time untill braindamage/death with hypoglycemic coma

[stormwatchtoo]

Hi everyone,

I am caretaker of a child with diabetes who regularly is hyper, and less regularly, hypoglycemic.  
I have a question that no one has really answered yet...
How long 'till there is braindamage/death when entering hypoglycemic coma?

I realize everyone is different, but would like an answer anyway...

stormwatchtoo

[JDRF-Team-ES]

I am sorry.  I really don't know the answer to that and I am not sure anyone does. The best bet is to try and catch those hypoglycemic events as quickly as possible so that the child does not go into a coma.  Every low blood sugar does not lead to a coma,  Frequent blood testing should help prevent serious low blood sugars.  I don't know how old this child is, but he or she may be able to tell you or give you some clues about how they are feeling that would indicate that their blood sugar is droppinbg or low.  That way you could treat it before there were any serious consequences like coma.  I am sure the family is very appreciative of all your efforts to understand and manage this child's disease.  Thank you for your interest.
Es

[Markie]

Apparently brain damage starts ocurring when the blood sugar drops below 10, which is very low. But the liver usually kicks in and produces glucose before this happens. And it usually causes the blood sugar level to rise substantially.

I have never heard of anyone dying because of a bad hypo. The dangers of hypoglyceamia are often over-dramatised.I wouldn't get too worried if I were you. If she is very active, test her blood sugar every now and again. And avoid high-carb meals.

Cheers,

Mark

[JDRF Team SGG]

Although death is rare from hypoglycemia, it does occasionally happen, and is considered a risk to young children. So I must disagree with the previous responder's comment. And many doctors tell parents of very young children to not attempt to get quite as low of glucose readings as we adults are encouraged to attain because of the risk of brain damage to developing young children. So I personally do not believe that the dangers are over-rated at all. I commend you for caring enough to ask this question.

The previous responder IS correct, however, in stating that the liver will release emergency sugars when the glucose levels drop for an extended length of time. Some diabetics seem to have better responses in the release of liver sugars than others, though, so you should not count on this solving the problem.

Children are more fragile than adults, so take that into consideration, but I would like to tell you a story of a severe hypoglycemic episode that almost killed me as a young adult, and I can tell you how long it took for the situation to become critical. When I was pregnant with my second child, I worked with doctors who were doing some of the cutting-edge diabetic research at the time. They used me as a bit of a test case and deliberately overdosed me on insulin for most of the pregnancy. For a great deal of the 9 months, I was hypoglycemic, and as a result, the warning symptoms of dropping sugar levels vanished. I could be feeling fine one moment and then simply pass out cold with almost no warning. Many times I was brought into the emergency room unconscious and revived with glucose in IV's. In any event, after my son was born, this happened one day at about 11 a.m. -- I passed out and came to on my own (probably due to a release of emergency sugars from the liver) at some point. When I came to, I was not able to get up or speak clearly or even pull myself to a telephone, but could only lie on the floor and hope that someone rescued me. I lay there until about 4 p.m., when my best friend called the house and my little 2 1/2 year old daughter, who was bored, picked up the phone and said, "Mommy is sick on the floor."

My friend knew of the problems with hypoglycemia and called 911 immediately. By the time the EMT squad arrived, my heart was beating irregularly and I was having difficulty breathing. The doctors in the emergency room said that the heart irregularity may have killed me if it had been allowed to continue another half hour or so.

Now, the point of this scary story is that the child is NOT in danger of death immediately. After passing out, I had about 5 hours until my life was in danger. As you can surmise, we can't tell you exactly how long a child would have before the condition became critical, but it isn't immediate. His liver will probably release some sugars, and you have adequate time to get help for him or her.

I have several suggestions:
1. Keep a glucagon kit in your daycare area. The child's parents can get this for you. If the child should ever get so hypoglycemic that he/she cannot swallow liquids (juice) quickly, don't wait for him to pass out, but mix the two vials of the glucagon kit and inject it anywhere under the skin. The child will be markedly better in about 15 minutes after this injection. The child MAY vomit after having glucagon injected, so roll him or her on his or her side. But even if the child is uncconscious, this should bring him back to consciousness within 15 minutes. Then you follow up with some liquid or solid food.

2. Know the symptoms of hypoglycemia VERY WELL so that you recognize them. In small children that I have babysat, we could tell when they were hypo by observing:
a. yawning for no reason
b. the child would complain of being cold or would snuggle in a blanket
c. the child would become very quiet and often would lie down on the carpet or couch (fatigue is a symptom)
d. sometimes the child gets sweaty for no reason
e. the child would get irritable or upset for no reason.

3. When in doubt, TEST the glucose levels. Don't guess -- check to make sure.

If you keep glucagon on hand for any emergency hypoglycemic episode, the child should be fine. The articles I have read about death by hypoglycemia, often called "dead in bed syndrome" because it is thought to be the cause of some young diabetics being found dead in the mornings, probably after suffering night hypoglycemia that didn't wake them, it is very rare. Not impossible, but rare. If the child naps, check his glucose before putting him down. If the child ever spends the night with you, you may want to do a glucose test on him in the middle of the night just to make sure that the levels are OK. The danger to either a child or an adult is when the hypoglycemic episode is not corrected for hours. An episode of a short duration is not a real danger.

This information is written to educate you, not to frighten you. Again, I want to state that severe problems from hypoglycemia are rare. But any hypoglycemic episode needs to be treated as quickly as humanly possible. You needn't fear death or brain damage if you keep a glucagon kit handy at all times. It really is a wonderful safety net.

I wish you and your small charge the very best.

