Diabetic coma

Definition
A coma is a state of unconsciousness. A diabetic coma is a life-threatening
diabetes complication.
If you have diabetes, dangerously high blood sugar (hyperglycemia) or
dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. If you
lapse into a diabetic coma, you're alive — but you can't awaken or respond
purposefully to sights, sounds or other types of stimulation. Left untreated, a
diabetic coma can be fatal.
The prospect of a diabetic coma is scary, but there's good news. The risk of a
diabetic coma is small — and prevention is in your hands. Start by following your
diabetes treatment plan.
Symptoms
A diabetic coma doesn't strike out of the blue. You'll first experience signs and
symptoms of high blood sugar or low blood sugar.
High blood sugar
If your blood sugar level is too high, you may experience:
■ Increased thirst
■ Frequent urination
■ Dry mouth
■ Nausea
■ Vomiting
■ Shortness of breath
Low blood sugar
If your blood sugar level is too low, you may feel:
■ Shaky or nervous
■ Tired
■ Sweaty
■ Hungry
■ Irritable
■ Confused
Causes
Prolonged blood sugar extremes — blood sugar that's either too high or too low
for too long — may cause various conditions, all of which can lead to a diabetic
coma.
Diabetic ketoacidosis. If your muscle cells become starved for energy,
your body may respond by breaking down fat stores. This process forms
toxic acids known as ketones. Left untreated, diabetic ketoacidosis can
lead to a diabetic coma. Diabetic ketoacidosis is most common in people
who have type 1 diabetes, but it can also affect people who have type 2
diabetes or gestational diabetes.
■Diabetic hyperosmolar syndrome. If your blood sugar level tops 600
milligrams per deciliter (mg/dL), or 33 millimoles per liter (mmol/L), the
condition is known as diabetic hyperosmolar syndrome. When your blood
sugar gets this high, your blood becomes thick and syrupy. The excess
sugar passes from your blood into your urine, which triggers a filtering
process that draws tremendous amounts of fluid from your body. Left
untreated, diabetic hyperosmolar syndrome can cause life-threatening
dehydration and loss of consciousness. Diabetic hyperosmolar syndrome is
most common in older adults who have type 2 diabetes.
■Hypoglycemia. Your brain needs glucose to function. In severe cases, low
blood sugar may cause you to pass out. Hypoglycemia is most common in
people who take too much insulin or skip meals or snacks. Exercising too
vigorously or drinking too much alcohol can have the same effect. How
quickly your blood sugar drops influences the symptoms of hypoglycemia.
For example, if it takes a few hours for your blood sugar to drop 50 mg/dL
(3 mmol/L), the symptoms may be minimal. If your blood sugar drops the
same amount in a few minutes, the symptoms will be more pronounced
Risk factors
Anyone who has diabetes is at risk of a diabetic coma. Risk factors for the
conditions that may lead to a diabetic coma vary, however.
For example, diabetic ketoacidosis is most common in people who have type 1
diabetes. Diabetic hyperosmolar syndrome is most common in older adults who
have type 2 diabetes — especially those who don't monitor their blood sugar or
who don't know they have diabetes.
When to seek medical advice
A diabetic coma is a medical emergency. If you pass out, you'll need someone to
request emergency medical help.
Tests and diagnosis
If you experience a diabetic coma, prompt diagnosis is essential. The emergency
medical team will do a physical exam and may ask those who are with you about
your medical history.
You may need various lab tests as well. The doctor may measure:
Your
 ■ blood sugar level
■ Your ketone level The amount of nitrogen or creatinine (a breakdown product of creatine, an
important part of muscle) in your blood
■ The proportion of red blood cells and fluid in your blood (hematocrit)
■ The amount of potassium in your blood
Complications
Left untreated, a diabetic coma can lead to permanent brain damage. In some
cases, an untreated diabetic coma can be fatal.
Treatments and drugs
Emergency treatment for a diabetic coma depends on whether your blood sugar
level is too high or too low.
If your blood sugar level is too high, you may be given intravenous fluids to
restore water to your tissues. You may need potassium, sodium or chlorine
supplements to help your cells function correctly. When enough fluid has been
replaced, short-acting insulin may be used to help your tissues absorb glucose
again. Any underlying infections will be treated as well
If your blood sugar level is too low, you may be given an injection of the hormone
glucagon. The injection will cause your blood sugar level to quickly rise.
Consciousness typically returns when blood sugar reaches a normal level.
Prevention
Good day-to-day control of your diabetes can help you prevent a diabetic coma.
Keep these tips in mind:
Follow your meal plan. Consistent snacks and meals can help you control
your blood sugar level.
■Keep an eye on your blood sugar level. Frequent blood sugar tests can
tell you whether you're keeping your blood sugar level in your target range
— and alert you to dangerous highs or lows.
■Take your medication as directed. If you have frequent episodes of high
or low blood sugar, your doctor may adjust the dosage or timing of your
medication. Your doctor may recommend regular glycated hemoglobin
tests to determine how well you're managing your blood sugar.
■Educate your loved ones, friends and co-workers. Teach loved ones
and other close contacts how to recognize early signs and symptoms of
blood sugar extremes — and how to summon emergency help should you
pass out.
■Wear a medical ID bracelet or necklace. If you're unconscious, the ID
can provide valuable information to your loved ones, co-workers and others
— including emergency personnel.
■Above all, keep your perspective. For most people who have diabetes, the risk of
a diabetic coma is small. Take good care of yourself to help prevent diabetes complications.