Dr. Peter Gott offers sound medical answers to reader questions in the new Lifestyles section...
Dr. Beach,
I work in a local emergency department. As a new medical technician, I assist with patients with various issues concerning their diabetes. I always mean to ask them but it seems we never get a chance, what does it feel like to have a low or high sugar? Why does it seem that they act so goofy sometimes or extremely ill at others? Also, when their sugar is low and we take care of them, it seems they often go in the other direction. Is that good?
Thankfully,
C.S.
Dear C.S.:
Patients will frequently ask me what it feels like to have blood sugars at the extreme levels. Sometimes they are nervous, but most often they just want to be prepared. To answer the first part of your question, we will explore both low- and high-blood sugars. The easiest way to understand low-blood sugar is to think about it in terms of alcohol. When the blood sugar is low, the brain is starving and not acting appropriately, much like an intoxicated person. These folks are often confused or combative and lose physical coordination. Typically, the symptoms begin mildly and accelerate into the full-blown insulin reaction. Unfortunately, if not treated, these patients can have seizures and become fairly ill. It is important to remember that these patients are not intoxicated and have an easily treated medical problem. The severity of their response is dependent on many factors, but is closely related to how quickly their sugar is dropping. For the most part, unless a patient is in a dangerous environment or intoxicated, people do not die from low-blood sugars. However, you can imagine the potential hazards if a patient is driving a car, climbing stairs or in another dangerous scenario.
High-blood sugars tend to be closer to the hangover. These patients will be extremely thirsty and urinate frequently. Often, they feel generally ill and have headaches. As their symptoms progress, nausea and vomiting become a serious issue. Depending on the type of diabetes and cause of the high sugar, things can progress to dehydration and diabetic keto-acidosis. This condition results from the cells of the body starving and breaking down fat in the body for energy. One of the by-products of fat breakdown is acid. With dehydration and acid buildup, the electrolytes become disrupted and the patient will become critically ill and can die. Prior to the discovery of insulin in 1921, this was the cause of death for anyone diagnosed with type 1 diabetes. Unfortunately, this is still a significant problem for patients with diabetes, and many people end up in the intensive-care unit or even die.
When a person has a significantly low-blood sugar and requires assistance, it is important to make efforts to not over treat and cause a higher sugar. The wide variation in blood sugars is stressful to the body and can make control very difficult for the patient. Imagine a patient with a blood sugar of 25, then by the time he or she gets medical attention and leaves the emergency department, their blood sugar is over 400. This makes the patient feel ill and complicates care further. This same patient may try to correct his or her sugar and worsen the condition. The recommended care for low-blood sugar is about 15 grams of carbohydrates, wait and re-check the sugar in 15 minutes, and then repeat if necessary. This therapy will enable a patient to recover from the low sugar without moving to the other extreme.
This was an excellent question, and your attempts at empathy for the people you care for should be commended. Good luck!
Dr. Jonathan Beach, who has lived with diabetes himself since age 4, heads the Northeast Center for Diabetes Care and Education at Urgicare of the Northeast in Plattsburgh. Send questions to him for this column, which runs the second Tuesday of every month, to: The Northeast Center for Diabetes Care and Education, 79 Hammond Lane, Suite #2, Plattsburgh, NY 12901 or diabetescenter@urgicarenortheast.com
