Definition of Diabetes mellitus (DM)

8
 Diabetic Coma

Hypoglycemic Coma
Hyperglycemic Coma
Etiology
a. Common (diabetic causes)
1- Excess insulin or oral hypoglycemic agents.
2- Missed meal
3- Exercise
4- Alcohol intake b. Rare non-diabetic causes
1- Liver diseases
2- Hypoadrenocorticicism
3- Hypopituitarism a. Too little insulin, or missed insulin dosage b. Infection c. Dehydration d. Exogenous steroid e. Emotional upset, stress f. Myocardial infarction
Clinical
Features
• Takes hour to develop (rapid onset)
• Tend to occur in dental practice
• Low glucose level a- Adrenaline release
1- Sweating – moist cold skin
2- Palpitation Full and rapid pulse
3- Tachycardia b- Cerebral hypoglycemia Brain use glucose only if its level fall → neuroglycopenia
1- Irritability, anxiety
2- Confusion
3- Loss of concentration
4- Unconsciousness (coma)
• Takes days to develop (slow onset)
• Does not tend to develop in dental practice
• High glucose level and accumulation of ketone bodies, leading to metabolic acidosis.
1- Nausea and vomiting
2- Features of dehydration (d.t. vomiting)
- Dry skin
- Sunken eyes
3- Excess ketone in breath, producing smell similar to acetone
4- Hyperventilation (to compensate for acidosis)
5- Confusion and stupor
6- Coma
Treatment
1- 2 teaspoonful of sugar dissolved in water by mouth if the patient is awake.
2- If unconscious patient a. IV, 25-30 ml of 50% dextrose b. IV, SC or IM, 1 mg glucagon
N. B - Glucagon ↑ glycogenolysis by the liver
3- Watch the patient for 30-60 minutes after recovery
• Occasionally hyperglycemia maybe present with features of hypoglycemia
• Treat as hypoglycemic state, If failed to recover the patient, call ambulance
• The extra glucose given have no marked significant effect on the patient

Sources:
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Lecture

• Doctor Handout

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