Source: http://www.med39.ru

First aid for hyperglycemia and hypoglycemia

When the first signs of acidosis appear, the patient experiences fatigue, weakness, loss of appetite, and ringing or noise in the ears. In addition, there may be a feeling of discomfort or pain in the stomach area, extreme thirst, urination becomes more frequent, and the smell of acetone appears from the mouth. When measuring blood glucose, its level is close to 19 mmol/l.

The precomatose state is characterized by constant nausea, vomiting, and with general weakness, vision and consciousness deteriorate. Breathing becomes more frequent, and a strong pungent odor of acetone comes from the mouth; hands and feet become cold. This condition in a patient can last for a day or more. If first aid is not provided, the patient may develop a diabetic coma.

When providing first aid, first of all, you need to measure your blood sugar. If the level exceeds 14 mmol/l, patients who are insulin dependent need to inject insulin and ensure they drink plenty of fluids. You need to measure your sugar level every 2 hours and administer insulin until the glucose level is completely restored.

If blood sugar does not drop, then the patient must be taken to the hospital to avoid breathing problems, and for this an oxygen mask is used.

Hypoglycemia is characterized by a sharp decrease in blood sugar levels. This condition is very life-threatening. As a rule, the development of hypoglycemia occurs if the glucose level is less than 2.8-3.3 mmol/l. At gradual decline glucose levels, the patient feels quite normal for a long time. If glucose levels drop sharply, an attack of hypoglycemia may occur. It is characterized by trembling inside the body, cold sweat, numbness of the lips and tongue. The pulse also quickens, a feeling of extreme hunger, fatigue and weakness appears.

Attention!

With hypoglycemia, the patient may experience a “twilight state” or loss of consciousness, so the actions of the first aid provider must be very quick. If the patient is slightly hungry, then he urgently needs to be given a couple of pieces of sugar or something sweet. After this, he needs to eat porridge and black bread. This will stop the drop in sugar levels.

If there is a distinct feeling of hunger, the patient needs to eat sugar, bread, milk, and fruit. These products will help relieve headaches, reduce sweating, drowsiness, and trembling. Adrenaline and cortisol will be released into the blood, which will eliminate the paleness of the skin. If the patient’s tongue and lips become numb, or they see double, then they should immediately be given a sweet drink, like Coca-Cola or Pepsi-Cola.

If the patient loses consciousness, it is necessary to immediately remove food from the mouth and place a piece of sugar under the tongue. You definitely need to call an ambulance. While he's driving ambulance, the patient needs to be given a glucagon injection. As a rule, after minutes the patient's condition will improve significantly.

Source: http://www.goagetaway.com

What are hyperglycemia and hypoglycemia?

Diabetes mellitus is a hereditary or acquired metabolic disease caused by a lack of insulin in the body, manifested by an increase in the concentration of sugar in the blood. The pancreas produces very little or no insulin. The main function of insulin is to transfer sugar formed in the body during the breakdown of carbohydrates from the blood into muscle cells. If the pancreas does not produce enough insulin, it is compensated with the help of tablets and injections.

The concentration of sugar in the blood plasma is constantly changing, so its regulation is necessary. It takes a longer time to determine the sugar content in blood plasma. According to the data received, it is established daily dose insulin and carbohydrate content. Despite proper sugar regulation, it is possible various disorders, for example due to stress, incorrect insulin dosage or poor diet.

When inserted too low dose insulin, hyperglycemia manifests itself. When too much insulin is administered, hypoglycemia occurs (low blood sugar).

First aid for hyperglycemia, hypoglycemia

The use of insulin reduces the risk of complications of diabetes, but even today diabetes is a very common cause of death. Older people with diabetes often do not understand and do not want to understand that their metabolism is impaired, so they most often need help. A first aid provider can identify diabetes mellitus by the following symptoms:

Fatigue, exhaustion.
Increased thirst.
Excessive urination.
Sometimes severe hunger or complete absence appetite.
Gradual loss of consciousness until it is completely lost.

The first aid provider must call a doctor. If a person has lost consciousness, he should be laid on his side.

With absence timely treatment diabetes mellitus may occur acute and chronic complications. The patient requires emergency medical care. One of the most severe acute complications of diabetes mellitus is diabetic coma with hyperglycemia and hypoglycemic coma with hypoglycemia.

Diabetic coma with hyperglycemia

A diabetic coma can occur due to poor diet, severe stress, infection, heart disease, after drinking alcohol, due to an accident, too little insulin, or other reasons. A diabetic coma can develop gradually: over the course of several days, the patient becomes thirsty, drinks a lot of liquid, and at the same time increases urination.

However, diabetic coma can also occur suddenly. This metabolic disorder is usually characterized by blood oxidation. When the blood sugar concentration increases gradually over several days or several hours, the following symptoms appear:

Dry skin.
Frequent, weak pulse.
Excessive urination.
Smell of acetone from the mouth.
Impaired consciousness, coma.
Very deep breathing.
Stomach ache.

First aid measures include providing vital signs and calling a doctor. If hyperglycemia is left untreated, the patient will fall into a coma and die.