[stay123]

I do not want to scare anyone, but I did feel the need to respond to this thread. A week ago, I lost my 21 yr. old brother to diabetes.  Like the previous poster, my family did not think that death was a real possibility resulting from a hypo episode. The doctors had told us that most likely, adrenaline would kick in and snap him out of it. For some reason, that did not happen this time, and my brother's brain was starved of sugar for too long. The doctors estimated he was low for at least 10 hours (he was in college and his roomates thought he went to work in the morning, when he was actually unconscious in his bed). He was in a coma for two days, but all the tests proved him to be braindead, so we stopped the respirator.
Please, please, please don't ever think that hypo episodes are not a big deal. I am not sure what the "time limit" is that can lead to coma/death, but the doctors told us that when the brain is deprived of sugar, it has the same effects as if it were deprived of oxygen, so the longer it goes on, the worse the outcome will be.

[patty88]

I just lost my younger sister 2 weeks ago.  She didn't show up for work, and by the time her boss notified the family and my sister found her, she was in a coma.  She never revived and we took her off of life support after 9 days.  I believe that she accidentlly took her Lantus to bring down a high blood sugar.  They had trouble in the E.R. bringing her blood sugar  back up.  Since I am also insulin dependent, I was scared into being extremely cautious.  It's good to have a plan with contacts and to be very careful when using large amounts of insulin (especially at night) to bring down a high or to cover a large meal.  It's also very important, if one isn't on the pump, to make sure that the different types of insulin are in completely different and marked containers.  I think if my sister had been on the pump she would be alive today.  She was very active and went low a lot during the night.  I don't want to scare people, but I do want to emphasize how careful they  must be.

[Shan911]

My nephew was diagnosed with congenial hyperinsulism and he has surgery when he was 2 months old to remove 98% of his pancreas.  My sister and her husband both have learning disabilities. Her husbands is not as bad as hers but neither one of them seems to get it.  My brother-in-law works all day and my sister stays home with my nephew.  She doesnt keep her home clean, she's gained almost 100 pounds after she had my nephew. She herself has developed type 2 diabetes even when she had several doctors tell her she was borderline and that she needed to get her weight under control. I pick up my nephew atleast every other weekend if not every weekend.  We check his meter and find that she has yet again not checked his sugar all week long or in the two weeks that we havent seen him.  When he comes to our house my mother and I check his sugar levels and find that his sugar goes down every two hours. We give him breakfast in the morning, check 2hrs later if low then give a snack, then check 2-3 hours later if low give lunch, then 2-3 hours later check again and if low give another snack then he eats dinner and then we feed him hot baby cereal for the night because it seems to hold his sugar levels higher. Well this thursday she had to call 911 b/c his sugar levels were down in the 30's.  When he is at our house we never let it get down past the 70's even though he has been teething and has been fussy so it has sometimes dropped down to the 60's a few times. My mom has made meals to send to their house and snacks, we have suspisions that she or her husband has eaten them instead of giving them to my nephew.  We have told her how important it is that he see's a nutritionist so we can figure out what he needs to be eating and how often. My mom and I have spent countless hours researching online to figure out what to do and then we tell her and she just says she will have to ask her husband and drops the subject. We are afraid that one day he might die, and we will be responsible because we didnt do enough to try to help.  What Im asking is......Do you think that we should call in a neglect report to DCFS? we have tried sitting her down and talking to her...saying that he could get brain damage...coma....death....that she could lose him either thru DCFS of permentatley through death.....but it doesnt seem to be sticking in her head. Today she talked to my mom and she said that he was acting fussy so she went  ahead and checked it.....when i think that it should be apart of her  schedule now that she should know how he is doing before he gets fussy.....but we took him a few days after they had to call 911 and i got up every 2 hours to check it and here is what we got...he had hot cereal, banannas, and whole vitamin d milk before he went to bed sugar levels as follows.....when he went to bed aprrox 1 1/2 hours after being feed....236 two hours later it was 36.....i woke him up gave him some glucose drink that I had picked up that day and got it up to 100 and then we gave him a peanut butter and jelly sandwhich with whole milk and a little bit of cereal he slept 2 hours more and when he got up it was 178........please just tell me if we are making too big of a deal or any of your thoughts....please...we are at a lose .....

[dr_ackula]

Friends.

I am very sorry for those who have lost family members as a result of this sad disease. Please accept my condolences.

I am a 3rd year medical student, I must admit i do not know much ... however, it is a fact that hypoglycemia is more dangerous than  hyperglycemic coma. When sugar storage is ran out, then the body shifts its metabolism of sugar, this causes excessive build up of pruvic acids in the blood. High acidity in the blood affects all kinds of things, not to mention the cellular injury that is produced to all types of cells in the body. Brain is injured specifically.

Even my teacher was not willing to put a time frame down for the max limit... He said 5 min after oxygen deprivation there is brain damage, and from what i know you have a window of 30 minutes in which  you can revive a hypoglycemic person, before brain damage begins to occur.

The longer you leave a person in a comatose state, the deeper the coma will gets and more unlikely is it that they will come out of it again. Since the leison to structure of the brain make it impossible to happen.

So, Please... look after yourself and your loved ones around you.

Sugar which is used to generate energy for the body
Glucagon for storage ...
Oxygen for burning feul of this energy generation mechanism

These are very very important elements of body and I would disagree with our friend above who said that it is not dangerous. It is VERY dangerous.

Time lines:
Resiratory arrest: 3-7 minutes --> leading to perm brain damage.
Glycemic coma: Max 30 minutes before brain tissue damage begins