Diabetes Coma and Precoma Unconscious Senseless, iNitrogen Narcosis

Nitrogen in Diabetic Coma and Pre-Coma:- Why Diabetic Individuals Become Senseless?

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CONTEXT

We recently had the opportunity to take a look into a very surprising case of a diabetic individual, who recovered from COVID a week before the event. One night he took his diner and the usual insulin dose of 12 units. He did not wake up from sleep for three days. After waking up, he had no idea of what happened in the last 72 hours. Doctors couldn’t answer why it happened.

He took our consultancy to understand what had happened. This was quite a challenging case, as the hospital discharge document had not many details of any of his monitoring parameters.

SENSELESSNESS

We had to dig deep into the pathogenesis of SENSELESSNESS and if there was any group where this phenomenon was common.

Turns out, that a lot of Scuba Divers die every year, becoming senseless while diving.

Nitrogen Narcosis

WHY?

When the environmental pressure suddenly changes in the body due to heavy depth and water pressure, the No2 atoms get broken and Nitrogen gets deposited in Brain Neurons, causing an effect like Alcohol consumption, confusing the divers.

This is called 💡Nitrogen narcosis

BLOOD UREA NITROGEN(BUN)

Urea nitrogen(BUN) is a normal waste product that your body creates after you eat. Your liver breaks down the proteins in your food — and while it does that, it creates blood urea nitrogen, also known as BUN. Your liver releases the substance into the blood, and it eventually ends up in your kidneys.

BUN and SUGAR

In Hypoglycemia (low sugar), just like Hyperglycemia, more Nitrogen is broken as BUN increases.

INSULIN and HYPOGLYCEMIA

Insulin has two categories:- fast actions, slow action. Often clinicians prescribe insulin dosage in balance. In the early morning, our parasympathetic system gets activated, spectating more insulin. Insulin doesn’t have any negative feedback loop. So, insulin secretes whether or not there is external insulin.

If long-term insulin was taken in the night, insulin increase in the body(because there is already excess insulin) causing Hypoglycemia(now a common prevalence in India). Under Hypoglycemia, the Ammonia ions get broken and Nitrogen is released into the blood. It is like an air bubble in the fluid, which then traverses to the brain and gets deposited there.

DIABETIC COMA

The body metabolizes Nitric Oxide(NO), at night. NO is an important component in Endothelial cell elasticity. Insulin imbalance in the cells causes erratic differential pressure in the body, just like Scuba Divers.

So, more Nitrogen is broken, and they rush to the brain and get deposited there. So, the patients get unconscious and have Diabetic Coma.

CONCLUSION

The arterial stiffness resultant from NO impaired Vasoconstriction is one of the prime reasons, why a lot of diabetes patients have their heart attacks at the night. As the brain is intoxicated, in most cases the patients don’t feel any pain(Silent Heart Atack).

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Rupam Das

Passionate, Accountable Student for Life

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