Diabetes, Insulin Shock And Diabetic Coma

"I'm not sure what's wrong with her. Suddenly she just sat down and seemed really confused. We went for a jog this morning but didn't have time to eat breakfast. We were on the way to get a late lunch when this happened."

Diabetes is caused by the body's inability to process and use the type of sugar carried by the bloodstream to the body's cells. Sugar is an essential nutrient. The cells of the body need both oxygen and sugar to survive. The body produces a hormone called insulin, which enables sugar carried by the blood to move into individual cells, where it is used as fuel.

If the body does not produce enough insulin, cells become "starved" for sugar. This condition is called diabetes. A person with diabetes must take supplemental insulin to bring insulin levels up to normal. Mild diabetes can sometimes be treated by oral medicine rather than insulin.

Diabetes is a serious medical condition. Therefore, all diabetic patients who are sick must be evaluated and treated in an appropriate medical facility. Two specific things can go wrong in the management of diabetes: insulin shock and diabetic coma. Both are emergencies that you must deal with as a first responder.

Insulin Shock

Insulin shock occurs if the body has enough insulin but not enough blood sugar. A diabetic may take insulin in the morning and then alter the usual routine by not eating or by exercising vigorously. In either case, the level of blood sugar drops and the patient suffers insulin shock.

The signs and symptoms of insulin shock are similar to those of other types of shock. Suspect insulin shock if a patient has a history of diabetes or is carrying medical emergency information. Symptoms of insulin shock include:

  • Pale, moist, cool skin.
  • Rapid pulse.
  • Dizziness or headache.
  • Confusion or unconsciousness.
  • Rapid onset of symptoms (within minutes).

A person experiencing insulin shock may appear to be drunk. You must keep this fact in mind. Mistakes have been and will continue to be made by first responders and others.

Insulin shock is a serious medical emergency. If insulin shock is not diagnosed and corrected by the administration of sugar in some form, the patient may die. Insulin shock can occur within a few minutes.

During your initial examination of every patient, look for an emergency medical alerting device to find out whether the patient has a pre-existing medical condition. If you suspect that a patient is suffering from insulin shock, try to get answers to the following questions:

  • Are you a diabetic?
  • Did you take insulin today?
  • Have you eaten today?

If the patient is diabetic, has taken insulin that day but has not eaten, you should suspect that the patient is going into insulin shock. If the patient is partly conscious, attempt to get some sugar into the patient's mouth. This is best done by helping the patient to drink something that contains a high concentration of sugar, such as a cola drink, orange juice or honey. Be sure that a drink you provide a person suffering from insulin shock is not "sugar free."

The amount of sugar absorbed by the body as a result of your efforts is often small but it may be enough to prolong consciousness until the patient receives further treatment.

If the patient is unconscious, do not try to administer fluids by mouth, since the patient may choke and aspirate the fluid into the lungs. Summon help immediately. Open the patient's airway and assist breathing and circulation if necessary. The patient must have sugar administered intravenously as soon as possible. This can be done by a paramedic or a physician.

Diabetic Coma

Diabetic coma occurs when the body has too much blood sugar and not enough insulin. A person with diabetes may fail to take insulin for several days. Blood sugar builds to higher and higher levels but there is no insulin to process it for use by body cells. The signs and symptoms of diabetic coma include:

  • History of diabetes.
  • Warm, dry skin.
  • Rapid, weak pulse.
  • Deep, rapid breathing.
  • Fruity odor on the patient's breath.
  • Slow onset of symptoms.

The patient may be unresponsive or unconscious. A patient suffering from diabetic coma may appear to have the flu (influenza) or a severe cold. As with insulin shock, misdiagnosis is common. It is not always easy to tell the difference between insulin shock and diabetic coma.

Insulin shock Diabetic coma
Pale, moist, cool skin Warm, dry skin
Rapid, weak pulse Rapid pulse
Normal breathing Deep, rapid breathing
Dizziness or headache
Confusion or unconsciousness Unresponsiveness or unconsciousness
Rapid onset of symptoms Slow onset of symptoms

Give conscious diabetic patients sugar by mouth and arrange for prompt transport to a medical facility. For unconscious diabetic patients, arrange for prompt transport to an appropriate medical facility. Every sick diabetic patient must be transported by ambulance to an appropriate medical facility for further treatment and examination.

Garry Briese is the executive director of the International Association of Fire Chiefs (IAFC) and, along with David Schottke, co-author of the new edition of First Responder: Your First Response In Emergency Care, available in summer 1996 from Jones & Bartlett Publishers. The book is produced by the American Academy of Orthopaedic Surgeons and the National Safety Council.