Type 2 diabetes hypoglycemic coma

　　The main causes of hypoglycemic coma in type 2 diabetes are as follows:

　　1. Inappropriate use of insulin:If the original dose of insulin is still injected when reducing food intake, or the dose is increased blindly without the doctor's permission, or not eating in a timely manner after injecting insulin.

　　2. Inappropriate use of oral hypoglycemic drugs:Diabetic patients may take an overdose of hypoglycemic drugs, such as the combination of metformin + glibenclamide + xiaoke pills, gliclazide + xiaoke pills + acesulfame potassium, or be misdiagnosed as diabetic patients and cause coma due to oral hypoglycemic drugs.

　　3. Inappropriate diet:Diabetic patients should still take hypoglycemic drugs when reducing their diet, or not eating in a timely manner after injecting insulin.

　　4. Comorbid diseases:If complications such as heart disease, hypertension, renal insufficiency, chronic obstructive pulmonary disease, chronic gastritis with duodenal ulcers, etc., are present.

　　Hypoglycemic coma in type 2 diabetes is prone to cause retinopathy, which is the main cause of blindness in adults, including diabetic patients; it can also lead to diabetic nephropathy, the primary cause of end-stage renal disease; hypoglycemic coma in type 2 diabetes can also increase the mortality rate and stroke rate by two to four times; 80% of diabetic patients die of cardiovascular diseases; it may also cause neurological lesions, which are the primary cause of non-traumatic amputation of the distal extremities.

　　Hypoglycemia is a strong stress for the body, with the patient showing sympathetic nervous system activation; hypoglycemia causes a lack of energy source for the central nervous system, leading to many dysfunctions. The patient may initially feel symptoms such as sweating, hand tremors, palpitations, hunger, irritability, headache, epilepsy attacks, hemiparesis, blurred vision, and coma, which are related to the duration, frequency, duration, and relief of the episode.

　　Symptoms of sympathetic nervous system activation: manifested as hunger, weakness, pale complexion, dizziness, palpitations, rapid pulse, cold sweat, and trembling of limbs.

　　Symptoms of brain dysfunction: palpitations, emotional excitement, hallucinations, mania, convulsions, drowsiness, and even death due to coma.

　　The initial symptoms of central nervous system involvement are mainly manifested as inattention, slow response, and disordered thinking. Subsequently, a series of neurological and psychiatric symptoms dominated by brain function suppression appear, such as visual disturbances, confusion, hearing impairment, drowsiness, confusion, behavior changes, dizziness, headache, rigidity, sensory abnormalities, ataxia, and sometimes mild hemiparesis, without high body temperature.

　　Severe cases can lead to coma. In some cases of diabetic hypoglycemia, there are no symptoms of sympathetic chromaffin system activation, and the main manifestation is neurohypoglycemia with suppression of cerebral cortex function, sometimes quickly falling into a coma. Children may experience convulsions or epilepsy-like seizures. Long-term, repeated, and multiple episodes of hypoglycemia can lead to dementia or psychiatric-like seizures. The manifestations of hypoglycemia can also be very atypical; some may present with angina, even myocardial infarction; some have no abnormal sensations, with coma as the initial symptom; some mainly present with chest tightness, shortness of breath, and difficulty breathing.

　　Hypoglycemia is the most common problem in the treatment of diabetes, especially when it becomes severe, that is, coma. It should be avoided as much as possible. After hypoglycemia occurs, it is necessary to carefully find the cause of hypoglycemia under the guidance of a doctor, first to exclude factors such as diet, exercise, and mood changes, and then consider whether the use of medication is reasonable, without immediately reducing the dosage, and secondly, to strengthen regular blood sugar monitoring.

　　Specifically, attention should be paid to the following points:

　　Firstly, eat on time, choose dry food for staple food, and avoid hunger. Liquid food is absorbed quickly, leading to a rapid increase in blood sugar after meals, with a short duration, which is easy to cause hypoglycemia before the next meal; dry food is absorbed slowly, causing a slow increase in blood sugar after meals, with a long duration. Secondly, avoid drinking, especially drinking on an empty stomach;

　　Before exercising, it is necessary to check blood sugar levels. If the blood sugar level is below 5.5mmol/L, it is recommended to eat 4 salted biscuits or a small apple before exercising; carry supplies as two 'treasures' that every diabetic patient should carry when going out: first, food such as candies, biscuits, etc., for emergency use in case of hypoglycemia, to correct hypoglycemia in a timely manner and avoid severe hypoglycemia; second, an emergency card (indicating name, phone number, diagnosis, medication, etc.), which provides important information for emergency care for diabetics, so that in case of severe hypoglycemia, diagnosis and treatment can be obtained in the shortest possible time.

　　Then, for elderly people over 60, be cautious when using strong hypoglycemic drugs that can easily cause hypoglycemia, such as Youjiangtang, and the blood sugar control standard should not be too strict. It should be taken under the guidance of a diabetes specialist doctor; finally, when injecting insulin, the dosage must be accurate, and meals should be eaten in a timely manner after injection. The insulin dosage should be adjusted in a timely manner according to the blood glucose monitoring results. For friends using insulin pump therapy or injecting insulin more than 3 times a day, blood glucose should be monitored at any time, 4 times a day, that is, before breakfast and after each meal. If the blood glucose level before breakfast is high, blood glucose levels at 2 am and 4 am should be measured.

