An Alarm:
Even when your diabetes is in the best state of control, there can be some problems which may lead to a critical situation. It happens occasionally in every diabetic life.
There are Basically Two Situations:
Hypoglycemia
When the blood sugar drops too low i.e., less than 40 mg/ 100ml, known as hypoglycemic coma, one can become unconscious, and may need urgent help. In extreme cases, it could be fatal. In minor degree of hypoglycemia, patients can cope themselves. Points to be borne in mind are:-
• Take your meals in time, if there is any chance of delay, take some snacks or fruits
• Before indulging in any undue physical exercise, make sure you have some extra food
• You should have some access to biscuits, toffee, fruits or any sweet drinks, in case it happens.
• If it is a recurrent feature, get your treatment and diet adjusted accordingly.
Hyperglycemia Can Be Dangerous At Times
When blood sugar level rises very high and there is no adequate insulin, fat is utilised to produce energy for survival -the by products, which are acidic in nature accumulate, causing excess of ketones, acidosis; and dehydration, leading to coma. It is a dangerous situation, unless treated well in time, may result in death. The basic cause is just lack of insulin for some time.
This type of diabetic coma is not as common as hypoglycemic coma. It occurs more frequently in Type I diabetics, those who are taking insulin (as they are deficient in their own insulin), and invariably precipitated by omission of insulin or its wrong adjustment, some stressful situations, infection or any other acute medical or surgical illness. It is never sudden, it may take 12 to 72 hours to develop.
The classical picture is, gradually increasing blood sugar, dehydration, vomiting, deep rapid breathing with fruity smell, an acutely ill patient, gradually slipping into coma. Very rarely, patients are diagnosed diabetic for the first time, when they are in diabetic coma.
If one is aware of its possibility, and is vigilant, it can be detected at much earlier stages, and treatment is simple and more effective with better results.
If there is any change in daily schedule like travelling when patient is taking insulin, or is on tablets, he must try to take the same dose of insulin and adjust the food intake accordingly.
If there is any illness such as fever, diarrhoea, vomiting, pain in abdomen, etc., one has to be cautious that diabetic control is not disturbed. You cannot afford to miss insulin, but you can take smaller quantities of plain insulin more frequently after monitoring blood glucose levels (Glucometer is handy in such situations).
Ensure adequate fluids intake orally to avoid getting dehydrated. You may need intravenous fluids if vomiting or pain in abdomen prevents oral intake.
You should check urine ketones frequently with Ketodiastix or Gluketur strips. Positive ketone test in urine should be taken seriously, never to be ignored.
Any complicating illness such as infection should be attended promptly. This is a complicated situation, it is better to inform your doctor in the beginning rather than later, as the earlier treatment is easier and results better.