Something strange happened tonight while I was visiting my uncle at his home. He is a diabetic, and had neglected to eat at all today (d’oh). I was in the living room watching tv, and he was in the bathroom doing some work. My son came in the room and told me that my uncle was passed out on the floor, so I went in there and I was able to rouse him somewhat, but he seemed very lethargic and said that he was really hot. I grabbed his Accucheck machine and checked his blood sugar, and it was 253. I got him up off the floor and onto his bed, and he asked me to get his insulin and give him a shot, so I gave him 50 units. He napped for 30 minutes or so, then got up, vomited, ate dinner, and now seems fine, except that he has a chill.
He said that he was working in the bathroom, and suddenly felt very tired and hot, and felt his heart racing and then slowing way down, and that’s when he passed out. Yesterday he had an MRI with contrast medium, and he thinks that has something to do with it, but I’m not sure about that.
Imagine you have a car with a full tank of gas, but a constriction in the fuel line makes it sputter.
This is what diabetes is like. Diabetics have all this sugar (=energy) in their bloodstream but their body cannot make any use of it. If unchecked, their body starts shutting down (become lethargic) until they fall into coma and die.
Being a diabetic means that you must follow a certain schedule religiously. You have to do regular blood tests with the Accucheck, eat certain foods at certain times, take your insulin at certain times and keep a logbook.
Your uncle missed a meal, which for a diabetic is enough to throw blood sugar levels out of whack (too high or too low), and maybe he missed his insulin injection. Make sure that he keeps up with his schedule.
Did your uncle skip his insulin because he didn’t eat?
Is he on Metformin?
Why did he have the MRI done?
Just one chill or multiple w/ fevers?
Has this ever happened to him before?
Was he doing anything particularly strenuous when the incident happened (like lifting something heavy)? Did he cough, defecate or urinate shortly before the incident?
Is 50u his regular dose? What type of insulin was it?
What do his blood sugars normally run?
My thoughts are that this might possibly be because of hyperglycemia, and I would continue to watch him for more nausea/vomiting or increased urination which may indicate a serious condition called diabetic ketoacidosis, although I think this is unlikely. I don’t know that loss of consciousness is common in an acute spike of blood sugar, although I could be wrong (and if I am please correct me!).
My other thoughts are that his passing out could be due to increased vagal tone, which long story short, can cause a loss of consciousness: you can read more here Reflex syncope - Wikipedia. The fatigue/hot sensation seems more vagal to me, and if he can point to a specific trigger I think this is also likely.
Finally, if he is on metformin and received contrast, then he could have some acute renal failure, which could lead to an electrolyte imbalance (most notably increased potassium), which could cause a cardiac arrhythmia, which could cause syncope (very unlikely because most places are extremely vigilant about giving contrast to people on metformin).
Here’s hoping he continues to do well and this is just an isolated incident.