　　Hypoglycemia is a strong stress for the body, and patients show sympathetic nervous system excitation: hypoglycemia causes the central nervous system to lack an energy source, resulting in many dysfunctions. This disease requires the following examinations during the examination:

　　1. Measure fasting and发作时的 blood glucose levels, blood insulin and C-peptide levels, calculate the insulin release index (fasting blood insulin/fasting blood glucose), and do a fasting test (whether fasting for 12-72 hours induces hypoglycemia) and insulin release inhibition test when necessary, comparing serum C-peptide levels before and after injection.

　　2. Abdominal ultrasound examination should be performed when necessary.

　　3. X-ray examination. For patients suspected of having an insulinoma, abdominal CT, especially pancreatic CT, portal and splenic vein catheter blood sampling to measure insulin, and selective pancreatic artery angiography can be performed.

　　For patients with type 2 diabetes and hypoglycemic coma, ensure that each meal contains an adequate amount of complex carbohydrates (all kinds of staple foods), and strictly follow the meal schedule. If the meal time is delayed due to certain special circumstances (such as during travel), it is necessary to eat some soda crackers, bread, and water first to supplement energy and prevent blood sugar from dropping.

　　In addition, be serious about asking doctors for help to check the dosage of insulin or hypoglycemic drugs to prevent overuse. Eat less and more often, and hypoglycemia patients are best to eat small and frequent meals, about 6-8 meals a day. Eating a small amount of snacks and desserts before bedtime will also be helpful.

　　In addition, alternate food types, do not eat the same food frequently, as allergies are often related to hypoglycemia. Food allergies will worsen the condition, making the symptoms more complex; foods to be limited; strictly limit the intake of monosaccharides, try to eat less refined and processed products (such as instant rice and potatoes), white flour, soda, alcohol, and salt.

　　Avoid fruits and fruit juices with high sugar content (for example, grape juice mixed with 50% water for drinking). Also, eat less macaroni, noodles, meat broth, white rice, corn flakes, and sweet potatoes. Legumes and potatoes can be eaten twice a week; a balanced diet should strive for balance, with at least 50-60% carbohydrates (the same dietary principles as diabetics), including vegetables, brown rice, avocados, konjac, seeds, stone fruits, grains, lean meat, fish, yogurt, and raw cheese. Increase high-fiber diet; high-fiber diet helps stabilize blood glucose concentration.

　　When blood glucose levels drop, fiber and protein foods can be combined (for example, wheat bran cakes with fresh cheese or almond jam). Replace apple sauce with fresh apples, as the fiber in apples can inhibit blood glucose fluctuations. Also, you can add a glass of juice to quickly raise blood glucose levels. Fiber itself can also delay the decrease in blood glucose levels. Take fiber half an hour before meals to stabilize blood glucose levels. Taking spirulina tablets between meals can further stabilize blood glucose levels.

　　Hypoglycemia is a strong stress for the body, with symptoms of sympathetic nervous system excitement; hypoglycemia causes the central nervous system to lack an energy source, resulting in many functional disorders. At the onset of the disease, patients may feel dizzy, headache, hunger, weakness, and cold limbs. Subsequently, there may be confusion, disorientation, convulsions, and even coma, or it may manifest as mental confusion and hemiparesis. Therefore, timely treatment should be administered as soon as the diagnosis is confirmed. The conventional treatment method for type 2 diabetes hypoglycemic coma:

　　For mild cases, 50% glucose solution or juice, sugar water, and sugar-containing foods should be taken immediately. Early hypoglycemia may only have symptoms such as sweating, palpitations, fatigue, and hunger. When the patient is conscious, sugar water can be given, or biscuits or pastries with a high sugar content can be eaten; if the patient's consciousness has changed, 50% glucose 40-60ml should be administered intravenously, and for more severe cases, 10% glucose can be administered continuously by intravenous infusion. The application of glucagon: If conditions permit, 1mg of glucagon can be injected intramuscularly, but glucagon is expensive; it should be noted that if a patient treated with metformin develops hypoglycemia, glucose should be administered orally or intravenously for treatment. Eliminate the causes of hypoglycemia, such as excessive intake of oral hypoglycemic agents, excessive insulin, or improper use.

　　For severe cases, 50% glucose solution 50-100 milliliters should be administered intravenously. For patients with hypoglycemia caused by insulin or oral hypoglycemic agents, continuous intravenous infusion should be maintained. At least 10% to 20% glucose solution for 48 hours. In principle, the blood glucose concentration should be slightly higher than the normal range. Blood glucose levels should be continuously monitored and adjusted during infusion. To prevent recurrent hypoglycemia, a high-protein diet should be provided, with meals taken 3 to 6 times a day. Severe cases should be treated for critical illness rescue.