Source: http://doktorland.ru

First aid for diabetes

Type I diabetes mellitus in the vast majority of cases occurs in childhood or at a young age. The disease is associated with a deficiency of the pancreatic hormone - insulin, which ceases to be produced due to any damage to pancreatic cells or is not produced in sufficient quantity. In this case, glucose ceases to be absorbed by tissues and accumulates in the blood. Excess glucose in this case begins to be excreted through the kidneys in the urine.

Therefore, in the initial stages of the disease, frequent urination is observed, which is associated with the excretion of glucose. Patients also complain about constant thirst and use large quantity liquids. The kidneys are subject to increased stress and gradually cease to cope with it. This may cause symptoms such as abdominal pain, nausea and vomiting, and dehydration.

Since the use of glucose is disrupted, the body begins to intensively consume fats for energy. These are more energy-consuming and complex processes. Therefore, the processed fat is not completely burned and ketone bodies are formed in the body, which can cause various complications. The accumulation of ketone bodies in the blood leads to the development of a hyperglycemic state and ketoacidosis. Ketoacidosis is a very serious condition that can lead to hyperglycemic, or ketoacidotic, coma.

The main reason for the development of type I diabetes mellitus is a failure in immune system, in which antibodies to pancreatic cells begin to be produced and damage them. Viral diseases (for example, rubella, hepatitis, parotitis etc.) and hereditary predisposition.

Type II diabetes is now more common. In most cases, it develops in older people (after 40 years) and in obese people. The increase in blood glucose levels is not due to a lack of insulin, but to the fact that the cells of various tissues lose sensitivity to insulin, which can be produced in normal or even increased quantities. This is due to impaired metabolic processes due to excess weight.

The main reason is the lack of receptors in cells that should interact with insulin. In this case, glucose loses its ability to penetrate cells and accumulates in the blood.

Diabetes in pregnant women and those associated with malnutrition are separately distinguished. (see neonatal diabetes)

In any case, the symptoms of diabetes will be the same:

Type I diabetes mellitus is characterized by rapid, even sudden development of the disease; Type II diabetes mellitus develops slowly and its symptoms are less pronounced.

If diabetes mellitus is not treated, the level of glucose in the blood constantly increases, which leads to vascular damage and disruption of the functions of many organs and tissues. Complications of diabetes mellitus have serious consequences for health.

The following damage to organs and tissues is noted: cardiovascular diseases(, myocardial infarction, vascular atherosclerosis), arterial lesions lower limbs, retina (decreased vision), nervous system (sensitivity disturbances, dry skin and flaking, limb cramps), (protein excretion in the urine and dysfunction), various ulcerative processes on the skin, infectious complications, coma.

Let's consider the most frequent complications associated with violations of the diet or rules of insulin administration.

Hyperglycemic state

Characterized by an increase in blood glucose levels. It is a complication of diabetes mellitus and is associated with insufficient insulin production when the pancreas is damaged. This condition can also occur if increased need body in insulin during pregnancy, injuries, surgery, various infectious processes. Hyperglycemia occurs most often in patients with undiagnosed diabetes mellitus.

Attention!

Also, a hyperglycemic state can occur in patients with diabetes mellitus if they eat food without injecting insulin or if insulin pump delivery is interrupted if the catheter is blocked or damaged. Lack of insulin leads to a decrease in the uptake of glucose by cells, and energy starvation occurs in the tissues and cells of the body.

In insulin deficiency, fatty acids undergo incomplete oxidation; This causes ketone bodies and acetone to accumulate in the body. This condition, associated with the accumulation of large amounts of acidic products in the body, is called acidosis. It has a depressant effect on the nervous system and a negative effect on the cardiovascular system.

There are 3 stages in the development of diabetic acidosis:

moderate acidosis;
precoma stage;
coma.

Signs of a hyperglycemic state

On initial stage the formation of moderate acidosis in the patient is observed general weakness, increased fatigue, drowsiness and tinnitus, decreased appetite. In this state, abdominal pain, thirst, and increased urination may occur. If you come into contact with a patient at close range, you can smell acetone from your mouth. If at this stage a blood test is performed for sugar, its concentration will be increased to 19.4 mmol/l. The blood reaction will be acidic - up to pH = 7.3.

At the stage of diabetic precoma, patients constantly feel nausea, it is noted frequent vomiting, general weakness increases; the patient develops indifference to the environment, visual acuity decreases, shortness of breath develops, and may appear painful sensations in the area of the heart and in the abdomen, frequent urination is noted. This condition lasts from several hours to several days.

Usually, at the precoma stage, the patient is conscious, he retains his orientation in time and space, but there is retardation, and he gives monosyllabic answers to questions. You can also note the fact that the skin becomes dry and rough; the extremities are cold, the lips are dry, cracked, covered with crusts, they may have a bluish tint, and the tongue is coated with a brown coating.

As the severity of the condition worsens and symptoms increase, coma develops.

At the same time, the patient's breathing becomes deep, noisy and quickens. This type of breathing is characterized by an extended inhalation and a short, noisy exhalation; a pause can be observed before each inhalation. The patient emits a strong odor of acetone. Hyperglycemic coma is characterized by a decrease in blood pressure, especially when it decreases diastolic pressure(second digits). In addition, urinary retention and abdominal muscle tension are noted.

