Hyperglicemia and Hipoglicemia

Two different conditions can lead to a diabetic emergency; hyperglycemia and

hypoglicemia. Hyperglycemia is a state in which the blood glucose level is above
normal. Hypoglicemia is a state in which the blood glucose level is below normal.
Extremes of hyperglycemia and hypoglycemia can lead to a diabetic emergencies.
Ketoacidosis results from prolonged and exceptionally high hyperglycemia. Diabetic
coma then results when ketoacidosis is not treated adequately. Hypoglycemia, on the
other hand, will progress into unresponsiveness and eventually insulin shock.
The signs and symptoms of hypoglycemia and hyperglycemia can be quite
similar. For example, staggering and an intoxicated appearance or complete
unresponsiveness are signs and symptoms of both. Note that your assessment of
these potential emergencies should not prevent you from providing prompt care and
transportat as detailed in this chapter. However, in such urgent emergencies, the
earlier clues are gathered, the better for the patient. With specific information about
the type of emergency, you can help the hospital to prepare prompt, definitive care for
the patient.
Diabetic Coma
Diabetic coma is a state od unconsciousness resulting from several problems,
including ketoacidosis, dehydration because of excessive urination, hyperglycemia.
Too much blood glucose by itself does not always cause diabetic coma, but on some
occasions, it can lead to it.
Diabetic coma may occur in the patient who is not under medical treatment,
who takes insufficient insulin, who markedly overeats, or who is undergoing domr of
short stress that may involve an infection, illness, overexertion,fatigue, or drinking
alcohol. Usually, ketoacidosis develops over aperiod of time lasing from hours to
days. The patient may ultimately be found comatose with the following physical
signs:
- Kussmaul respirations
- Dehydration, as indicated by dry, warm skin and sunken eyes
- A sweet or fruity (aceton) odor on the breath caused by the unusual waste
products in the blood (ketones)
- A rapid pulse
- A normal or slighthly low blood pressure
- Varying degress of unresponsiveness
Insulin Shock
In insulin shock, the problem is hypoglycemia, insufficient gluscose in the
blood. When insulin levels remain high, glucose is rapidly taken out of the blood to
fuel the cells. If glucose levels get too low, there may be an insufficient amount to
supply the brain. If blood glucose remains can be quickly follow.
Insulin shock occurs when the patient has done one of the following:
- Taken too much insulin
- Taken a regular dose of insulin but has not eaten enough food
- Had an unusual amount of activity or vigorous exercise and used up all
available glucose

Insulin shock may also occur after the patient vomits a meal after he or she
took a regular dose of insulin. At times, insulin shock may occur with identifiable
predisposing factor.
Children who have diabetes may pose a particular management problem.
First, their high levels of activity mean that they can use up circulating glucose more
quickly than adults do, even after a normal insulin injection. Second, they do not
always eat correctly and on schedule. As a result, insulin shock can develop more
often and more severely in children than in adults.
Insulin shock develops much more quickly than diabetic coma. In some
distances, it can occur in a matter of minutes. Hypoglycemia can be associated with
the following signs and symptoms:
- Normal or rapid respirations
- Pale, moist (clammy) skin
- Diaphoresis (sweating)
- Dizziness, headache
- Rapid pulse
- Normal to low blood pressure
- Altered mental status (aggressive, confused, lethargic, or unusual behavior)
- Anxious or combative behavior
- Hunger
- Seizure, fainting, or coma
- Weakness on one side of the body (may mimic stroke)
Both extremes of diabetic coma and insulin shock produce unconsciousness
and, in some instances, death. But they call for very different treatment. Diabetic
coma is a complex metabolic condition that usually develops over time and involves
all the tissues of the body. Correcting this condition may take many hours in a well-
controlled hospital setting. Insulin shock, however, is an acute condition that can
develop rapidly. A patient with diabetes who has taken his or her standard insulin
dose and missed lunch may be in insulin shock before dinner. The condition is just a
quickly reserved by giving the patient glucose. Without that glucose, however, the
patient will suffer permanent brain damage. Minutes count.
Most individuals with diabetes understand and manage their disease well.
Still, emergencies occur. In addition to diabetic coma and insulin shock, patients with
diabetes may that you should always consider. Their only symptom may be not
feeling so well.