Wednesday, August 4, 2010

Hypoglycemic Coma in Diabetes Mellitus

Predisposing Factor
State of hypoglycemia can occur in people with diabetes mellitus. We can divide the coma hypoglycemia within 3 (three) categories, namely 1). Hypoglycemia in patients with early-stage diabetes mellitus, 2). Hypoglycaemia in the context of treatment of diabetes mellitus such as the use of insulin, the use of sulfonylurea, and infants born to mothers with diabetes mellitus. 3). Hypoglycemic that is not associated with diabetes mellitus. Predisposing factors of hypoglycemia in patients receiving insulin or sulfonylurea treatment. Factors associated with patients themselves, such as reduction / delay of food; drug dosage errors; excessive physical exercise; decrease insulin needs: healing from disease, diabetic nefropari, hypothyroidism, Addison's disease, hipopituitarisme; first days of delivery; disease and heavy day diabetic gastroparesis. While the factors associated with physicians is tight blood glucose control, provision of drugs that have potential hypoglycemic and replacement of insulin.

Hypoglycemic coma has been able to explain the pathogenesis. At meal time sufficient available sources of energy absorbed from the intestine. Excess energy is stored as macromolecules and is called an anabolic phase. Sixty percent of the intestinal absorption of glucose by the influence of insulin will be stored in the liver as glycogen, most of the rest are stored in fatty tissue and muscle as glycogen, too. Some will have more than glucose metabolism and aerobic to anaerobic energy throughout the body especially the brain. Approximately 70 percent of consumption takes place in brain glucose. The brain can not use free fatty acids as an energy source.
Digestion and absorption of protein will lead to an increase of amino acids in the blood with the help of insulin will be stored in the liver and muscle as a protein. Fat absorbed from the intestine through the lymph channels in the form of chylomicron, which then in hidrolasi by lipoprotein lipase into fatty acid. Origin fat will go through esterification with glycerol to form triglycerides to be stored in fatty tissue. The process took place with the help of insulin. At the time after eating or after 5-6 hours fasting, blood glucose levels began to fall, this condition also causes the secretion of insulin decreases while contraregulator hormones, namely glycogen, epinephrine, cortisol, and growth hormone will increase.

Clinical Manifestations
Hypoglycemia has symptoms are divided into two phases, namely:
1. Phase I, the symptoms caused by activation of autonomic centers in the hypothalamus so the hormone epinephrine is released. Initial symptoms are a warning because the patient was still conscious at that time so it can take necessary measures to cope with hypoglycemic information.
2. Phase II, the symptoms arising from disruption of brain function, so-called neurological symptoms.
Research on people with diabetes showed that there was no disturbance of brain function which is earlier than the phase I and is called subliminal brain dysfunction. In addition to warnings and neurological symptoms, occasionally showed hypoglycemic symptoms are not typical.

Checking blood glucose before and after the administration of dextrose injection.

Treatment must be done quickly. If the patient is still conscious then the action can be performed by patients themselves by drinking a solution of sugar 10-30 grams. In patients who did not realize then given 15-25 grams of dextrose bolus. If such action can not be done then it can be given honey or syrup to the mucosal lip.
When hypoglycemia occurred in patients receiving insulin therapy, the addition of dextrose injection may also be used via intramuscular glucagon 1 milligram dextrose especially if through intravenous injections very difficult.

Death may occur due to delays in treatment.

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