Often in a comatose state, body temperature drops and signs of dehydration appear. Coma may differ in the predominance of symptoms affecting any organ system. For example, a coma may develop with predominant damage to the gastrointestinal tract, with predominant damage to the cardiovascular or nervous system. Laboratory indicators of blood and urine tests are of great importance for diagnosis and treatment.

The main sign of decompensation of diabetes mellitus is the presence of hyperglycemia.

At the precoma stage, the blood glucose level is 19-28 mmol/l; when the glucose level increases to 30-41 mmol/l, a coma develops. In some cases, severe acidosis can develop even with relatively low blood glucose levels - up to 11 mmol/l. The development of acidosis in this way occurs in type I, in persons suffering from alcoholism, in adolescents with diabetes mellitus. In case of decompensated diabetes mellitus with laboratory research urine reveals glycosuria (the presence of glucose in the urine), normally it does not contain this substance.

A biochemical blood test can detect increased levels of acetone and acetoacetic acid, and acetone is also detected in the urine.

As a rule, with decompensated diabetes mellitus, the acid-base balance is disturbed with a predominance of acidic metabolic products, and blood acidification occurs.

First aid for hyperglycemia

In cases where the development of hyperglycemia is associated with insulin deficiency for any reason, it is necessary to compensate for its deficiency. You should first determine your blood glucose level using. If the blood glucose level exceeds 13.9 mmol/l, then it is necessary to administer insulin using a pen syringe or pump, after first replacing the catheter and establishing a basal (continuous) insulin administration regimen. You need to drink plenty of calorie-free drinks (water, low-fat broth).

Blood glucose levels should be monitored every 2 hours and insulin should be administered to normal levels. If syringe pens are used to administer insulin, it is possible to inject usual dose insulin after determining blood glucose levels. Most often, a severe hyperglycemic state occurs when the diagnosis of diabetes mellitus is not established. In this case, the victim, as a rule, does not have the means to provide first aid, so you must definitely call a doctor.

A patient with signs of hyperglycemia should be urgently hospitalized. The administration of drugs must be carried out in a hospital setting under the control of blood glucose levels and other indicators of biochemical studies.

The emergency medical team carries out measures aimed at eliminating dehydration, normalizing the volume of circulating blood and disorders of cardio-vascular system. To do this, intravenous infusions of warmed isotonic sodium chloride solution are carried out. In parallel with this, insulin therapy is carried out; it consists of a single administration of a simple insulin drug in an individually calculated dose. You can give the patient oxygen through a mask.

Immediately after the patient’s admission to the hospital, a blood test is performed for glucose, acid-base status, potassium, sodium, calcium, chlorine, phosphorus, magnesium, bicarbonates, urea, total and residual nitrogen. At the same time as the examination, the fight against acidosis continues. For this purpose, the stomach is washed with a solution of soda (sodium bicarbonate), then catheterization is performed Bladder, determine the volume of urine and the content of glucose and acetone in it. Monitoring equipment is connected to the patient.

Continue intravenous infusion of isotonic sodium chloride solution. In case of low blood pressure, hormonal drugs - prednisolone or hydrocortisone - are administered intravenously; in particularly severe cases, infusions of donor plasma and blood are performed.

Together with saline solution, an intravenous drip infusion of insulin is carried out; in addition, intramuscular injection of insulin can be arranged every hour. To accurately set the injection rate medicines For intravenous infusions, various dosing devices are used.

Blood glucose levels are monitored hourly. When it decreases to 11.1-13.9 mmol/l, the physiological solution is replaced with a 5% glucose solution, which is administered to prevent hypoglycemia. Subsequently, they switch to administering insulin subcutaneously every 3-4 hours under monitoring blood glucose levels.

As a rule, with hyperglycemic coma there is a deficiency of potassium. Therefore, to replenish its level, a 1% solution of potassium chloride is administered intravenously.

In order to normalize the acid-base balance of the blood, sodium bicarbonate solution is infused intravenously. If there is insufficient phosphate content in the blood, potassium phosphate is used. This drug is diluted in saline solution or 57o glucose solution and administered intravenously. It should be remembered that potassium supplements must be administered very slowly.

In addition to conducting intensive care, the reasons that provoked this condition should be eliminated. When an infectious disease is detected, antibiotics are used, antishock therapy, in severe cases, hardware is indicated artificial ventilation lungs. To prevent vascular thrombosis, heparin is prescribed.

Source: http://03-ektb.ru

Hyperglycemia – glucose levels rise unreasonably?

Hyperglycemia is a clinical condition of the blood in which there is an increased level of glucose in its composition. This condition can be caused by inflammatory or nervous pathologies, as well as severe stress, but most often it accompanies diabetes mellitus.

Clinical picture of the condition

If you recognize the first ones in a timely manner characteristic manifestations disorders, then the very dangerous consequences of the disease can be prevented. The former are usually caused by extreme thirst. When a person's plasma glucose level rises, he constantly begins to want to drink. The patient can drink up to 6 liters of liquid per day. Accordingly, the urge to urinate also becomes more frequent.

