Diabetic Coma

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A condition in which a person with diabetes mellitus becomes unconscious (comatose) and unresponsive due to either very low levels of blood sugar, or very high levels of blood sugar. If the glucose level is too low, the person has hypoglycemia and if the level is too high, the person has hyperglycemia.

The three types of coma associated with diabetes i.e. ketoacidotic coma, hyperosmolar coma and hypoglycaemic coma

Ketoacidotic Coma
Ketoacidotic coma is more common in people with Type 1 diabetes. This type of coma is triggered by the accumulation of ketone bodies (ketones) in the blood.

Ketones are by-products produced as a result of fat being broken down into fatty acids for fuel. This occurs when there is not enough insulin circulating to transport glucose out of the blood and into the cells in the body, where the glucose can be used as energy and nourishment. Instead, fat is broken down, which is then converted to ketones in the liver.

Ketones are strongly acid and cause the blood to become too acidic. When the body does not have the help of insulin, ketones build up in the blood and “spill” over into the urine so that the body can get rid of them. Ketones that build up in the body for a long time lead to serious illness and coma.

Common causes of ketoacidosis include,

• a missed dose of insulin or

• an acute infection.

 Symptoms of ketoacidosis include,

• extreme thirst

• lethargy

• frequent urination

• nausea

• vomiting

• abdominal pain

• progressive drowsiness

• deep, rapid breathing

• a fruity or acetone smell on the breath may also be present.

Hyperosmolar Coma
Hyperosmolar coma is a complication of type 2 diabetes caused by severe dehydration and very high blood glucose levels (hyperglycaemia) without the presence of ketones. The blood is concentrated with sodium, glucose, and other molecules that normally attract water into the bloodstream. When the kidneys are conserving water, however, this creates a vicious cycle of increasing blood-glucose levels and increasing dehydration.

Cause that may lead to high blood glucose levels include,

• improperly managed their medications and diet.

• an infection or illness.

Symptoms of Hyperosmolar coma include,

Those at most risk of this type of coma are people with Type 2 diabetes, who have an infection or acute illness and have reduced their intake of fluids or are taking diuretic medication or steroids.

Hypoglycemic Coma
Hypoglycemia is a medical term referring to a pathologic state produced by a lower than normal amount of sugar in the blood (below 3.5 mmol/L). It happen from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function. Derangements of function can range from vaguely "feeling bad" to coma and (rarely) death.

Causes of Hypoglycemic include,

• too much insulin or diabetes medication.

• exercises strenuously without eating extra food or reducing their insulin intake.

• too much alcohol consumption or drinks alcohol without eating food.

• inadequate food intake and insulin injection during pregnancy for diabetic women.

Symptoms of Hypoglycemia include,

• trembling

• palpitations

• weakness

• sweating

• intense hunger

• confusion, altered behavior, drowsiness or coma may occur if the blood glucose becomes very low.

First aid for diabetic coma:
First aid for someone who has lapsed into a diabetic coma includes:

• Call for help. Get immediate medical care by dialing an emergency telephone number, or transport to an emergency room or clinic or doctor's office.

• Don't try to give unconscious patient anything to eat or drink, as they may choke.

• Turn patient onto their side to prevent obstruction to breathing.

• NEVER GIVE INSULIN unless you are completely certain you know what you're doing and are sure the patient is NOT HYPOGLYCEMIC. Mistakes with insulin can kill.

• If medical equipment such as glucose meters are available, take a blood glucose level reading of the patient immediately.

• If the patient is conscious and suffering from hypoglycemia, give sugar in some form. Fruit juice, glucose or white sugar dissolved in juice or water, glucose tablets or gel, BUT NOT diet drinks. Artificial sweetners DO NOT WORK. Avoid fatty, oily, or protein rich foods if possible, for digestion and absorption of the sugar will be delayed. If suffering from hyperglycemia, do not feed the patient. Push water while conscious instead. And get the patient to medical treatment promptly.

Diagnosis methods
The cause of a diabetic coma is diagnosed using a number of tests, including:

• Medical history.

• Physical examination.

• Blood tests, including glucose and ketones.

• Urine tests.

Treatment options
Treatment options for diabetic coma include,

• Ketoacidotic Coma - intravenous fluids, insulin, and administration of potassium and sodium.

• Hyperosmolar Coma - plenty of intravenous fluids, insulin, potassium and sodium given as soon as possible.

• Hypoglycemic Coma - administration of the hormone glucagon to reverse the effects of insulin, or glucose given intravenously.

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