[How I treat...severe hypoglycemia in a diabetic patient].
Severe hypoglycaemic episodes are defined as need of assistance and may progress to profound coma. They can occur in patients treated with insulin, generally for type 1 diabetes, or in patients receiving sulphonylureas, for type 2 diabetes. Diagnosis is usually obvious, at least in insulin-treated patients, and requires an urgent intervention from the entourage. Such an intervention should comprise the oral administration of carbohydrates with high-glycaemic index if consciousness allows it or, if not, the injection of glucagon. When necessary, people should ask the help of a physician who will inject hypertonic glucose intravenously. Hypoglycaemic coma related to an absolute or relative excess of insulin should, in most cases, be treated at home. In contrast, a hypoglycaemic coma due to a too high dosage of sulphonylurea always requests a hospitalisation in order to carefully supervise the patient and to provide a prolonged intravenous infusion of glucose. It is mandatory that family or entourage members of any diabetic patient at risk to develop severe hypoglycaemia receive a specific education in order to promptly apply the best treatment capable of a rapid and safe recovery from hypoglycaemic coma.
Service de Diabétologie, Nutrition et Maladies métaboliques, Service de Médecine interne générale, Département de Médecine, Université de Liège.
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RP
Radermecker
J C
JC
Philips
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Scheen
D001786:Blood Glucose / Q000378:metabolism; D003128:Coma / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D019422:Dietary Sucrose / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005934:Glucagon / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000517:prevention & control*; D007328:Insulin / Q000009:adverse effects / Q000097:blood; D013453:Sulfonylurea Compounds / Q000009:adverse effects
D001786:Blood Glucose; D019422:Dietary Sucrose; D005765:Gastrointestinal Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D005934:Glucagon