Causes of development in patients with diabetes mellitus
Patients with a diagnosed history of diabetes mellitus represent the most frequent risk group for developing hypoglycemic states. In this category of patients, a critical drop in blood sugar is usually caused by non-compliance with the treatment regimen or diet.
The main etiological factors include:
- Insulin overdose. Administration of the drug in a dose exceeding the body's requirement.
- Skipping a meal. Insufficient food intake leads to a pronounced carbohydrate deficiency against the background of hypoglycemic agent action.
- Excessive physical exertion. Active muscular work requires high energy expenditure, which quickly depletes available glucose reserves.
Etiology in patients without diabetes mellitus
The development of hypoglycemic coma is also possible in individuals who do not suffer from diabetes mellitus. In such cases, the causes are of a completely different nature and are associated with impaired synthesis, breakdown, or uptake of carbohydrates.
Key causes in this group:
- Alimentary factors. Prolonged fasting and lack of adequate nutrient intake.
- Congenital pathologies. Various congenital defects in carbohydrate metabolism, as well as severe enzymopathies.
- Toxic and medicinal effects. Overdose of oral hypoglycemic agents (specifically sulfonylurea derivatives), as well as the use of valproates and salicylates.
- Severe liver damage. Leads to a critical disruption of glycogen breakdown (glycogenolysis) and the formation of new glucose (gluconeogenesis).
- Endocrine insufficiency. Conditions accompanied by adrenal cortex hypofunction or decreased adenohypophyseal function.
Emergency care: precomatose period
The management tactics for a patient with hypoglycemia strictly depend on their level of consciousness. The main goal of all interventions is the rapid relief of hypoglycemia and the prevention of further progression into coma.
If the patient is in the precomatose period (consciousness is preserved), therapy consists of oral replenishment of carbohydrate deficiency. For this purpose, foods and solutions containing fast-acting carbohydrates are used:
- Dextrose solution;
- Sweet tea or regular sugar;
- Honey, jam, or candy.
Drug therapy for loss of consciousness
If the patient's condition worsens or if there is a complete loss of consciousness, oral carbohydrate intake is impossible and contraindicated. In this situation, drug therapy is initiated immediately.
The action algorithm includes:
- Intramuscular (IM) administration of counterregulatory hormones. Glucagon is used at a strict dose of 1 mg.
- Intravenous (IV) replenishment of glucose deficiency. An infusion of a 10–20% dextrose solution is performed.
Important to remember: in the event of critical violations of vital functions, the patient is indicated for immediate cardiopulmonary resuscitation (CPR).
Class and exam questions
Which laboratory parameter serves as a criterion for hypoglycemic coma?
The laboratory criterion for this condition is a drop in glycemic levels below 2–3 mmol/L.
What does the choice of emergency care tactics in hypoglycemia depend on?
The choice of tactics and method of carbohydrate administration directly depends on the patient's level of consciousness. If the patient is conscious, carbohydrates are given orally; if unconscious, medications are administered intramuscularly and intravenously.
What dose of glucagon should be administered?
In case of loss of consciousness, glucagon is administered intramuscularly at a dose of 1 mg.
What pathogenetic mechanism underlies central nervous system damage in hypoglycemia?
The underlying lesion is critical energy starvation of brain tissue due to a lack of glucose in the blood.
What else to study on this topic
- Mechanisms of brain energy starvation development during glucose deficiency
- The effect of sulfonylureas on carbohydrate metabolism
- The role of the liver in glycogenolysis and gluconeogenesis
- Pathogenesis of hypoglycemia in adrenal cortex hypofunction
- Indications and algorithm for cardiopulmonary resuscitation (CPR) in comas
Master the entire topic in the Pediatrics course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Hypoglycemic coma" and 3,738 other subject pages
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 71 video lessons on the subject
Other topics in "Chapter 13. Main syndromes requiring emergency care"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.