When the glucose level reaches 10 mmol/l, sugar is also found in the urine, as it begins to be excreted in urine. As the amount of urine increases, so does excretion from the body. healthy salts, which is accompanied by characteristic signs. Among the most obvious manifestations of hyperglycemia, symptoms such as increased causeless weakness, as with arterial hypotension, dry mouth, headache, should be highlighted long-term, frequent fainting and visual impairments, skin itching and sudden weight loss.

The characteristic symptoms of hyperglycemia are also caused by disorders of the gastrointestinal tract such as diarrhea or constipation, often these symptoms replace each other. Patients often note the appearance of sudden irritability, chilliness in the extremities and decreased sensitivity, numbness of the lips, acetone smell from the oral cavity.

Hyperglycemia can result dangerous consequences such as the accumulation of large amounts of ketone bodies in the body (ketoacidosis) and their subsequent excretion along with urine (ketonuria). Such disorders can provoke ketoacidotic coma. Such a coma leads to vasodilation, collapse and hypotension, which can be fatal.

In order to promptly suspect the development of ketoacidotic coma, it is important to know its characteristic symptoms caused by signs of dehydration (dry and pale tongue and skin), depressed functioning of the nervous system, rapid and shortness of breath, loss of appetite, constant feeling thirst.

You may experience pain in the abdomen and increased urine output. Such a disorder does not necessarily become a characteristic symptom of diabetes mellitus. Hyperglycemia may accompany endocrine disorders, which is why timely medical examination is so important.

What contributes to the emergence

In general, hyperglycemia occurs postprandial and fasting. The postprandial form of the pathology consists of an increase in glucose immediately after eating. Manifestations on an empty stomach are caused by elevated sugar levels when the patient has not eaten for about 8 hours. There is also a transient form of the disease, which is usually short-term in nature and usually occurs after severe stress or eating, rich in carbohydrates. Transitory variety the disorder is characterized by rapid self-recovery of glucose levels.

The responsibility for regulating plasma sugar lies with insulin, which is produced by the cells of our body. If a patient with hyperglycemia has type 1 diabetes, the pancreas produces significantly less insulin, because due to the productive inflammatory process Necrosis and apoptosis (death) of cells responsible for insulin production occurs.

When a patient develops type 2 diabetes, the body’s tissues stop accepting insulin, which is why the hormone, although produced in sufficient quantities, does not perform its direct function, which is why hyperglycemia develops.

Often, the causes of development are determined by the abuse of high-calorie foods, psycho-emotional stress, etc. Increased physical and mental overload or, conversely, excessive behavior passive image life contributes to the development of a hyperglycemic state. It happens that they are caused by bacterial or viral pathological conditions, chronic diseases.

Causes for diabetic patients similar condition may be associated with missing an insulin injection or a drug that lowers serum glucose levels, as well as violations of medical prescriptions or diet.

Manifestation in children

In children, hyperglycemia is divided according to the types of diabetes. Since children are more often diagnosed with diabetes of the second type, i.e., its non-insulin-dependent variety, then, accordingly, this type of pathology is predominantly found in them. Children often end up in medical institutions with severe hyperglycemic consequences, which is due to the lack of timely diagnosis diseases.

Attention!

Most often, a hyperglycemic attack develops rapidly and suddenly in children, with sharp deterioration the patient's condition. More often, the pathology is observed in children whose families do not provide adequate attention to the physical education and development of the child, there is no complete and proper nutrition, rest and work regime. In general, the latter factors are considered to be the determining causes of cases of hyperglycemia in childhood.

Children living in urban areas are more susceptible to developing this condition, which is associated with their inert lifestyle. U junior schoolchildren and children attending kindergarten, the development of pathology is promoted excessively high loads physical, mental and mental. Often the cause of excess blood sugar in children is impaired metabolism.

What to do during an attack

First aid for hyperglycemia requires precise definition glucose levels. If the patient is insulin dependent, then if the glucose level is above 14 mmol/l, treatment with insulin injections and drinking plenty of fluids. The patient needs to periodically measure sugar and administer insulin until glucose levels reach normal indicators. In cases where such treatment is not justified, the patient must be hospitalized, since there is a risk of acidosis and respiratory impairment.

In the case of non-insulin-dependent patients, treatment of hyperglycemia should be aimed at eliminating excessive acidity. To do this, the patient needs to drink soda solution or mineral water. Similar treatment quickly normalizes stomach acidity. If the patient experiences increased dryness and roughness of the skin, then treatment such as wet rubbing with a towel is indicated, especially in the areas under the knees, on the wrists, on the forehead and neck.

Treatment

Due to the fact that hyperglycemia is a symptomatic manifestation of other pathologies, treatment of this syndrome carried out through the treatment of the disease that caused it. In general, patients are advised to measure their sugar regularly. For diabetic causes of hyperglycemic syndrome, treatment with insulin injections is indicated, due to which glucose levels decrease. In the future, the patient is advised to control carbohydrate intake in particular and calories in general.

