Talk:Diabetic coma

From Wikipedia, the free encyclopedia

WikiProject Medicine This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
Start This page has been rated as Start-Class on the quality assessment scale
Mid This article has been rated as Mid-importance on the importance assessment scale

Moved in from Talk: Diabetes Shock

It's fair to point out that the original author of this piece wanted it spelt CHOCK - please see (slightly edited) text below from AntonioMartin who said (inter alia):

I have to tell you that the word chock needs to be changed back on the title from shock to chock. ( ... ) how doctors like spelling the word that describes a sugar reaction. ( ... ) doctors have told me that the word Shock means something different to them, like the shock from seeing something big happen, I guess.

Having said that, I have checked on the BMJ and American Diabetes Association websites (including a search on all journals accessible from there) plus Medline, and have not been able to find any evidence for this practice. Antonio, can you please offer us a reference for it? It's not that I disbelieve you but I do wonder whether it was just some local usage among the particular doctors you met or something - I am very surprised that I can find no reference to it anywhere else. Nevilley 08:56 Dec 4, 2002 (UTC)

dictionary.com does not give any medical usage for the word chock. -- Zoe

In English, at any rate, there is insulin shock, and diabetic shock, and diabetic crisis, and diabetic coma, and insulin shock, and diabetic ketoacidosis; there is hyperglycemia, euglycemia, hypoglycemia: but alas, there is no "chock". -- Someone else 09:23 Dec 4, 2002 (UTC)

Try this google search: Google search for diabetic chock -"chock full" versus this: Google search for diabetic shock

I'm sorry to be so stupid but I am not quite sure what these searches prove - I am especially confused by the first one which seems to combine "chock" in the (disputed) diabetic sense with "chock full". Can you please clarify, for me at least, what these demonstrate? Thanks. Nevilley 11:01 Dec 4, 2002 (UTC)

A google search for "diabetic chock" returned one, repeat ONE, example, in ALL languages. "Chock full" has nothing to do with diabetes. -- Zoe

I think you mean a search for '"diabetic chock"', since you're quoting something that's already in quotes. ;) But yes, I also only get one match for it. As for the "chock full" thing, the minus sign gets Google to omit articles which contain the term immediately following it from its search results. So in this case, you'd avoid pages that contained the term "chock full". It's quite a useful feature if you're searching for terms that are used in many different contexts. Not much use in this situation, but you might find it useful in the future... -- Oliver PEREIRA 03:20 Dec 5, 2002 (UTC)

I'm a paramedic and I've never heard the word before. There are eight different medical conditions called shock--the only one I know much about is hypovolemic shock. When the doctors on ER say someone is going into shock, they mean hypovolemic shock. Tokerboy 03:41 Dec 5, 2002 (UTC)

[edit] Old text removed 4/18/05, with what's wrong with it in parentheses.

of the 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. Hyperglycemia is just a term for raised blood glucose but in some cases it can lead to a life-theathening condition called diabetic ketoacidosis. (No, the mechanism is different) Patients with diabetes mellitus type 1 are especially prone to this condition.

Causes for this condition vary; in the case of diabetes, it could be due to too much food too quickly or forgetting to inject oneself with insulin (not quite-- the most common causes are actually new onset of type 1 diabetes, intentional omission of insulin, or mismanagement of an illness), while in the case of hypoglycemia it could be due to a lack of food, too much exercise for current conditions, or to an insulin or other medication overdose. While no particular amount of sugar in the blood is generally recognized as the starting point to acute problems of glucose management (people vary), usually the person who has hyperglycemia has a blood glucose reading of 500 mg/dL (28 mmol/L) or more is at risk of hyperglycemic osmotic coma (the high gluocse sort), while a patient whose blood glucose level is 50 mg/dL (3 mmol/L) or less is at risk of a hypoglycemic diabetic coma. (Again, not quite. DKA and hyperglycemic hyperosmolarity rarely cause unconsciousness unless the glucose is more than twice 500, and hypoglycemia rarely causes unconsciousness unless the glucose is well under 50, though the glucose may be higher when the patient is found).

Without performing a blood glucose test, it is difficult to tell with certainty whether the coma is caused by hypoglycemia or hyperglycemia as symptoms can be similar. (As outlined in the article, except for the coma, symptoms are not at all similar).

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.

First aid for diabetic coma includes the following:

Other first aid measures include:

  • If working equipment (ie, glucose meters) are available, a blood glucose level reading should be taken immediately. NEVER GIVE INSULIN unless you are completely confident you know what you're doing and are sure the patient is NOT HYPOGLYCEMIC. Mistakes with insulin can kill, and quickly (not quickly).
  • If the patient is conscious (then it isn't diabetic coma) 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 DO NOT WORK. Avoid fatty, oily, or protein rich foods if possible, for digestion and absorption of the sugar will be delayed. A chocolate bar is not as good as a sugary tea, for instance, nor is regular milk (high fat content) in comparison to skim milk (much lower fat content). 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 (vain) 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 any unconscious person (including hard candies). Regardless of whether they are hypoglycemic or hyperglycemic.
  • If a blood test is not possible, and sugars are given, immediate improvement after administering sugars should begin (within five to fifteen (5-10) minutes). If this does not occur, it wasn't hypoglycemia (depends on how much glucose was given and how long the patient was unconscious). The diabetic coma was (is) probably the result of hyperglycemia (not without lots of other evidence). This requires quite different and prompt medical treatment. Failure to receive that treatment may result in acidosis, perhaps ketoacidosis and death. The additional sugars given should not immediately harm the patient, but they must receive medical treatment as quickly as possible.

First aid providers are encouraged to test blood glucose if possible. If not, give sugar in some form. _Never_ give insulin without compelling evidence that the problem is hyperglycemia. Giving too much sugar is less dangerous to the hyperglycemic patient than giving insulin to the hypoglycemic patient.

Paramedics are familiar with the treatment of diabetic coma and will treat it with administration of sugars, blood test for glucose, administration of insulin (they don't give insulin, at least in North America) and rapid transport to a hospital if necessary.

Doctors recommend that:

  • Diabetic patients should always carry glucose tablets and/or a tube of glucose gel in case of hypoglycemia. Another good place for emergency glucose is in the refrigerator, if you are at home.
  • Diabetic patients should wear a "Medic-Alert" (TM) or other bracelet or jewelry identifying them as diabetic. Otherwise, a diabetic coma could be mistaken for drunkenness, especially by the uninformed. Undertrained police have been known to place patients into the local 'drunk tank' instead of obtaining medical attention for them. This can result in death. Diabetics have died because they were treated as intoxicated instead of suffering from a medical emergency.
  • Friends and family of diabetic patients should learn how to give first aid in a diabetic emergency, and how to operate the diabetic person's blood glucose meter. If possible, they should also learn how and when and why to give insulin injections if necessary.

If a diabetes patient has young children living with him/her, it is also very important to teach them the appropriate local emergency telephone number.

There is some valid info here, well-meant, but not entirely accurate and a bit all-over-the place for an encyclopedia article. If you think we should restore some of it, please explain. alteripse 03:29, 18 Apr 2005 (UTC)

[edit] Article flagged for cleanup

I flagged this article for cleanup because the formatting of the last 2 paragraphs is completely wonky. I'm at work and don't have the time to fix this now (the text is pretty unclear also, not necessarily an easy fix). This problem appeared on 16:30, March 26, 2008.

Ohzopants (talk) 15:43, 18 April 2008 (UTC)