Diabetic shock.

Abstract

I N RELATING DIABETIC shock to the general medical topic of shock, we must clarify our terms. In a dictionary sense,. s~ock is a sudde~ vital depression due to an injury or an emotion. In ordinary discussions one usually thinks of insulin shock, the condition resulting from overdosage of insulin, as diabetic shock. In the following discussion, however, the several forms of sudden vital depression commonly seen in diabetic patients will be reviewed. There are five subdivisions of this subject. There is insulin shock, diabetic ketosis, hyperosmolar coma, lactic acidosis coma, and lastly the forms of shock seen in other patients. Hyperosmolar coma and lactic acidosis coma are quite unusual. Their diagnosis and management are highly specialized procedures and need not be discussed here. We come to the two specific cases of insulin shock and diabetic ketosis. Both stem from the chemistry of this disease and are at opposite poles. Lack of insulin, excessive stress from em.otions, illness or injury cause ketosis. It could be a first symptom in young diabetics. It is slowly progressive, with premonitory symptoms of weakness, nausea, polyuria and polydipsia. This is stressed because the necessity for treatment can usually be recognized before coma sets in and should be initiated before coma is actual. In insulin shock, quite the reverse occurs when the dose of insulin is excessive, if the patient exercises unduly or if a meal is postponed. Treatment of the latter requires immediate carbohydrate intake such as orange juice, sugar cubes, sweet soda or candy. Those patients controlled on oral drugs rather than insulin can develop a similar low blood sugar, though this is rather uncommon. Ketosis develops from too little insulin. This may be from skipped dosage, emotional stress OT an associated illness. It may also supervene in a previously unrecognized diabetic. Glucose builds up in the body. There is no insulin to help burn it up. The body burns its fat stores. Acetone and acid products are accumulated causing excessive urination and dehydration, with nausea and poor appetite before actual coma occurs. As stated previously, this builds up in five to twenty-four hours. Insulin shock is usually more sudden. The cardinal symptoms of insulin shock may be