A diet for hyperglycemia requires the absolute exclusion of foods containing sucrose and glucose from food: chocolate, cakes, sweets, jam, ice cream, etc. strong desire When eating sweets, it is recommended to consume honey, but only in limited quantities. The diet recommends avoiding strong broths based on fish and fatty meats, as well as mushrooms.

Hyperglycemic coma - severe complication diabetes mellitus Develops due to poor nutrition, infection, mental trauma, intoxication and if the patient did not receive insulin or did not receive enough of it, or suddenly interrupted treatment with insulin or sulfonamide drugs that lower blood sugar.

Coma can occur as a result of hypoinsulinism due to Graves' disease, acromegaly, Itsenko-Cushing's disease, bronze diabetes, pancreatitis, diencephalitis, etc. Increased secretion of contrainsular hormones (glucagon, cortisol, etc.) is of great importance in the development of diabetic ketoacidosis.

The normal level of glucose in blood plasma is less than 6.38 mmol/l, in whole venous blood and in whole capillary blood - less than 5.55 mmol/l. A hypoglycemic state develops when the concentration of glucose in the blood plasma decreases to 2.75 mmol/l. When the level of glucose in the blood increases above 8.88 mmol/l, sugar appears in the urine (glucosuria). Hyperglycemic coma appears against the background of high glycemia, reaching 14-33 mmol/l.

Harbingers

Weakness, loss of appetite, drowsiness, headaches, nausea, vomiting, diarrhea or constipation.

Sugar, acetone and acetoacetic acid appear in the urine, and hyaline casts and leached red blood cells appear in the sediment. Albuminuria.

Symptoms

Loss of consciousness or mental depression. The face is pale or slightly hyperemic. The skin is dry, pale.
Facial features are pointed.

Breathing is heavy, deep, noisy (Kussmaul). Smell of acetone from the mouth. The tongue is dry, slightly coated. Hypotony of the eyeballs.

The pulse is small, frequent, weak filling. Arterial pressure downgraded. Sometimes a collapsed state.

Muscle flaccidity, often decreased or absent tendon reflexes. Body temperature is often reduced.

In the blood, neutrophilic leukocytosis with a shift in the formula to the left, severe hyperglycemia, a sharp decrease in reserve alkalinity (acidosis) Hyperchloremia, hyponatremia. The hematocrit number and hemoglobin content are increased.

Differentiate with hypoglycemic coma, as well as with variations of diabetic coma: hyperglycemic (ketoacidotic), hyperosmolar (non-acidotic) and lactic acid (hyperlactic acidic) In contrast to the hyperglycemic coma described above, hyperosmolar coma is characterized by significant hyperglycemia, reaching 33-100 mmol/l, and the absence of ketonemia , hyperosmolarity of blood plasma (350-500 mOsm/l), hypernatremia (up to 170-200 mmol/l), hypokalemia and azotemia. This type of coma usually develops in the elderly, after excessive fluid loss.

Lactic acid coma often develops in the elderly. The anamnesis contains indications of long-term treatment diabetes mellitus with biguanide drugs. Glycemia is moderately elevated, there is no glucosuria. There is hyperkalemia, azotemia, high levels of lactic acid in the blood (more than 1.5 mmol/l), hyperpyruvatemia (more than 0.15 mmol/l)

Urgent Care

1. Insulin - 50 units intravenously in 20 ml of isotonic sodium chloride solution and 50 units subcutaneously. Before and after administering insulin, check the sugar level in your urine.

If the unconscious state continues and blood sugar has not decreased, then 20-30 units of insulin should be administered subcutaneously every 2 hours.

Constant monitoring of blood sugar, acetone and urine sugar is necessary.

When the blood glucose level decreases to 16.55 mmol/l, the insulin dose is reduced; At the same time, intravenous drip administration of a 5% glucose solution is started.

2. Isotonic sodium chloride solution - 800-1000 ml in a “cocktail” with 20-30 ml of 10% potassium chloride solution and 500 ml of 10% glucose solution - intravenously, drip.

In case of hyperosmolar coma, instead of isotonic, a hypotonic (0.45 - 0.6%) sodium chloride solution is used.

3. Sodium bicarbonate - 200-300 ml of 4% solution intravenously, drip.

4. Korglykon - 1 ml of 0.06% solution or strophanthin - 0.5 ml of 0.05% solution in 20 ml of isotonic sodium chloride solution intravenously, slowly.

5. Mezaton - 1 ml of 1% solution intramuscularly (can be repeated after 3-4 hours)

6. Sulfocamphocaine - 2 ml of 10% solution subcutaneously.

7. Ascorbic acid- 2-3 ml of 5% solution intramuscularly. Cocarboxylase - 0.1 g (2 ampoules of dry powder, 0.05 g each, diluted in 4 ml of solvent) intramuscularly or intravenously, drip.

8. In case of lactic acid coma, if the above measures are ineffective, hemodialysis is performed.

9. Hospitalization is urgent.

V.F.Bogoyavlensky, I.F.Bogoyavlensky

Coma

Diabetes is an endocrine disease associated with absolute insufficiency of insulin (type 1 diabetes mellitus, insulin-dependent) or relative(type 2 diabetes mellitus non-insulin dependent).

