Healthy- Treating Uncontrolled Diabetes

In severe uncontrolled diabetes cases where the initial blood glucose level exceeds 500 milligram percent and there is marked ketosis (overproduction of ketones) and acidosis (abnormal increase in blood acidity), much greater insulin resistance is likely. Blood samples for analysis to assist ongoing management of the severe uncontrolled diabetes may be withdrawn through infusion every hour.

In severe uncontrolled diabetes cases, 50 units of soluble insulin should be given intramuscularly (in muscle) every half hour until there is a fall of the blood glucose level to below 3oo milligram percent. This indicates that glucose and potassium are passing into the cells and that carbohydrate is being metabolized. Further insulin requirements should be decided in the light of blood and urinary glucose levels. It must be appreciated that insulin will continue to be required for normal metabolism after the crisis has passed. It should be prescribed as two or more doses of soluble insulin daily. If the blood deficiency levels show evidence of deficiency, then a supplement must be added to the infusion.

In mild cases of severe uncontrolled diabetes, potassium may be given by mouth four gram potassium chloride in 200 ml. water every four hours. As soon as the diabetic patient can swallow, good natural sources are fresh orange juice, tomatoes and horlicks and as the crisis lessens, clinical examination should be repeated. Undetected infection must be suspected if the diabetic patient fails to respond in four to six hours.

Diabetic coma which is a severe uncontrolled diabetes state occurs in elderly often obese subjects, more frequently females than males. It is of insidious onset, and usually presents as disordered consciousness ranging from mild confusion to deep coma. Focal neurological signs may develop and epilepsy has been recorded. The outstanding features on clinical examination are deranged consciousness, dehydration and the absence of ketosis. The patients may be covered with a uraemic frost.

When the diagnosis is suspected, it may be confirmed by measuring the blood sugar level, which is always greatly raised. Treatment consists of correcting the dehydration. The repair fluid of choice is 0.5 normal sodium chloride supplemented with water by mouth or naso-gastric drip (through nose to stomach).

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