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Suggest Treatment For Anxiety Along With Pins And Needles In A Diabetic

Posted on Thu, 29 Oct 2015

Question: Hi;
My friend is very frightened. He is 64, grossly overweight, diabetic, has asceities, and out in the boonies of Panama.
Hi does not take his meds as regularly as he should.
Immediate symptoms are very hot head, pins and needles all over and of course anxiety.
I asked his assistant to give him a Gabapentin pill and chew an aspirin.
He is an hour from competent medical care. He has just suffered a bad business betrayal yesterday.
I don't know if his blood sugar is high or low, as he lost his meter, he usually takes 15cc insulin morning and night. don't know if he has today.
Any guess if this is a diabetic episode, stress or heart attach? Remember, he's out of the country and we're anonymous but looking for a direction to run..
Thanks

Answered by Dr. Dr. Muhammad Sareer Khalil (47 minutes later)

Brief Answer:
Explained in detail

Detailed Answer:
Hello and Welcome

I appreciate your concern

The main emergent factor that is commonly encountered in diabetics is hypoglycemia. With no emergent care available at present even if he is diabetic , hypoglycemia should be treated as with further hyperglycemia, the damage wont be as bad as with hypoglycemia. If his oral intake is intact then some sweet or plain sugar drinks can be given. Emergency room transfer should be done. Meanwhile, his airway should be cleared especially if there is altered consciousness. ECG, Blood counts and a comprehensive metabolic panel should be done after resuscitation of the patient based on his clinical findings and vitals. Once the patient undergoes this workup, one can be more sure about the cause. If there is high grade fever and a raised TLC count then antibiotics should be administered after taking blood and urine cultures. If upon presentation the patient is dehydrated then IV fluids would be required. If there are ECG changes that indicate an MI then a cardiology critical care unit transfer should be done. If the blood sugar is markedly raised then insulin-regular, fluids and electrolyte balance maintenance would be the priority.

Let me know if you have any query

Wishing you best of health

Thanks

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Dr. M.S. Khalil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (30 minutes later)

Thank you for quick response.
Came to find out he had far too much to drink last night and often becomes a drama queen after such an episode.

My question is an academic one;
After the ingestion of an excess of sugar (alcohol), once metabolized, even by a badly damaged liver, would be expected to be a trigger to a relative hypoglycemic episode.
Is my reasoning logical?

Answered by Dr. Dr. Muhammad Sareer Khalil (18 minutes later)

Brief Answer:
Explained

Detailed Answer:
Hello again.

Yes, Alcohol intoxication can lead to hypoglycemia. Liver function tests including the PT and ALT should be looked for. Dextrose, Thiamine and naloxone should be administered in alcoholic patient presenting with confusion.

Thanks

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar