Diabetic coma sounds serious. And that’s because it is. At least, it can be. Research has come a long way.
As fatal as a coma might sound, mortality from this condition has gone way down. We have scientific research to thank for that.
Now that healthcare practitioners are more aware of diabetic coma signs and symptoms to watch out for, patients can get faster treatment.
Patients can also take preventative measures to ensure that their type I or type II diabetes does not progress to a diabetic coma.
Recovery from a diabetic coma is possible. Sometimes without any long term side effects. The outlook for patients experiencing diabetic coma has undoubtedly improved over time. Let’s get into the details around the diabetic coma.
What is a diabetic coma?
A diabetic coma happens when someone with diabetes loses consciousness. It is an acute complication of diabetes mellitus. A diabetic coma has two potential causes. One is diabetic ketoacidosis (called DKA for short).
The other is the hyperosmolar hyperglycemic state. The hyperosmolar hyperglycemic state involves extremely high blood glucose levels and coma. Both diabetic ketoacidosis and nonketotic hyperosmolar coma can happen at the same time and often do.
Diabetic coma can occur in type 1 diabetes or type 2 diabetes. It can happen when blood sugar levels are too low or too high.
Diabetic ketoacidosis is a buildup of ketone bodies in the blood. The criteria for diabetic ketoacidosis are as follows:
- Urine ketones positive or more than 8 millimoles per Litre
- Blood ketones higher than 3.1 millimoles per Litre
- Acidic blood with a pH less than 7.3
- Bicarbonate in the blood is lower than 15 millimoles per Litre
- Random glucose level is less than 11.1 millimoles per Litre
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Symptoms
A diabetic coma is a relatively straightforward and simple diagnosis. The symptoms of diabetic coma are typically:
- Polyuria (frequent urination)
- Dehydration
- Poor appetite
- Increased thirst
- Feeling tired
- Upset stomach
- Flushed or dry skin
- Kussmaul breathing (deep, labored breathing)
Symptoms of low blood glucose levels to look out for that could lead to diabetic coma include:
- Headache
- Fatigue
- Heart palpitations
- Confusion
- Dizziness
- Shakiness
Symptoms of high blood sugar to look out for that could lead to diabetic coma include:
- Increased thirst
- Frequent urination
- Urine test showing high glucose levels
- Blood test showing high glucose levels
More severe symptoms of diabetic coma include the following:
- Vomiting
- Dizziness
- Weakness
- Confusion
- Difficulty breathing
Polyuria is an important symptom. This is because there is an average lag of six days between the onset of polyuria and diabetic hyperosmolar syndrome. This is why it is crucial to address increases in urination frequency with your doctor as soon as they come up.
Research has shown that vacuolar lesions in the proximal tubules of the kidneys are characteristic of diabetic coma. Fats accumulating in the kidneys are what lead to these lesions.
Research also shows that lung dysfunction is possibly involved in symptoms of hyperosmolar hyperglycemic nonketotic diabetic coma.
There is a compound called 1,5-AG. This is short for 1,5-anhydroglucitol. This is a form of glucose. It competes with glucose for kidney reabsorption. Lower concentrations of 1,5-AG in the blood demonstrate high blood sugar levels over the past one to two weeks. Patients with diabetic coma have significantly lower blood concentrations of 1,5-AG compared to healthy patients with diabetes.
Treatment
Diabetic coma is straightforward and simple to treat. With today’s therapeutic possibilities, the therapeutic goal can be achieved. And what is that goal? Low mortality, of course.
Depending on the underlying illness, mortality rates can remain low. It is important to have early diagnosis and up to date intensive treatment for success in diabetic coma treatment.
The major goal with the treatment of diabetic coma is to replace major water loss since this is what is responsible for this clinical condition. We also want to stimulate glucose metabolism with insulin.