Diabetic coma- one of the most severe complications of diabetes mellitus, resulting from absolute or relative deficiency of insulin and metabolic disorders. There are two types of diabetic coma: hypo- and hyperglycemic.

Hypoglycemic coma develops with a sharp decrease in blood glucose levels to 2-1 mmol/l. Occurs due to a violation of the diet, an overdose of insulin, or the presence of a hormonal tumor (insulinoma).

Clinical picture hypoglycemic coma is characterized by loss of consciousness, psychomotor and motor impairment, hallucinations, clonic and tonic convulsions. The skin and mucous membranes are sharply pale, moist, there is profuse sweat, tachycardia with relatively normal blood pressure values, rapid, shallow, rhythmic breathing. Blood glucose levels decrease

Intensive therapy : 20-80 ml of 40% glucose solution is immediately injected intravenously. If it is possible to control blood glucose levels, maintain it within 8-10 mmol/l by administering a 10% glucose solution with insulin.

According to indications, glucagon, adrenaline, hydrocortisone, cocarboxylase, and ascorbic acid are used.

For the prevention and treatment of cerebral edema, mechanical ventilation is performed in hyperventilation mode, intravenous infusions of 20% mannitol.

Ghyperglycemic coma. Blood glucose concentrations sometimes reach

55 mmol/l.

Clinical picture hyperglycemic coma is characterized by a lack of consciousness, the skin and mucous membranes are dry, warm, moderately pale or hyperemic. It is often felt acetone smell from mouth. The eyeballs are sunken, “soft”, the pulse is rapid, blood pressure is reduced. Bradypnea, respiratory rhythm disturbances (Kussmaul type), polyuria, agitation, convulsions, and increased reflex activity are noted.

Intensive therapy. Correction of hyperglycemia is carried out by administering insulin. Preference is given to short-acting insulin as it is more “controllable”. The most effective is intravenous drip administration using dispensers at a rate of 6-10 units per hour under constant monitoring of blood glucose concentration. Depending on the level of hyperglycemia, the first dose can be increased to 20 units. Correction of metabolic acidosis should be aimed at activating buffer systems and normalizing the functions of the cardiovascular and respiratory systems, oxygenating the blood, improving microcirculation and perfusion of organs and tissues.

What is hyperglycemic (diabetic) coma

Hyperglycemic (diabetic) coma- a relatively slowly developing condition associated with an increase in blood glucose levels in diabetes mellitus and the accumulation of toxic metabolic products

What provokes hyperglycemic (diabetic) coma:

Uncontrolled treatment of diabetes mellitus with insufficient insulin administration.

Refusal to use insulin.

At the onset of diabetes mellitus, when the patient still does not know about his disease at all, before a diagnosis is made, as a rule, diabetic (hyperglycemic) coma begins to develop.

Various dietary errors, injuries and infectious diseases can provoke the development of diabetic (hyperglycemic) coma in patients with diabetes.

It occurs when diabetes mellitus occurs for a long time with few symptoms and the patient does not receive insulin or receives small doses.

Symptoms of hyperglycemic (diabetic) coma:

The precomatous and comatose state of patients with diabetes mellitus requires their emergency hospitalization. Comprehensive treatment of coma includes restoring insulin deficiency, combating dehydration, acidosis, and loss of electrolytes. In the initial stage of a diabetic coma, insulin must first be administered. Only crystalline (simple) insulin is administered and in no case long-acting drugs. Insulin dosage calculated depending on the depth of the coma. For mild coma, 100 units are administered, for severe coma - 120-160 units, and for deep coma - 200 units of insulin. Due to impaired peripheral circulation with the development of cardiovascular failure during the period of diabetic coma, the absorption of administered drugs from subcutaneous tissue slows down, therefore half of the first dose of insulin should be administered intravenously in 20 ml of isotonic sodium chloride solution.

For elderly patients, it is advisable to administer no more than 50-100 units of insulin due to the risk of developing coronary insufficiency in them. In precoma, half the full dose of insulin is administered.

Subsequently, insulin is administered every 2 hours. The dose is selected depending on the blood glucose level. If after 2 hours the blood glucose level increases, then the dose of administered insulin is doubled. The total amount of insulin administered during diabetic coma, ranges from 400 to 1000 units per day. Along with insulin, glucose should be administered, which has an anti-ketogenic effect. It is recommended to start administering glucose after its level in the blood begins to fall under the influence of insulin. A 5% glucose solution is administered intravenously. To restore lost fluid and electrolytes, 1-2 liters per hour of an isotonic sodium chloride solution is injected intravenously in combination with 15-20 ml of a 10% potassium chloride solution, warmed to body temperature. In total, 5-6 liters of liquid are administered per day; for patients over 60 years of age, as well as in the presence of cardiovascular insufficiency - no more than 2-3 liters. To combat metabolic acidosis, 200-400 ml of a 4-8% solution of freshly prepared sodium bicarbonate is administered intravenously, which cannot be mixed with other solutions. Intravenous administration of 100-200 mg of cocarboxylase, 3-5 ml of 5% ascorbic acid solution is indicated. To restore hemodynamic disorders, cardiac glycosides are prescribed (1 ml of 0.06% solution of corglycone intravenously), 1-2 ml of a 20% solution of caffeine or 2 ml of cordiamine are injected subcutaneously or intravenously.

