DIABETIC EMERGENCIES
Hypoglycemia, or insulin reaction: Taking too much insulin, exercising too much without eating, skipping or delaying a meal (or even not eating as much as planned) will mean that there is not enough sugar in the blood to use up the injected insulin. Then the blood sugar level will fall—sometimes to a hypoglycemic level, far below normal. The person may turn pale and feel shaky or dizzy. Arms and hands may feel numb, and there may be a tingling sensation around the mouth. As sensitive brain cells become affected by the lack of sugar, the person may become tired and irritable, feel disoriented, say irrational things, and even act peculiarly. Without prompt treatment, an insulin reaction may lead to convulsions and collapse.
Ketoacidosis (sometimes called diabetic coma): This develops gradually after a number of days of poorly controlled diabetes. Without enough insulin, the body is unable to utilize sugar for energy, so it begins to use stored fats instead. The ketones released when fats are broken down build up in the blood and pass into the urine and breath. These acid ketone bodies act as poisons, and the person may ultimately fall unconscious.
What to do in diabetic emergencies: Both insulin reaction and ketoacidosis are very serious medical emergencies. Their causes are opposite, and they require opposite treatments.
For insulin reaction, immediately provide sugar in the form of two sugar cubes, one-half cup of fruit juice or regular soda (not diet soda!), or the amount of candy equal to six or seven Lifesavers. Within ten minutes the person should feel better. After the insulin reaction is over, additional food such as milk, bread, and crackers should be eaten, and then normal activities can be resumed.
Never try to force any food or drink down the throat of an unconscious person—it might go into the windpipe and cause suffocation. An emergency injection of glucagon can help to bring a person out of a severe insulin reaction. A doctor might also give an intravenous injection of glucose. In any case, speed is important.
Ketoacidosis requires emergency treatment in a hospital. But what if a person with diabetes suddenly collapses, and you are not sure whether the cause is ketoacidosis or insulin shock? What should you do?
When uncertain, treat for an insulin reaction. Hypoglycemia develops so rapidly that quick action may be needed to save the person’s life or prevent brain damage. If it turns out that the person was really suffering from ketoacidosis, a little more sugar is not going to make much difference, and there will be time to correct for the mistake with injections of insulin. Call a doctor if the person does not respond to a dose of sugar within ten to fifteen minutes, or falls unconscious.
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