Introduction
This is a case of 51 years old Douglas Adams, who was brought in the hospital by a friend confused and disorientated. His Glasgow coma rate was 14/15 on admission due physical injuries. He seems to be suffering from some spells of dizziness and unconsciousness. He is also anxious, looking pale, has hand tremors and has cold sweats. Going through his documentation, I found that the patient had been diagnosed with type 1diabetes and hypertension in some other hospital with. The patient is also allergic to penicillin. The available information also shows that the patient is undergoing diabetes medication.
Data collection
Patients with diabetes 1 and 2 are at higher risk of contacting hypoglycaemia. The patient had consumed many drugs and is currently under medication of humalog mix 25: 26 units’ mane, 16 units nocte. perindopril 4mg mane, asprine 100mg daily. Apparently, taking such an amount of drugs without good diet may lead to low blood sugar. Low blood sugar leads to a medical disorder known as hypoglycaemia (Elsborg et al., 2011). Many patients are unaware of their blood sugar levels. The weight of the patient is 70kg. This is an overweight if you compare with his weight of 190cm. His Glasgow coma is still 14/15 as it was on admission. His vital signs are HR-82 bpm, BP-110/87 mmHg, RR-18, T-36.8. His blood sugar level is 5.2 mmol/L. He has good memory since later that morning he rings the buzzer to inquire when the planned tests will commence.
Study Hypothesis
Insulin intake with altered nutrition
Taking insulin with altered nutrition may cause hypoglycaemia (Faldini et al., 2011). Insulin in the body is released from the pancreas due to increased sugar consumption. This leads to absorption of more glucose leaving tryptophan for absorption. Depressed people tend to increase the sugar consumption in their diet. Insulin reception in the cell membrane is regulated after high sugar diets. This leads to the cells becoming insulin resistance. Due to lack of enough energy in the body, adrenaline is released into the blood system. Adrenaline is used to convert glycogen in to glucose to rapidly lift blood glucose level. Too much insulin in the body causes the level of the blood sugar to drop (Donnelly, Garber & Caterson, 2010). When too much insulin is released in to the blood system blood sugar is reduced. The pancreas in reaction to more glucose levels in the blood generates insulin. The medication required that Douglas take adequate meals because the drug intake was very high. If he could not afford enough meals, the insulin from the medication could lead to hypoglycaemia (Drabkin, David & Ravdin, 2010).
Symptoms
Most symptoms of hypoglycaemia are connected to those of low blood sugar. Such symptoms are cold sweats, nervousness, hand tremors, anxiety, trembling, palpations, and slurred language.
Unawareness could be the result of low blood sugar
If a patient with diabetes does not sense those similar symptoms, diabetes may occur. As a result, they may be aware their blood sugar is extremely low hence it may lead to a coma.
Unconsciousness may lead to physical injury
Unconsciousness may lead to physical injuries leading to Glasgow Coma. Glasgow coma occurs when a person has a brain injury (Sanchez & Isabel, 2011). Low blood sugar reaching the brain may also lead to a coma. Considering the dizzy spells, the patient might not have taken the medication as prescribed. A patient may develop seizures while the nervous system may get permanent damages if untreated (Ruggiéro, 2002).
Low blood sugar reaching the brain may lead to coma
Low blood sugar should be treated at early stage to reduce risk of threatening situations. Seizure and unconsciousness can lead to a coma. Low blood sugar reaching the brain could lead to a coma. Build-up of ketones in the blood stream is the main cause of coma. The brain requires enough glucose to function.
Lack of Knowledge
Lack of knowledge by patients that having one disorder could lead to other complications if proper diagnosis is not carried out is very important. The most efficient hypoglycaemia intervention is avoidance (Bailey, 2010).
Physical Assessment
Endocrine System and Integumentary System Assessment
Conducting the patient’s physical assessment, the patients’ BP is 105/80mm Hg from 110/87mmHg, HR up from 82 to 88bpm and RR-18, T 36.5 down from 36.8. From this, it is evident that insulin was lowering his Blood glucose. The cholesterol level is 5.2 mmol/L, which is not desirable. It is evident that the weight and height of this patient i.e. 70kg and 190 cm respectively, are incomparable. This means the patient should have many exercises to reduce further gain in weight. Sweating is also evident throughout the body. Sweating is mostly caused by taking high blood pressure medicine such as beta-blockers. The smell of the sweat produced after taking these drugs is also very intense.
Neurological System Assessment
When asked his name, the patient tries to answer but his words are slurred. This shows that the patient has Glasgow coma caused by traumatic brain injury. Glasgow coma scale is used to check the level of consciousness. A patient is asked questions and then marks are awarded according to his answers and level of consciousness.
The physical injuries as confirmed by the X- ray computerized tomography were caused by falls caused by the dizziness that mainly occurs after taking his medications. Therefore, it is confirmed that he has hypoglycaemia. Hypoglycaemia recurrence can be reduced by intake of glucose (Cryer, 2007). Glucose can be administered orally to patients who can talk and swallow while not in a coma. Hypoglycaemia may be modified by use of 15:15 law. In this rule, 15-20 grams of carbohydrate is used, and blood glucose checked after 15-20 minutes. With or without hypoglycaemia signs, the level of the blood glucose should be less than 70 mg/dl (Hardy & O’Brien, 2006). Handling for blood glucose should be stopped when a level of more than 70 mg/dl is achieved. Examples of such carbohydrates are sugar, glucose tablets, fruit juice and non-fat milk.
In case, the blood glucose is higher than 70 mg/dl, a snack of protein and carbohydrate should be arranged (Cryer, 2007). Example of a snack is peanut butter sandwich. Honey and glucose gel also help in increasing blood glucose levels. The patient should also get enough meals because the drugs would be too intense if a good nutrition is not available (Flegg, 2005).
Conclusion
In the course of the four hours, it is evident that the patient’s condition has improved and further tests will later be conducted to confirm his progress. Hypoglycaemia is a disease most common with diabetic patients. It is very rare to non-diabetics. The patients should be educated on how to prevent a recurrence of hypoglycaemia. This includes insulin therapy, exercises, and oral treatment administration. Not skipping of meals and eating before exercises is critical for patients undergoing medication. They should be advised on correct steps to follow in case of a missed dose. Those patients with diabetes should also learn the symptoms and signs of Hypoglycaemia.
Recommendation
Hypoglycaemia may be caused by physical activity thus; medication should be adjusted before any exercise. The patient should take a snack if the blood glucose is below 100mg/dl before any exercise (Saxena et al., 2010). There are also glucose injections called glucagon for those with severe hypoglycaemia. Glucagon is a hormone that opposes the consequences of insulin causing discharge of glucose in the blood system. It increases glucose by 30-100 mg/dl in minutes. There is a glucagon urgent situation kit with 1mg to be mixed 1 ml of sterile water included in the kit as doses for adults. When injected deep into the muscle, absorption and healing is hastened. Its side effects can comprise of headaches and nausea (Elsborg et al., 2011). After looking at the patient’s pathophysiology, it is recommended that patients suffering from diabetes should enquire whether their prescriptions could lead to hypoglycaemia depending on their glucose levels. The time to take the prescriptions should also be followed strictly. The quantity of the drugs should be followed to avoid inconsistency in the blood system. Patients should also inquire whether they should be taking their medications when suffering from other ailments and what to do in case a meal is skipped.
References
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