Hyperglycemic hyperketonemic coma

A serious complication of diabetes mellitus, which is a consequence of severe insulin deficiency and decreased tissue glucose utilization, which leads to severe ketoacidosis, disruption of all types of metabolism, dysfunction of all organs and systems, primarily the nervous system, and loss of consciousness.

Emergency care algorithm :

Urgently call a doctor to provide qualified medical care;

Ensure monitoring of the patient’s condition (blood pressure, pulse, respiratory rate);

Take blood and urine from the patient for testing;

Prepare emergency medications when the doctor arrives:

for intravenous drip administration- Ringer's solution, 4% solution sodium bicarbonate, 5% glucose solution, 0.9% chloride solution sodium;

short-acting insulin preparations (Homorap, Actrapid, Insulrap, Humalog);

cardiac glycosides: 0.05% strophanthin solution or 0.06% corglycone solution, 10% solution of caffeine, 1% mesatone solution;

cocarboxylase, ascorbic acid;

warm 2% solution of soda for enema;

5. Ensure the administration of medications as prescribed by the doctor

Hypoglycemic coma.

Arises as a result sharp decline blood sugar levels (hypoglycemia), most often in diabetic patients receiving insulin. The pathogenesis of hypoglycemia is based on the discrepancy between insulinemia and glycemic levels. In typical cases, hypoglycemia occurs due to an overdose of insulin, significant physical activity or insufficient food intake after its administration and develops 1 to 2 hours after the insulin injection (sometimes later). When administering long-acting insulin preparations, a hypoglycemic state and coma can develop after 4-5 hours, but also with insufficient food intake that does not correspond to the administered dose of the drug.

Algorithm for providing emergency care:

Administer 10-20 ml intravenously. 40% glucose solution;

When blood pressure decreases, administer intravenously plasma and its substitutes: polyglucin, rheopolyglucin, albumin and cardiac glycosides: corglycon - 0.06% solution 0.5 mg/kg slowly intravenously, hormones, prednisolone, hydrocortisone 5 ml/kg;

At convulsions administer diazepam 0.3-0.5 ml/kg slowly intravenously or sodium hydroxybutyrate 20% solution 0.5-0.75 ml/kg.

Main signs of diabetic and hypoglycemic coma

Diabetic precoma and coma	Hypoglycemic precoma and coma
Causes: the patient did not receive or received little insulin.	Causes: the patient received a lot of insulin or after it did not accept the introduction sufficient quantity carbohydrates
Symptoms: lethargy, drowsiness, weakness, gradual deterioration state to coma.	Symptoms: anxiety, excitement, delirium, change mental health, often sudden darkness or loss consciousness.
Smell of acetone from the mouth	No acetone odor
Lack of appetite nausea vomiting.	Increased appetite, feeling of hunger
Glubokoye noisy breathing	Normal breathing
Dry skin	Moist skin, often profuse sweat.
Frequent poor filling pulse	Sometimes slow, often intermittent pulse.
For the most part normal temperature	The temperature is often below normal.
Muscle flaccidity.	Trembling of limbs, cramps, muscle tightness
Abdominal pain occurs frequently	No abdominal pain
Urine contains sugar and acetone.	There is no sugar in the urine, sometimes there may be traces of acetone.
Blood sugar is very high	Blood sugar is below normal

Coma is an extreme manifestation of any disease that is associated with loss of consciousness and serious condition of the patient. A person’s position between life and death is caused by deep inhibitions of processes in the cerebral cortex. Occurs with head injuries, malaria, meningitis, poisoning, hepatitis, diabetes mellitus and a number of other diseases in severe forms. Such conditions are especially dangerous for children.

Types of coma in diabetes mellitus

After some time has passed since the onset of the disease, the human body adapts to some fluctuations in blood sugar levels. However, a very rapid decrease or increase in this indicator leads to irreversible processes in the body. Comatose states are acute complications in case of illness. Depending on the initial development of the clinic sugar lumps is divided into the following types:

Hyperglycemic– characterized by a strong increase in blood glucose levels. It occurs more often in patients with type 2 diabetes mellitus.
Hypoglycemic. The main reason is a sharp decrease in glucose levels.
Ketoacidotic. Due to a lack of insulin, the body receives a lack of energy through the process of breaking down fats. As a result, an excess amount of ketone bodies (acetone and acids) is formed, which affect the nervous system. As a result, a coma state develops.
Hyperlactacidemic. Lactic acid accumulates in tissues and blood due to metabolic disorders and the liver does not have time to remove such volumes from the body. In connection with which coma develops, which is the rarest of all types, but causes the most severe conditions patients.
Hypersmolar. This type of coma most often develops in older people. It occurs due to disrupted metabolic processes against the background of very high levels of glucose in the blood. It develops very rarely in children.

Hyperglycemic coma can develop in both adults and children with diabetes mellitus and who have not received adequate therapy. The cause may be a missed insulin injection, causing shortage this protein hormone. In this case, metabolic processes in the body are disrupted. Coma can develop regardless of the type of diabetes, even if the disease has not yet been diagnosed. The consequences can be severe.