The fundamental principles of treating diabetic coma include the following:
- Improve circulation through small blood vessels (microcirculation) by replacing lost fluids and electrolytes
- Administer a small insulin dose through an IV or an intramuscular injection
- Prevent hypokalemia (low levels of potassium in the blood)
- Correct for acidosis (a pH under 7.1)
Treatment for diabetic coma should be well-planned and supportive. Other essential goals in the treatment of diabetic coma include the following:
- Preventing thromboembolism (blood clots)
- Fending off shock, which can occasionally be caused by infections
- Preventing cerebral edema, which can be fatal
Health care providers will carefully observe patients’ heart, lung, and kidney functions. This is important in the first as well as the second phase of treatment. Initial treatment strategies for ketoacidosis and hyperosmolar nonketotic coma are similar.
Ketoacidosis
In ketoacidosis, the first priorities are insulin levels, fluid, and electrolyte replacement.
Despite low or normal blood sugar levels, patients with ketoacidosis should get insulin treatment. They should also receive glucose supplementation. This will help to correct the ketoacidosis.
Insulin treatment helps the cells to absorb any extra circulating glucose. On the other hand, if you have severe hypoglycemia, a glucagon injection can help to increase blood sugar levels.
Hyperosmolar non-ketotic coma
In a hyperosmolar nonketotic coma, rehydration and replacing electrolytes are of primary importance.
Insulin therapy
Based on research, we now know that insulin therapy is best at low doses. These are doses such as four to eight units per hour.
After insulin treatment and rehydration, there will be quick changes of fluid and electrolytes into intravascular spaces. This is a major therapeutic challenge. We want to avoid this situation because it can lead to complications due to the following factors:
- Hypokalemia (low potassium levels in the blood)
- Hypophosphatemia (low phosphorus levels in the blood)
- Hypomagnesemia (low magnesium levels in the blood)
- Hypovolemia (low volume of blood itself)
It is important to avoid the above consequences. We can do this by replacing fluids, potassium, phosphorus, and magnesium. Regular laboratory and clinical monitoring are important in this situation.
Blood sugar levels
When blood sugar concentrations dip below 14 mmol/L, we want to maintain this level. This is because lowering below this level too quickly can increase the risk of brain edema (swelling due to water on the brain).
Another potential cause of brain edema is replacing fluids too quickly with crystalline solutions. This can also lead to complications such as adult respiratory distress syndrome.
If hypovolemia occurs even with adequate fluid replacement, you will probably be given a colloid containing albumin.
Ask your health care provider when it would be appropriate to use glucose tablets to increase your blood sugar levels.
Electrolyte replacement
It is crucial to estimate and follow up on osmolality levels. It is also vital that we prevent rapid changes in blood glucose and electrolyte levels. These are important points in every case of a diabetic coma.
Treatment of diabetic ketoacidosis involves bicarbonate therapy. It also includes phosphate and magnesium replacement.
Phosphate and magnesium therapy are important when their levels are below the normal range. This is particularly true if the clinical situation is critical.
Hyperosmolarity and the resulting severe dehydration need to be vigorously treated, especially when the total calculated osmolarity is higher than 230 to 240 milliOsmoles per Litre.
Intravenous fluids (I.V. fluids) can help to improve fluid levels throughout the body.
Prevention
Researchers have determined that the following are important in the prevention of diabetic coma:
- Improving patients’ education about diabetes control and diabetic coma, as well as symptoms to look out for
- Increasing knowledge regarding diabetes among general health care practitioners
- Reducing the number of recidive cases
Hypoglycemia unawareness can be dangerous. If you have diabetes, it is important to track your glucose levels.
Pay attention to what you eat. The key to preventing diabetic coma is healthy blood sugar control. This means you should be taking your insulin and testing your blood sugar and ketones based on your doctor’s recommendations.
Pay close attention to how many carbs you are eating. This is important for those with type 1 diabetes and those with type 2 diabetes. There are diabetes certified educators out there. Hire one who can help you to create a meal plan specific to diabetes.
Be sure you know what to do if you miss a dose of medication or insulin. Have your doctor explain to you what to do if you start to feel symptoms of low blood sugar or high blood sugar.
