# first diabetic seizure/D50 experience



## LucidResq (Jul 15, 2008)

I was riding with the FD today when we got a call for an unconscious party. 

Came to a guy laid out completely postictal in his backyard - unresponsive, foaming at the mouth, snoring, etc. Wife said he's diabetic and had been having trouble with his levels lately, and his BGL was extremely low so the medic I was with pushed some D50. 

Within 2 minutes the man was coming to, looking around and talking. Within 5-10 minutes he was a little tired but completely oriented, coherent, and normal. 

It was just really cool to witness how fast he turned around with a little sugar. I've heard about it before but to actually witness it was really neat. It made my day.


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## firecoins (Jul 15, 2008)

diabetic coma sounds more like it.


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## LucidResq (Jul 15, 2008)

Yeah that would be more accurate. The wife did describe convulsions that occurred PTA, but he was definitely way out.


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## mycrofft (Jul 15, 2008)

*Hyperglycemia doesn't cause seizures*

but never forget potential for underlying seizure disorder! And glucose would not have wakened him...although a needle stick might.

yeah, one of our little magic tricks, along with IV nifedipine titrated to EKGpulse):///////////////..//..//..//..//..

And ammonia poppers.


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## mikeylikesit (Jul 16, 2008)

it is really hard for me to handle diabetic patients that are in a coma. since i am diabetic and i have gotten that low before it always gives me a slight case of conversion disorder...then i go and check my sugar and I'm fine(after the call or while I'm awaiting the D-50 to kick)


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## Medic9 (Jul 16, 2008)

I love to see a patient after you give them D-50. They ask who you are, why you are there etc. The family thinks you are a miracle worker and can't thank you enough. Those are the calls that make me remember I can make a difference.


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## Ridryder911 (Jul 17, 2008)

C'mon Gang! Looks like it is time everyone might want to review endocrinology. 



firecoins said:


> diabetic coma sounds more like it.


Uhh.. Diabetic coma? Me thinks *NOT!*

Diabetic Coma is caused by *HYPER*glycemia, you mean *Insulin Shock*... right? 


And yes, HYPERglycemia CAN cause seizures. Remember, CSF is a major buffer of pH as well as hyperglycemia can cause K+, Na+. Cl- shifts causing irritability and SEIZURES. Ever witnessed Dialysis seizures? 

R/r 911


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## firecoins (Jul 17, 2008)

Ridryder911 said:


> C'mon Gang! Looks like it is time everyone might want to review endocrinology.
> 
> 
> Uhh.. Diabetic coma? Me thinks *NOT!*
> ...




your right


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## mikeylikesit (Jul 17, 2008)

Ridryder911 said:


> C'mon Gang! Looks like it is time everyone might want to review endocrinology.
> 
> 
> Uhh.. Diabetic coma? Me thinks *NOT!*
> ...


 Depend how low the BS gets and how long it stays that way. if the BS is around something that i have heard of as 18 mg/dl. then the patient can go into a coma due to lack of nutrients to the brain and other vital organs. however most diabetics that experience this have depleted glycogen reserves and are incapable of rebounding on their own so the body just stands idly by while it slips away.


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## Ridryder911 (Jul 17, 2008)

mikeylikesit said:


> Depend how low the BS gets and how long it stays that way. if the BS is around something that i have heard of as 18 mg/dl. then the patient can go into a coma due to lack of nutrients to the brain and other vital organs. however most diabetics that experience this have depleted glycogen reserves and are incapable of rebounding on their own so the body just stands idly by while it slips away.



Still not considered a "Diabetic Coma".. It may produce a coma state or unresponsive but the common definition is r/t hyperglycemia. Again, as you well know is associated over a period of time usually r/t infection, n & V, diarrhea, etc... Causing excessive metabolism of utilizing the fat (ketones) in reserve... thus the pH level is altered. The unresponsiveness is usually associated with other factors causing the LOC change, not always directly to the glucose level. 

R/r 911


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## Hastings (Jul 17, 2008)

Anyway, yeah, it's neat seeing diabetics come around. It's often a slow, confused thing for most patients here, but my last one was an elderly guy who went from completely unresponsive on the floor to standing up and walking to the ambulance IMMEDIATELY after giving D50. I mean, this guy reacted so quickly that he was AAOx3 before all the Dextrose was even given. I like that.


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## VentMedic (Jul 17, 2008)

Hastings said:


> Anyway, yeah, it's neat seeing diabetics come around. It's often a slow, confused thing for most patients here, but my last one was an elderly guy who went from completely unresponsive on the floor to standing up and walking to the ambulance IMMEDIATELY after giving D50. I mean, this guy reacted so quickly that he was AAOx3 before all the Dextrose was even given. I like that.



What was the guy's lactate level at the hospital?   Too often the elderly diabetic gets into glucose problems when they are at the threshold of sepsis or some other serious problem.


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## Hastings (Jul 18, 2008)

VentMedic said:


> What was the guy's lactate level at the hospital?   Too often the elderly diabetic gets into glucose problems when they are at the threshold of sepsis or some other serious problem.



New insulin pump. We turned it off, gave the D50, and he was ready to run a marathon.


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