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Understanding and Preventing Diabetic Coma

What is diabetic coma?

Diabetic coma is a serious, potentially life-threatening complication associated with diabetes. A diabetic coma causes unconsciousness that you cannot awaken from without medical care. Most cases of diabetic coma occur in people with type 1 diabetes. But people with other types of diabetes are also at risk.

If you have diabetes, it’s important to learn about diabetic coma, including its causes and symptoms. Doing so will help prevent this dangerous complication and help you get the treatment you need right away.

How diabetes can lead to coma

Diabetic coma can occur when blood sugar levels are out of control. It has three main causes:

Hypoglycemia

Hypoglycemia occurs when you don’t have enough glucose, or sugar, in your blood. Low sugar levels can happen to anyone from time to time. If you treat mild to moderate hypoglycemia immediately, it usually resolves without progressing to severe hypoglycemia. People on insulin have the highest risk, though people who take oral diabetes medications that increase insulin levels in the body may also be at risk. Untreated or unresponsive low blood sugars can lead to severe hypoglycemia. This is the most common cause of diabetic coma. You should take extra precautions if you have difficulty detecting symptoms of hypoglycemia. This diabetes phenomenon is known as hypoglycemia unawareness.

DKA

Diabetic ketoacidosis (DKA) occurs when your body lacks insulin and uses fat instead of glucose for energy. Ketone bodies accumulate in the bloodstream. DKA occurs in both forms of diabetes, but it’s more common in type 1. Ketone bodies may be detected with special blood glucose meters or with urine strips to check for DKA. The American Diabetes Association recommends checking for ketone bodies and DKA if your blood glucose is over 240 mg/dl. When left untreated, DKA can lead to diabetic coma.

Nonketotic hyperosmolar syndrome (NKHS)

This syndrome only occurs in type 2 diabetes. It’s most common in older adults. This condition occurs when your blood sugar is too high. It can lead to dehydration. According to the Mayo Clinic, people with this syndrome experience sugar levels in excess of 600 mg/dl.

Signs and symptoms

There is no single symptom that is unique to diabetic coma. Its symptoms can vary depending on the type of diabetes you have. The condition is often preceded by a culmination of several signs and symptoms. There are also differences in symptoms between low and high blood sugar.

Signs that you may be experiencing low blood sugar and are at risk for progressing to severe low blood sugar levels include:

  • sudden fatigue
  • shakiness
  • anxiety or irritability
  • extreme and sudden hunger
  • nausea
  • sweating or clammy palms
  • dizziness
  • confusion
  • decreased motor coordination
  • speaking difficulties

Symptoms that you may be at risk for DKA include:

  • increased thirst and dry mouth
  • increased urination
  • high blood sugar levels
  • ketones in the blood or urine
  • itchy skin
  • abdominal pain with or without vomiting
  • rapid breathing
  • fruity smelling breath
  • confusion

Symptoms that you may be at risk for NKHS include:

  • confusion
  • high blood sugar levels
  • seizures

When to seek emergency care

It’s important to measure your blood sugar if you experience any unusual symptoms so that you do not progress to a coma. Diabetic comas are considered emergencies that require prompt medical attention and are treated in a hospital setting. Like symptoms, diabetic coma treatments can vary depending on the cause.

It’s also important to help instruct your loved ones on how to respond if you progress to a diabetic coma. Ideally they should be educated on the signs and symptoms of the conditions listed above so that you do not progress this far. It can be a frightening discussion, but it’s one you need to have. Your family and close friends need to learn how to help in case of an emergency. You won’t be able to help yourself once you fall into a coma. Instruct your loved ones to call 911 if you lose consciousness. The same should be done if you experience warning symptoms of diabetic coma. Show others how to administer glucagon in the case of diabetic coma from hypoglycemia. Be sure to always wear a medical alert bracelet so that others know of your condition and can contact emergency services if you’re away from home.

Once a person receives treatment, they can regain consciousness after their blood sugar level is normalized.

Prevention

Preventive measures are key to reducing the risk for diabetic coma. The most effective measure is to manage your diabetes. Type 1 diabetes puts people at a higher risk for coma, but people with type 2 are also at risk. Work with your doctor to make sure your blood sugar is at the right level. And seek medical care if you don’t feel better despite treatment.

People with diabetes should monitor their blood sugar daily, especially if they are on medications that increase insulin levels in the body. Doing so will help you spot problems before they turn into emergencies. If you have problems with monitoring your blood sugar, consider wearing a continuous glucose monitor (CGM) device. These are especially useful if you have hypoglycemia unawareness.

Other ways you can prevent diabetic coma include:

  • early symptom detection
  • sticking to your diet
  • regular exercise
  • moderating alcohol and eating when drinking alcohol
  • staying hydrated, preferably with water

Outlook

Diabetic coma is a serious complication that can be fatal. And the odds of death increase the longer you wait for treatment. Waiting too long for treatment can also lead to brain damage. This diabetic complication is rare. But it’s so serious that all patients must take precautions.

The takeaway

Diabetic coma is a serious, potentially life-threatening complication associated with diabetes. The power to protect from diabetic coma is in your hands. Know the signs and symptoms that may lead up to a coma, and be prepared to spot problems before they turn into emergencies. Prepare both yourselves and others about what to do if you become comatose. Make sure to manage your diabetes to reduce your risk. 

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