Do not give sugar , carbohydrates, or fats in any form.

LECTURE 5

DIABETES

DIABETES – inability to metabolize carbohydrate as the result of failure of the pancreas to secrete insulin

One of the causes of unconsciousness or semiconsciousness, for which the correct emergency care is of paramount importance, is diabetic coma There are two forms. One results from the diabetic`s inability to obtain the insulin he required on schedule or from his eating improperly and not taking enough insulin. The other results from taking too much insulin or from not being able to get enough carbohydrate food to balance the amount of insulin is accustomed to taking.Strictly speaking. the first condition is known as diabetic coma (or diabetic ketaacedosis). And the second as insulin coma.

The symptoms and appearance of a person in each of these two conditions are very different; therefore, it is usually not difficult to tell them apart.

Diabetic coma occurs when there is insufficient insulin in the body to fully metabolize carbohydrates and fats. Because the substances are only partially broken down chemically, they form various compounds that are acid in nature and seriously alter the body`s chemistry, Consequently, the patient is thrown into a condition which is known medically as acedosis. If acedosis becomes severe enough, the individual gradually becomes confused, disoriented, and stuporous, and eventually lapses into coma.

Signs and symptoms The face is flushed, the lips are cherry-red color, the skin is very dry, the temperature is lowered although the patient looka as though he had a fever (a point of differentiation from heat stroke), and breathing is spasmodic. Characteristically, there is the sickly sweet odor of acetone (the odor of nail-polish remover) or spoiled fruit on the breath. This odor is clue to the condition.

Do not confuse the odor of acetone with that of alcohol – an all too common mistake. People have been thrown into jail for being drunk when they were actually in diabetic coma.

This condition may have come on over a period of several hours preceded by excessive thirst, excessive urination, excessive appetite followed by loss of appetite and increasing weekness leading to drowsiness

Treatment Call for medical assistance immediately. From a strictly emergency care standpoint, there is little to be done until help arrives. However, if this is not available quickly and if insulin is at hand, it should be given by hypodermic injection, in doses of 50 units, repeated in 30 minutes. This action will save the person`s life and will tide him over until medical care arrives.

If neither medical or no insulin is available, treat the case as one of shock and administer fluids in large amounts by mouth if he he hasn`t lost his consciousness. If the victim is unconscious, administer fluids by rectum, using a salt solution (1 teaspoonful to a quart of water or bicarbonate of soda in the same concentration, in the amounts up 2 quarts or more.

Do not give sugar, carbohydrates, or fats in any form.

Many persons in diabetic coma tend to be nauseated, although there may be little in the stomach. Since the victim may be in a semistupor, he must be prevented, by turning the head to one side, from sucking vomited matter into the lungs, and it must be made certain that an adequate airway is maintained, These victims seem to do better in semireclining position, particularly since a complicating heart condition may also be present,

Insulin coma In some ways, insulin coma presents just the opposite picture from diabetic coma. The condition is due to little sugar in the blood as the result of too much insulin, which may be present one reason or another.

Signs and symptoms The person presents an ashen-white countenance; the skin is moist and clammy and covered with a cold sweat; and he is obviously in a state of shock. The pulse is rapid, but the breathing is slow and shallow. There is no odor of acetone on the breath.

Treatment Medica[ aid, should, of course, be obtained, but sometimes improvement can be brought about even before aid becomes available. What the victim needs is sugar, and this must be gotten into him very quickly, even he is unconscious. To do this, keep placing a little granulated sugar unger his tongue as rapidly as it is absorbed, until the victim regains обретать снова; восстанавливать consciousness. If this method is too slow, sugar solution should additionally be instilled by rectum, as a retention enema. удерживающая клизма

Orange juice is an excellent sourse of carbohydrate (sugar), even if the victim is semiconscious, can be given in very small amounts, by teaspoon, until enough sugar has been absorbed to bting about a return of consciousness of sufficient degree to permit him to swallow larger amount safely, From then on, recovery usually is rapid.

Sometimes it is impossible to get enough sugar into an unconscious persun except by intravenous infusion of glucouse in ssline. In severe cases that do not respond quickly to other routes of administration, this ishould not be deferred = since the victim may go into convultions if the blood sugar lrvel becomes too low. This can be carried out en route by properly trained ambulance personnel and may prove to be a lifesaving procedure if the case is not actually one of insulin coma.

Insulin resistance -ИНСУЛИНОРЕЗИСТЕНТНОСТЬ

insulin-dependant diabetes -инсулинозависимый диабет

hyperglycemia - glucose intolerance or diabetes mellitus -гипергликемия (нарушение толерантности к глюкозе или сфхарный диабет

Disease	Cause	Signs and symptoms	Treatment
Diabetic coma (ketaacedosis)	This condition is due too much sugar in the blood as the result too little insulin From the diabetic`s inability to obtain the insulin he required on schedule or from his eating improperly and not taking enough insulin	This condition preceded by -excessive thirst - excessive urination - excessive appetite followed by loss of appetite and increasing weekness leading to drowsiness The face is flushed, the lios are cherry-red color, the skin is very dry, the temperature is lowered although the patient looks as though he had a fever (a point of differentiation from heat stroke), and breathing is spasmodic.Characteristically, there is the sickly sweet odor of acetone (the odor of nail-polish remover) or spoiled fruit on the breath	Giving insulin by hypodermic injection, in doses of 50 units, repeated in 30 minutes. will save the person`s life and will tide him overuntil medical care arrives. Do not give sugar, carbohydrates, or fats in any form. Since the victim may be in a semistupor, he must be prevented, by turning the head to one side, from sucking vomited matter into the lungs, and it must be made certain that an adequate airway is maintained,
Insulin coma	This condition is due too much insulin in the blood as the result too little sugar From taking too much insulin or from not being able to get enough carbohydrate food to balance the amount of insulin is accustomed to taking.	The person presents an ashen-white countenance; the skin is moist and clammy and covered with a cold sweat; and he is obviously in a state of shock. The pulse is rapid, but the breathing is slow and shallow. There is no odor of acetone on the breath.	What the victim needs is sugar, and this must be gotten into him very quickly, even he is unconscious. To do this, keep placing a little granulated sugar unger his tongue as rapidly as it is absorbed, until the victim regains consciousness.

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