Diabetic Coma Symptoms

A diabetic coma is one of the most life-threatening complications of diabetes.  The main symptom is unconsciousness.  A diabetic coma can be the result of having a blood glucose level that is too high (hyperglycemia) or a blood glucose level that is too low (hypoglycemia). The diabetic in a diabetic coma is unconscious and can die if the condition is not treated.

Symptoms of Diabetic Coma

Before you lapse into a diabetic coma, there are usually warning signs of blood sugar levels that are too low or blood sugar levels that are too high.  For example, if the blood sugar is too high, the you may experience tiredness, abdominal pain, shortness of breath, increased urination, increased thirst, a rapid heart rate, a dry mouth, and a fruity smell to your breath.

If the blood sugar is too low, you may experience signs and symptoms of hypoglycemia, including weakness, tiredness, anxiety, tremulousness, nervousness, nausea, confusion, problems communicating, light-headedness, hunger, or dizziness.  If you have had diabetes for many years, you may not have many symptoms of low blood sugar and won’t know you have the condition prior to falling into a coma.

If you suspect that you have either high blood sugar or low blood sugar, you need to check your blood glucose levels and do what your doctor has recommended for you to treat the disease.  If you don’t feel better after trying home remedies, you need to call 911 and get some kind of emergency care.

Causes of Diabetic Coma

The main cause of a diabetic coma is an extremely high blood sugar or an extremely low blood sugar.  The following medical conditions can cause a diabetic coma:

• Diabetic hyperosmolar syndrome. This is a condition in which the blood sugar is as high as 600 mg/d: or 33.3 mmol per liter. There are no ketones in the urine but the blood is thicker due to the high blood sugar levels.
• Diabetic ketoacidosis. This occurs when the muscles of the body lack in cellular fuel so that the body begins to break down fatty acids to be used instead of glucose for fuel.  The byproduct of fatty acid breakdown is the development of ketones in the urine and bloodstream.  If this isn’t treated, the diabetic ketoacidosis can result in a diabetic coma.  This is more common among type 2 diabetic but can affect patients with gestational diabetes or type 2 diabetes if the condition is severe.

When the blood glucose levels reach such high proportions, it turns the blood into a thick, syrupy fluid.  This triggers the kidneys to try to shed the excess glucose, taking water with it so that the individual can quickly become dehydrated.

• If the blood sugar becomes too low, the brain does not get enough fuel and cannot function.  The end result is unconsciousness and a diabetic coma.  It can be caused by drinking too much alcohol, eating too little, exercising too much, or taking too much insulin. The major symptoms of hypoglycemia, particularly sweating, hunger, and tremulousness, usually occur prior to falling into a coma but, if you have had diabetes for a long time, you may have no symptoms and will simply fall into a coma.

Risk Factors for Diabetic Coma

A diabetic coma can happen in anyone who is diabetic.  Type 1 diabetics have a greater risk of having a diabetic coma because they often use insulin and have wider fluctuations in their blood glucose numbers when compared to type 2 diabetics. Any diabetic with high levels of glucose or low levels of glucose are at risk for developing a diabetic coma.  Type 2 diabetics are at a greater risk of having a diabetic coma from diabetic hyperosmolar syndrome rather than diabetic ketoacidosis or hypoglycemia.

Problems that contribute to developing a diabetic coma include the following:

• Any trauma, surgery, or illness. Blood sugar levels tend to rise when you are under stress from a trauma, surgery, or major illness.  This is because of an increased stress response from the adrenal glands, which raise blood sugar levels.  This can lead to diabetic ketoacidosis and secondary diabetic coma.
• Problems with insulin delivery. If you take your insulin by means of an insulin pump, you will need to evaluate your blood sugar quite frequently. This is because the insulin pump can fail or a kink can develop in the tubing of the pump so that insulin is not given when it is needed.  Even pumps without tubes can fail and can lead to markedly elevated blood sugar levels and secondary diabetic coma.
• Poor diabetic control. If you are not good about taking your insulin or other medications for diabetes, you can have blood sugars that are too high.  If they get high enough, you can lapse into a diabetic coma.
• Drinking alcohol. Alcohol can make your blood sugars unpredictable. It can lower the blood glucose levels after drinking the alcohol, even if you haven’t had alcohol for 1-2 days.  The hypoglycemic caused by alcohol use can trigger a diabetic coma.
• Skipping insulin doses. People on insulin usually know that, by skipping their insulin dose, they will lose some weight.  If this happens too many times, diabetic ketoacidosis can ensue, resulting in a secondary diabetic coma.
• Illicit Drug Use. If you use drugs such as Ecstasy or cocaine, you can raise your risk of developing elevated blood glucose levels and secondary diabetic coma.

Complications of Diabetic Coma

If the diabetes is such that the blood sugar is too high too low for a long period of time and you develop a diabetic coma, the end result can be irreversible damage to the brain and death from complications of the coma.

Testing for Diabetic Coma

It is vital to make the proper diagnosis once you have become unconscious from a diabetic coma.  The first thing the paramedics or doctor will do is to check a blood sugar level and do a physical examination.  If you are a diabetic prone to high fluctuations of your blood glucose levels, you should wear a medical identification necklace or bracelet to make sure the paramedics know to look for diabetes as a cause of being in a coma.

As part of the diagnosis of diabetic coma, the doctor will order a blood glucose level, a blood and urine ketone level, levels of potassium, sodium, and phosphate, and kidney function studies.  These will likely be abnormal if you are in a diabetic coma.

Treatment of Diabetic Coma

Diabetic comas need to be treated promptly in order to avoid permanent brain damage and death. The treatment depends on whether the blood sugar is too high or the blood sugar is too low.

If the blood sugar is too high, IV fluids will be given to raise the amount of water in your body.  Supplements of phosphate, sodium, and potassium will be given in order to keep your body functioning normally.  Insulin will be given to bring the blood sugar down, and, if there is an underlying cause behind your high blood sugar, this will be treated.

If the blood sugar is too low, the paramedics will likely give you an injection of glucagon, which is a hormone that rapidly increases your blood sugar.  An IV will be established and the paramedics will give you 50 percent dextrose solution to increase the blood glucose levels.

References:

1. Diabetic coma. http://www.mayoclinic.org/diseases-conditions/diabetic-coma/basics/definition/con-2002569. Accessed 5/22/16.