Skip to main content. Home Diabetes. Diabetic coma. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. Diabetic ketoacidosis coma Diabetic hyperosmolar coma Diabetic hypoglycaemic coma First aid for diabetic coma Diagnosis of diabetic coma Treatment for diabetic coma Where to get help Things to remember. Diabetic ketoacidosis coma Diabetic ketoacidosis typically occurs in people with type 1 diabetes, which was previously known as juvenile diabetes or insulin dependent diabetes mellitus IDDM , though it can occasionally occur in type 2 diabetes.
Symptoms of ketoacidosis Symptoms of ketoacidosis are: extreme thirst lethargy frequent urination due to high blood glucose levels nausea vomiting abdominal pain progressive drowsiness deep, rapid breathing a fruity or acetone smell on the breath.
Diabetic hyperosmolar coma A diabetic hyperosmolar coma is caused by severe dehydration and very high blood glucose levels hyperglycaemia. Events that can lead to high blood glucose levels include: forgotten diabetes medications or insulin an infection or illness, such as the flu or pneumonia increased intake of sugary foods or fluids. Diabetic hypoglycaemic coma Hypoglycaemia, or low blood glucose levels below 3. Symptoms of hypoglycaemia Symptoms of hypoglycaemia include: tremor racing pulse or heart palpitations sweating weakness intense hunger confusion, altered behaviour, drowsiness or coma — these may occur if the blood glucose level becomes very low.
Prolonged or frequent coma should be avoided and hypoglycaemia needs to be treated quickly. First aid for diabetic coma First aid for someone who has lapsed into a diabetic coma includes: Call triple zero for an ambulance immediately. Turn them onto their side to prevent obstruction to breathing.
Follow any instructions given to you by the operator until the ambulance officers arrive. If available, administer 1 mg of glucagon for rapid reversal of hypoglycaemia. Diagnosis of diabetic coma A coma is a medical emergency. The cause of a diabetic coma is diagnosed using a number of tests including: medical history physical examination — the person may be wearing an emergency bracelet identifying their medical condition blood tests — including tests for glucose and ketone levels.
Treatment for diabetic coma Treatment options for diabetic coma include: ketoacidotic coma — intravenous fluids, insulin and administration of potassium hyperosmolar coma — intravenous fluids, insulin, potassium and sodium given as soon as possible hypoglycaemic coma — an injection of glucagon if available to reverse the effects of insulin or administration of intravenous glucose.
Where to get help In an emergency, always call triple zero The emergency department of the nearest hospital Your doctor Diabetes specialist Baker Heart and Diabetes Institute Tel. Diabetic coma is a medical emergency and needs prompt medical treatment. Uncontrolled blood glucose levels may lead to hyperglycaemia or hypoglycaemia. Low or persistently high blood glucose levels mean your diabetes treatment needs to be adjusted. Determination of electrolytes levels is important to identify life-threatening conditions that the hyperosmolar state produces in HHS and DKA.
Excess excretion by the kidneys loses water in compensation to correct it. This makes the concentration of some solutes in the blood even higher at the expense of others. Testing of the following are indicated:. Since infection can convert a well-controlled diabetic into an hyperglycemic state, so diagnostic tests for infection, such as bacterial cultures, blood counts, and chest X-rays, are indicated.
Identifying between HHS and DKA as the cause of coma and diagnosing the types of electrolyte disturbances allow for a rational approach to rapid treatment, which is necessary to avoid death. The two causes of diabetic coma, hyperosmolar hyperglycemic state HHS and diabetic ketoacidosis DKA , differ in whether or not there is ketoacidosis. Although both have severe hyperglycemia, that of HHS is more severe. The results of metabolic changes in both lead to abnormalities in electrolyte concentrations, which can be life-threatening.
Identifying the cause of the diabetic coma and determining the severity of the electrolyte abnormalities can then guide treatment.
Prevention of serious complications of diabetes, including diabetic coma, requires keeping the diabetes in strict glycemic control by vigilant and aggressive blood glucose management. Even then some things can induce a hyperglycemic state that is unavoidable. Beginning a regimen of steroids due to a flare of an arthritic condition can raise blood sugars as a side effect of this medication.
When an well-controlled diabetic patient begins to develop hyperglycemia without explanation, hidden causes should be sought and identified, including infection, drugs, or drug-drug interactions. Diabetic ketoacidosis DKA and hyperosmolar hyperglycemic state HHS , life-threatening complications of diabetes, give warning signals. Since either hyperglycemic state—ketotic DKA or non-ketotic HHS —can create neurological changes that lead to coma and death, recognizing warning signals is the best way to avoid untoward outcomes.
Patient self-testing plays an important part of recognizing warnings of hyperglycemia. Since DKA progresses more rapidly, it may be more difficult to identify its warning signals in a timely way compared with the slower onset of changes in HHS.
In either, the warning signals of a worsening hyperglycemic state include the following:. Vascular Health Clinics is a regional multi-specialty program. Advertising on our site helps support our mission. We do not endorse non-Vascular Health Clinics products or services.
This information is provided by Vascular Health Clinics and is not intended to replace the medical advice of your doctor or healthcare provider. The symptoms also include increased thirst and a frequent need to urinate. Other symptoms of elevated ketone levels include:. A diabetic coma is a medical emergency. Treating hyperglycemia requires intravenous fluids to improve fluid levels throughout your body.
You may also receive insulin to help your cells absorb the extra circulating glucose. If your sodium, potassium, or phosphate levels are low, you may get supplements to help bring them up to healthy levels.
The treatment will be similar for DKA. Once your blood glucose levels are in a healthy range, you should start to feel better almost immediately. If the symptoms occurred for a while before treatment or if you were in a diabetic coma for several hours or longer, you could experience some brain damage.
An untreated diabetic coma may also result in death. People who receive emergency treatment for a diabetic coma usually recover fully. Your doctor may recommend that you wear a medical identification bracelet that explains the nature of your diabetes and other health concerns. This may help ensure you get the proper treatment for future problems quickly. If you experience a diabetic coma without knowing you have diabetes, your doctor will work with you to develop a diabetes treatment plan.
This will include medications, as well as recommendations for diet and exercise. The key to preventing a diabetic coma is proper blood glucose management. This means taking your insulin and testing your blood glucose and ketones as your doctor recommends.
You should also pay close attention to your carbohydrate intake. This is true for people who have type 1 or type 2 diabetes. They can help you create a diabetes meal plan. You should know what to do if you miss a dose of insulin or other diabetes medication.
Ask your doctor about that, as well as what to do if you start to feel symptoms of hyperglycemia or hypoglycemia. Diabetes can affect other parts of your health. Uncontrolled diabetes can harm your cardiovascular health in particular. Be prepared to change medication doses or adjust your diet along the way. Take steps to manage your diabetes properly and ask your doctor any questions you have about how to prevent a diabetic coma.
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