Keep in mind that diabetes doesn’t just affect your blood sugar. It also affects many other parts of your body and health. Poorly controlled diabetes can affect your heart health.
Remember that as you age, your medication dosing needs may change. You may need to alter your doses over time. Work with your prescribing doctor in order to do this.
Although you may never experience a diabetic coma in your lifetime with diabetes, it is common enough that you should be aware of the risk factors. Be sure you are managing your diabetes and blood sugar properly. Ask your doctor any questions you have about preventing a diabetic coma.
Recovery
A diabetic coma can be a catastrophic emergency. Unfortunately, diabetic coma does occur regularly in both types I and type II diabetes. It can even be fatal.
The good news is that the mortality of diabetic ketoacidosis is going down. Over the past years, the mortality of diabetic ketoacidosis has gone down to as low as one percent.
Hyperosmolar nonketotic coma is still fatal in 20 to 30% of cases. This is because of severe underlying conditions or complications. Morbidity and mortality of hyperosmolar nonketotic coma are higher in patients with no previous history of diabetes mellitus.
In fact, the morbidity for those with no previous history of diabetes is 67%, compared to 33% of those with a diabetes history. Mortality in those with no previous history of diabetes is 50%, compared to 25% of those with a diabetes history.
The most frequent causes of death in a diabetic coma are infections and clotting disorders. Death from a diabetic coma in industrialized countries can only be decreased by prevention. Prevention includes the education of diabetic patients and physicians so that they can detect metabolic changes early on.
There is good data to show that quick diagnosis of diabetic ketoacidosis hyperosmolar coma and rapid rehydration reduce mortality and complications.
One study found that patients treated with insulin plus glucose supplementation had a quicker recovery from acidosis. This was compared to those treated with a bicarbonate IV infusion and continuous kidney replacement therapy.
In children, diabetic ketoacidosis can cause brain injuries that range from mild to severe.
Once blood glucose levels are back to a healthy range, you will start to feel better quickly. If diabetic coma led to unconsciousness, you would likely feel better once treatment begins.
The sooner you get treatment, the shorter the effects should last. However, if symptoms were going on for a while before treatment, you could have some lasting brain damage.
If left untreated, diabetic coma could result in death. On the other hand, if you receive emergency treatment for a diabetic coma, you can usually recover to the full extent. If you have had a diabetic coma, your doctor might have you wear a medical I.D. bracelet explaining your condition. This can help to make sure that you get help quickly should diabetic coma come on in the future.
If you don’t have any history of diabetes but experience a diabetic coma, your doctor can help develop a diabetes treatment plan. This will probably include medications, diet, and exercise modifications.
If you ever see someone losing consciousness, be sure to call the emergency number for your area. It could be something simple like a drop in blood pressure or an anxiety attack. However, it could be something more serious like a diabetic coma. Calling emergency medical services is good practice just in case it is a more serious situation. If you know the person who los consciousness has diabetes, tell first responders this information. It may change their course of treatment.
If you suspect a diabetic coma, but the person has not lost consciousness, use a home blood sugar test. If glucose levels are higher than 240 milligrams per deciliter, then use a home urine test kit for ketones.
And if ketone levels are high, then bring this patient to the doctor. But if their ketone levels are low or negligible, then they may just need a dietary adjustment, exercise, or medication. This could be enough to lower their blood glucose levels to a safe range.
Conclusion
As you can see, diabetic coma is something that patients can bounce back from. Especially if they lack underlying conditions or diabetic complications. If you have diabetes, it is important to keep your blood sugar levels under control.
Using lifestyle, diet, and the medications recommended by your health care practitioners can be helpful. It is important that you are aware of the symptoms of impending diabetic coma.
Read through the above, and write them down somewhere if you need to. It is crucial to keep an eye out for them in yourself or a loved one if you or they have diabetes.
Treatment and recovery are possible, especially with today’s knowledge and technology. But the best practice will always be prevention. If you are concerned about your risk factors for a diabetic coma, speak to your health care provider about it today.
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