Side effects of diabetic coma?
December 29, 2011 11:30 AM Subscribe
Please can anyone offer advice / guidance on what appear to be mild side effects following a diabetic coma?
Background
My Dad is 77 and has been a type 2 diabetic for about 40 or so years. He has managed really well for most of that time. He went onto one shot of slow-acting insulin once a day a few years ago, and has managed to keep a very tight control on his blood sugar - with the exception of a few problems with his eyes, he's in remarkably good shape for a man of his age and with his background health issues (also has high blood pressure, high cholesterol - all pretty much controlled).
Incident
We have a family tradition of meeting up for a breakfast on Xmas Eve, in a local cafe or restaurant. Dad is ALWAYS first there. You can probably guess the rest. No Dad, trip to his house (Mum died 6 years ago), brother breaks front door down, Dad is unconscious in bed. I am also a diabetic and know what a hypo looks like. So paramedics were called (and were wonderful and reassuring), gave him a shot of what I assume to be glucagon, said "He'll come round in about 30 minutes" (which he did), off to hospital for checks, sent home to stay with brother for Xmas.
To the best of our ability to work it out, he was potentially unconscious for maybe two and a half hours. My SiL spoke to him last at about 8.15am, we were due to meet at 9.30am and we ended up finding him at about 10.15am. He was spark out, sweaty and groaning a bit when we found him.
Hospital doctors did some basic tests of his neurological functions (raise and lower legs, touch fingers to noses, follow Dr's finger with eyes, something involving touching palm and back of hand onto other palm. He seemed to do OK, except I noticed his left hand responses weren't quite as accurate as RH ones (he's not got the best eyesight but even so ...). One doctor wanted to do a CT scan but was overruled by a more senior colleague - who said effects were due to the hypo. No mention was made of any neurological follow-ups. He's already got an appointment at his diabetic clinic in a week or so.
The Question
Dad is a great talker and a bright man. I have noticed since the events of Xmas Eve that his speech has been very slightly slurred - obviously during the first day it was very noticeable, now my husband says he can't really tell. I can, though. Dad said he is finding he's occasionally forgetting some names (he already did this though) but that he feels his speech is pretty normal and although he said at first he found he was umming and erring a bit, he feels his speech is as fast as it was. Again, it's pretty much normal, but I think it might be a bit slower than usual. In terms of his intelligence and ability to hold his train of thought and an arguement, there really doesn't seem to be a difference.
I know you are not my doctor etc. I am just anxious to know if anyone has had a friend, relative or partner go through something similar, be unconscious for a similar length of time due to low blood sugar, suffer some side effects ... and then what? As I said, Google is confusing the hell out of me - I know it's lack of glucose to the brain that causes the problems but there's a lot of talk of repeated severe hypos causing long-term brain damage and not much on what a single espisode of this nature might do.
tl:dr - apparently mild side effects due to hypoglycemia-based unconsciousness - prognosis, duration, resolution?? Any anecdata you can share?
Background
My Dad is 77 and has been a type 2 diabetic for about 40 or so years. He has managed really well for most of that time. He went onto one shot of slow-acting insulin once a day a few years ago, and has managed to keep a very tight control on his blood sugar - with the exception of a few problems with his eyes, he's in remarkably good shape for a man of his age and with his background health issues (also has high blood pressure, high cholesterol - all pretty much controlled).
Incident
We have a family tradition of meeting up for a breakfast on Xmas Eve, in a local cafe or restaurant. Dad is ALWAYS first there. You can probably guess the rest. No Dad, trip to his house (Mum died 6 years ago), brother breaks front door down, Dad is unconscious in bed. I am also a diabetic and know what a hypo looks like. So paramedics were called (and were wonderful and reassuring), gave him a shot of what I assume to be glucagon, said "He'll come round in about 30 minutes" (which he did), off to hospital for checks, sent home to stay with brother for Xmas.
To the best of our ability to work it out, he was potentially unconscious for maybe two and a half hours. My SiL spoke to him last at about 8.15am, we were due to meet at 9.30am and we ended up finding him at about 10.15am. He was spark out, sweaty and groaning a bit when we found him.
Hospital doctors did some basic tests of his neurological functions (raise and lower legs, touch fingers to noses, follow Dr's finger with eyes, something involving touching palm and back of hand onto other palm. He seemed to do OK, except I noticed his left hand responses weren't quite as accurate as RH ones (he's not got the best eyesight but even so ...). One doctor wanted to do a CT scan but was overruled by a more senior colleague - who said effects were due to the hypo. No mention was made of any neurological follow-ups. He's already got an appointment at his diabetic clinic in a week or so.
The Question
Dad is a great talker and a bright man. I have noticed since the events of Xmas Eve that his speech has been very slightly slurred - obviously during the first day it was very noticeable, now my husband says he can't really tell. I can, though. Dad said he is finding he's occasionally forgetting some names (he already did this though) but that he feels his speech is pretty normal and although he said at first he found he was umming and erring a bit, he feels his speech is as fast as it was. Again, it's pretty much normal, but I think it might be a bit slower than usual. In terms of his intelligence and ability to hold his train of thought and an arguement, there really doesn't seem to be a difference.
I know you are not my doctor etc. I am just anxious to know if anyone has had a friend, relative or partner go through something similar, be unconscious for a similar length of time due to low blood sugar, suffer some side effects ... and then what? As I said, Google is confusing the hell out of me - I know it's lack of glucose to the brain that causes the problems but there's a lot of talk of repeated severe hypos causing long-term brain damage and not much on what a single espisode of this nature might do.
tl:dr - apparently mild side effects due to hypoglycemia-based unconsciousness - prognosis, duration, resolution?? Any anecdata you can share?
Hypoglycemia is well known in the medical world to cause symptoms that can appear to be of a stroke - slurred speech, etc. But these symptoms typically resolve when the blood sugar has been treated (either immediately or soon after). So why would your dad have stroke-like symptoms after having hypoglycemia that resolved? Well, there are a few possibilities - what if he had a mild stroke beforehand, and became confused, and that caused him to mis-dose his insulin, and that was what led to the hypoglycemia? I mean, to me the question is - why did he go hypoglycemic? He's been on the same regimen for years without a problem. He either didn't eat or had vomiting/diarrhea/other illness and used insulin on top of that, or he used too much insulin... (or perhaps his body's need for insulin just changed, but if he hasn't changed his dose since then, that doesn't seem likely). Anyway, that's all just theoretical, but I just thought I'd bring up the possibility that something happened to the chicken before it laid the egg...
I'm an emergency doc and not too familiar with chronic complications of illness, but I did find this note on WebMD: "Prolonged severe hypoglycemia can cause irreversible brain damage..." as well as a similar one on the Merck Manual website. Can't find the citation for these statements at the moment.
Bottom line is that I agree with elizeh that it's very worth seeing the primary care doctor soon about. IANY (or his) D, of course.
posted by treehorn+bunny at 11:24 PM on December 29, 2011
I'm an emergency doc and not too familiar with chronic complications of illness, but I did find this note on WebMD: "Prolonged severe hypoglycemia can cause irreversible brain damage..." as well as a similar one on the Merck Manual website. Can't find the citation for these statements at the moment.
Bottom line is that I agree with elizeh that it's very worth seeing the primary care doctor soon about. IANY (or his) D, of course.
posted by treehorn+bunny at 11:24 PM on December 29, 2011
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posted by elizeh at 3:10 PM on December 29, 2011 [2 favorites]