Causes

The diagnosis of diabetes mellitus is a serious disease and must be treated with full responsibility. After all, to lead a normal lifestyle, you need to monitor your blood glucose levels and follow all doctor’s instructions. Failure to comply with these requirements may result in undesirable results. So, Both error and forgetfulness can lead to the development of hyperglycemic coma. Here are the reasons why such an unexpected situation may arise:

not diagnosed in time,
failure to administer the next dose of insulin on time,
consequences of refusing insulin injections,
incorrect dosage of insulin when prescribed,
changing types of insulin,
gross disregard for the principles of diet for diabetes,
related serious illnesses or surgery in the presence of diabetes mellitus,
stress.

Signs

The development of hyperglycemic coma occurs gradually - it can last several hours or days. In children it develops within 24 hours. It is preceded by the following signs:

constant headache
strong thirst
weakness and drowsiness,
a sharp decrease in body weight,
lack of appetite,
facial redness,
increase in daily urine output,
rapid breathing,
nausea and vomiting, painful sensations in a stomach.

12–24 hours after the first signs appear, the condition worsens, apathy towards everything appears, urine completely ceases to be excreted, the smell of acetone appears from the mouth and shortness of breath. A person's breathing becomes frequent with deep and noisy sighs. After some time, a disturbance of consciousness occurs, followed by a fall into a coma.

In children it is not difficult to determine which one. It is difficult to prevent it. To do this, parents must lead constant surveillance behind the child. The signs and consequences of hyperglycemic coma in children are almost the same as in adults. If an adult himself can assess his condition, then this action should be performed by the parents instead of the child.

Symptoms

Except partial or complete violation consciousness and the smell of acetone, there are a number of other symptoms by which these conditions are diagnosed:

recessed eyelids,
eyeballs are soft,
acetone smell,
breathing is heavy, noisy,
peritoneal tension,
muscle tension leading to cramps
low blood pressure,
the pulse becomes thready and frequent,
skin becomes cool and dry,
coated tongue dark brown, dry,
reflexes are almost completely absent,
in some cases shock and fever are noted.

Urgent Care

Insulin-dependent patients are aware of the possibility of worsening their condition. When hyperglycemic coma develops, urgent Care must be provided immediately. If the patient is conscious, you need to find out if he has insulin with him and provide all possible assistance in performing the injection. If you don’t have the medicine with you, first aid will be provided by the arriving brigade.

If loss of consciousness occurs, help with hyperglycemic coma consists of placing the patient in a comfortable position, and turn your head to the side to prevent choking on vomit, as well as to avoid tongue sticking. Call an ambulance.

Treatment is carried out in a hospital. First aid is to ensure that oxygen therapy is carried out. Then treatment is carried out by simultaneous fluid replenishment and insulin administration according to special schemes, the development of which used a specific algorithm.

Hypoglycemic coma

This type of coma develops very quickly, so its occurrence is especially dangerous in children. As a result, action must be taken quickly after diagnosis. Some diabetics who have been ill for a short time have individual sensitivity to insulin. It can be very high. Their treatment requires individual approach, and this must be taken into account when there is a sharp drop in blood sugar when first aid is provided.

Comatose states with hypoglycemia can be caused by the following reasons:

no one taught diabetics how to prevent coma when primary symptoms appear,
excessive drinking,
ignorance of your correct dose of insulin or its administration was not accompanied by carbohydrate intake,
an increased dose of tablets that force the body to produce internal insulin.

Symptoms of hypoglycemia

The primary symptoms of hypoglycemic coma are as follows:

pale skin,
increased sweating,
a feeling of trembling in the arms and legs,
increased heart rate,
it is impossible to concentrate attention,
I really want to eat
anxiety,
nausea.

For these symptoms, you need to eat several glucose tablets. The first manifestations of hypoglycemic coma in children are similar; they need to be given sweet tea, candy, or a piece of sugar.

Secondary symptoms indicating an approaching state of hypoglycemic coma:

severe headache and dizziness,
feeling of weakness,
a feeling of fear, reaching the point of panic,
the person starts talking, disturbances in visual perception of images appear,
trembling in the limbs, convulsions.

These signs in children, without adequate assistance, lead to seizures masticatory muscles And rapid loss consciousness. The state of hypoglycemic coma in adults, which occurs after drinking large amounts of alcohol, is especially dangerous. In this case, all the symptoms confirm that the person is simply drunk. At this time, alcohol blocks the liver from synthesizing glucose. There is a decrease in blood sugar levels.

Diabetic patients are usually treated by administering insulin before meals. However, there are reasons when eating is not possible.

In this case, you need to eat a piece of sugar or candy to avoid hypoglycemia.

When treating patients, it is necessary to learn to distinguish the signs of hypoglycemia from hyperglycemia. This is necessary so as not to introduce glucose instead of insulin or vice versa.

Emergency treatment in hospital begins with intravenous administration glucose, and then it is administered by dropper. In order to prevent cerebral edema, diuretic injections are given. Oxygen therapy is also performed.