Introduction
Diabetes has been on the rise in recent years throughout the world. In this condition, increased blood glucose levels can be observed. If diabetes is not treated properly, it may cause complications. Diabetic coma is one of the serious complications linked to diabetes.
What Is Diabetes?
Diabetes is a chronic health issue related to blood glucose (sugar levels). The body's ability to turn food into energy is affected in this condition. The food consumed is broken down into glucose and enters the bloodstream. When blood sugar levels are increased, the pancreas secretes insulin. Insulin is a hormone that is important for the entry of glucose into the cells. This glucose in the cell gets converted into energy and used in the body.
In diabetic conditions, the required insulin levels are not released, or the body cannot use it as well as it should. Blood glucose levels increase when insulin is insufficient or the cells cannot respond properly. If this condition remains for long periods, it may lead to health complications like heart disease, vision loss, and kidney disease. There are different types of diabetes present. The main types include type 1, type 2, and gestational diabetes.
What Is Diabetic Coma?
If the diabetes is not controlled, it may lead to diabetic coma or loss of consciousness. Uncontrolled blood glucose may result in hyperglycemia (high blood sugar) or hypoglycemia (low blood glucose levels). When these conditions become dangerous, it may lead to diabetic coma. This condition is a life-threatening disease. In a diabetic coma, the person may not be able to respond to sights, sounds, or other types of stimulation. If this condition is not corrected immediately, it may result in death. There are three types of diabetic coma. These include
- Diabetic ketoacidosis coma.
- Hyperosmolar coma.
- Hypoglycemic coma.
Diabetic Hyperosmolar Coma: This type of coma occurs due to dehydration and very high levels of blood glucose (hyperglycemia). The reasons for high blood glucose levels include,
- Missed diabetic medications or insulin.
- An infection or illness like flu or pneumonia.
- Increased consumption of sugary foods or fluids.
This condition is more common among those with type 2 diabetes, especially with infection or acute illness, and usually involves a reduced intake of fluids. Kidneys work hard to remove excess blood glucose along with more water. The individual affected by this condition may feel thirsty, but they cannot replace the lost fluid by drinking more water. They may experience dehydration and need intravenous fluids. If this treatment is not given, the affected individual may experience hyperosmolar coma. Hyperosmolar coma takes several days to weeks to develop. If dehydration and high blood glucose are identified and treated early, it may help prevent coma.
Diabetic Ketoacidosis Coma: This type of coma is more common among those with type 1 diabetes or insulin-dependent diabetes mellitus (IDDM). It can be seen occasionally among those with type 2 diabetes. This condition may be due to the accumulation of ketones. Ketones are strongly acidic and make the blood too acidic. When insulin levels are low, the body cannot use glucose properly. In place of glucose, fat is broken down and converted into ketones in the liver. It has been observed that when insulin levels are low, ketone levels increase excessively. Common reasons for excess ketones include missed doses of insulin or an acute infection in an individual with type 1 diabetes. Ketoacidosis may be the first sign of type 1 diabetes.
Diabetic Hypoglycemic Coma: Hypoglycemia means low blood sugar levels. When the blood glucose levels are below 3.5 mmol/l, it may be known as hypoglycemia. This condition is due to the intake of insulin or any other medications related to diabetes among diabetics. The reasons for diabetic hypoglycemic coma include
- When an extra or increased dose is taken.
- Performs exercises without having sufficient food.
- Skipping of meals or snacks.
- Consuming more alcohol or drinking alcohol on an empty stomach.
If blood glucose levels fall too low, it may lead to unconsciousness (hypoglycemic coma) and seizures.
What Are the Symptoms of Diabetic Coma?
The main symptoms of diabetic coma include
Unconsciousness: It is a state of very deep sleep. It may be difficult to wake a person with this condition.
Absence of Eye Response: Eyes remain closed and do not react to any sort of responses except for light reflex.
Absence of Motor (Movement) Response: The movements done with consciousness are absent. Some reflex responses may be present.
Symptoms of diabetic ketoacidosis that may occur before diabetic coma include
- Experiencing nausea and vomiting.
- Pain in the abdomen.
- Experience rapid, deep breathing at a constant pace (Kussmaul breathing).
- Fruity smelling breath.
- Experience fatigue.
- Feel disoriented or needing clarification.
- Reduced alertness.
Symptoms related to diabetic hyperosmolar coma include
- Mental changes like delirium, hallucinations, and confusion.
- Experience loss of consciousness.
- Increased thirst or dry mouth.
- Increased frequency of urination.
- Problems related to vision.
- Weakness or paralysis of one side of the body.
Symptoms that may occur before diabetic hypoglycemic coma:
- Vision gets blurred, or double vision may occur.
- Experience slurred speech.
- May feel difficulty with coordination.
- Feel disoriented.
- Experience seizures.
What Causes Diabetic Coma?
Diabetic complications like hypoglycemia, hyperglycemia, and ketoacidosis, if not treated, may result in diabetic coma. Dehydration, along with hyperosmolar hyperglycemia and ketoacidosis, may trigger diabetic coma. Severe hypoglycemia may result in the shutting down of the brain, leading to a coma.
How to Diagnose Diabetic Coma?
Diabetic coma is a serious condition that is a medical emergency and needs to be treated in the hospital.
- A medical history is taken, and blood glucose tests are performed.
- Tests are done to assess ketone bodies.
Wearing a medical alert bracelet or necklace in an emergency is important. It is important to inform people about the condition. This helps in emergencies to treat or prevent diabetic coma.
How to Treat Diabetic Coma?
Diabetic coma needs to be treated only in hospitals. The treatment depends on the cause.
1. The treatment for diabetic ketoacidosis coma and diabetic hyperosmolar hyperglycemia include:
Intravenous (IV) Fluids: IV fluids are administered to correct dehydration and electrolyte imbalances.
Insulin: Insulin can be given either through IV injection or subcutaneously.
Other Treatments: Other necessary treatments may be provided. Underlying conditions or infections are treated to improve blood sugar levels.
2. Treatment for diabetic hypoglycemic coma:
Emergency Glucagon: Glucagon in its synthetic form can be administered through injection or as a nasal spray. This synthetic glucagon helps release stored glucose from the liver. This helps increase blood glucose levels. Additional medical treatments may be needed to manage other complications, like organ failure.
What Is the Prognosis of Diabetic Coma?
If proper treatment is given for the underlying cause, diabetic coma can be survived. Some individuals may experience permanent brain damage. If proper treatment is not taken in time, the person may die. The diabetic ketoacidosis coma has a death rate of 0.2 % to 2.5 %. Those who experience coma exhibit hypothermia (low body temperature) and have low urine output (oliguria). They exhibit the worst outcomes. Up to 20 % of individuals with diabetic hyperosmolar hyperglycemia die because of the condition. Individuals who develop coma and have low blood pressure exhibit a poorer prognosis.
Conclusion
A diabetic coma is a medical emergency that needs to be attended to immediately. Three types of diabetic comas should be well understood in order to know their early signs and symptoms. If treatment is delayed, the individual may lose their life. Hence, knowing about the condition, its causes, symptoms, management, and prognosis is important. Knowing the condition in detail may help identify it early. Early diagnosis may lead to effective treatment. This, in turn, may lead to a good quality of life.
