what a wonderful world: July 2009

chronicals:

1830hrs tgk mak tido dlm bilik, nyenyak then i angkat kain jemur tghr td kat ampaian

1845hrs lalu lagi depan bilik mak, she stil sleep in the same position.. i locked gate rumah call puteh home

1900hrs abah ask me to check on mak.. she's been sleeping since

asar.. and cakap merepek dari jam 5pm

i masuk bilik and touch her.. she sweating.. cold..

1905hrs i check on her glucose, shockly 1.7 mmol/l

immediately i make some sweet black coffee and give some sweets

i mixed some ice dgn air paip, and i lap muka mak and her body.i still keep repeating calling her name.. tp mak mendiamkan diri. kopi yg i bancuh pun mak x telan..

1945hrs i check her BP, 211/105 and again i check her glucose.. nasib baik, ( not really baik )sugar naik 2.1.. naik sikit sangat

2000hrs after talking to abah, we decide to call for an ambulance.

2015hrs ambulance sampai, paramedic do some check up then bawa mak to GH Permaisuri Bainun

2045hrs i follow ambulans dgn keta

2100hrs tiba di GH, doktor kat emergency ward tgh entertain mak.. alhamdulilah mak dah sedar, tp dia masih lg confused kat mana and what had happen to her. x berhenti henti dia tanya abah mana, anak2 lain dah tau ke.. hopefully esok sabtu, ada la mana2 kakak balik tengok mak

2220hrs mak transfer to wad 8A, perempuan kelas III. katil 1.

2330hrs after suapkn mak makan, tukarkn baju dia.. i decide to go home since byk perkakasan mak x dibawa bersama..

0000hrs tiba kat rumah, park je keta, dah terdengar Puteh berbunyi dr dlm rumah..surprisingly abah x kunci pagar.. and pintu rumah..

wonder why.

me : abah x kunci pagar ke

abah : kot depa balik.. ( my sisters ).

me : depa kata nak balik mlm ni ke?

abah : tak

so i pun kunci la pintu..

info on hypoglycemia

what is

Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of blood glucose. The term hypoglycemia literally means "under-sweet blood" (Gr. hypo-, glykys, haima).
Hypoglycemia can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function (neuroglycopenia). Derangements of function can range from dysphoria or "feeling bad" to coma, seizures, and (rarely) permanent brain damage or death. Hypoglycemia can arise from many causes and can occur at any age. It also sometimes occurs at what appears to be random intervals.
The most common forms of moderate and severe hypoglycemia occur as a complication of treatment of diabetes mellitus treated with insulin or less frequently with certain oral medications. Hypoglycemia is usually treated by the ingestion or administration of dextrose, or foods quickly digestible to glucose.
The level of glucose low enough to define hypoglycemia has been a source of controversy in several contexts. For many purposes, plasma glucose levels below 70 mg/dl or 3.9 mmol/L are considered hypoglycemic

Hypoglycemic symptoms and manifestations can be divided into those produced by the counterregulatory hormones (epinephrine/adrenaline and glucagon) triggered by the falling glucose, and the neuroglycopenic effects produced by the reduced brain sugar.

symptom

Adrenergic manifestations
Shakiness, anxiety, nervousness, tremor
Palpitations, tachycardia
Sweating, feeling of warmth
Pallor, coldness, clamminess
Sudden change in colour, pale, green
Dilated pupils (mydriasis)
Feeling of numbness "pins and needles" (parasthaesia) in the fingers

Glucagon manifestations
Hunger, borborygmus
Nausea, vomiting, abdominal discomfort
Headache

Neuroglycopenic manifestations
Abnormal mentation, impaired judgment
Nonspecific dysphoria, anxiety, moodiness, depression, crying
Negativism, irritability, belligerence, combativeness, rage
Personality change, emotional lability
Fatigue, weakness, apathy, lethargy, daydreaming, sleep
Confusion, amnesia, dizziness, delirium
Staring, "glassy" look, blurred vision, double vision
Automatic behavior, also known as automatism
Difficulty speaking, slurred speech
Ataxia, incoordination, sometimes mistaken for "drunkenness"
Focal or general motor deficit, paralysis, hemiparesis
Paresthesia, headache
Stupor, coma, abnormal breathing
Generalized or focal seizures

treatment

Oral intake of glucose
The blood glucose can usually be raised to normal within minutes with 15-20 grams of carbohydrate, although overtreatment should be avoided if at all possible. It can be taken as food or drink if the person is conscious and able to swallow. This amount of carbohydrate is contained in about 3-4 ounces (100-120 ml) of orange, apple, or grape juice, about 4-5 ounces (120-150 ml) of regular (non-diet) soda, about one slice of bread, about 4 crackers, or about 1 serving of most starchy foods. Starch is quickly digested to glucose, but adding fat or protein retards digestion. Composition of the treatment should be considered, as fruit juice is typically higher in fructose which takes the body longer to metabolize than simple dextrose alone. Following treatment, symptoms should begin to improve within 5 to 10 minutes, although full recovery may take 10–20 minutes. It should be noted that over treatment does not speed recovery, and will simply produce hyperglycemia afterwards, which ultimately will need to be corrected.

Intravenous glucose
If a person cannot receive oral glucose gel or tablets, such as the case with unconsciousness, seizures, or altered mental status, then emergency personal (EMTs/Paramedics and in-hospital personnel) can establish a peripheral or central IV line and administer a solution containing dextrose and saline. These are normally referred to as Dextrose (Concentration) Water, and come in 5%, 10%, 25% and 50%. Dextrose 5% and 10% come in IV bag and syringe form, and are mainly used in infants and to provide a fluid medium for medications. D10W is given at a 2cc/kg rate for Neonates and Infants. Dextrose 25% is given in children under the age of 8, and Dextrose 50% is given in adults. The Dosage for D50W is one half of the ampule, with verification of IV patency after the half of the amp is given, and a recheck of blood glucose levels before administering the other half. Dextrose 25% and 50% are heavily necrotic due to their hyperosmolarity, and should only be given through a patent IV line - Any infiltration can cause massive tissue necrosis.

Glucagon
Glucagon is a hormone that rapidly counters the metabolic effects of insulin in the liver, causing glycogenolysis and release of glucose into the blood. It can raise the glucose by 30-100 mg/dl within minutes in any form of hypoglycemia caused by insulin excess (including all types of diabetic hypoglycemia). It comes in a glucagon emergency rescue kit which includes tiny vials containing 1 mg, which is a standard adult dose. The glucagon in the vial is a lyophilized pellet, which must be reconstituted with 1 ml of sterile water, included in the "kit". In the widely used Lilly Emergency Kit, the water is contained in a syringe with a large needle for intramuscular injection and must be injected into the vial with the pellet of glucagon before being injected. Glucagon works if given subcutaneously, but absorption and recovery are faster if it is injected deep into a muscle (usually the middle of the outside of the thigh). It has an even more rapid effect when given intravenously but this is rarely practicable. Side effects of glucagon can include nausea and headache, but these can also occur after severe hypoglycemia even when glucagon is not used. Risks of glucagon use are far lower than risks of severe hypoglycemia, and it can usually produce a faster recovery than calling for paramedics and waiting for them to start an intravenous line to give dextrose. If someone uses this kit, they should be seen in an emergency room, as glucagon depletes glycogen stores, and can lead to a deadly rebound hypoglycemia.
In the United States, normal use of this kit in the out-of-hospital setting is restricted to EMS units carrying paramedics (EMTs in some states can use glucagon, but most require very specific training to do so).