Understanding and Preventing A Diabetic Coma

Whatever your age, you could be at risk of diabetes. Most forms of diabetes are chronic – lasting throughout your life – but are manageable with the right medications and/or lifestyle changes. Understanding the disease, which is the first step in recognizing early diabetes warning signs, starts with knowing the role of glucose (sugar) in the body.

Your body breaks down carbohydrates into glucose and releases it into your bloodstream. Beta cells in the pancreas, a large gland in your belly that helps with digestion and the regulation of blood sugar, produce insulin and deliver it into the bloodstream. From there, insulin moves glucose from the blood into your body’s cells, which use it for energy and other essential processes. When the pancreas fails to do its job in producing and regulating insulin to transform food into accessible cell energy, the result often is diabetes, Type 1, or Type 2.

When diabetes becomes a medical emergency

Should your blood sugar level become dangerously high (hyperglycemia) or too low (hypoglycemia), you can fall into a coma, or state of unconsciousness. A diabetic coma, also called a diabetic-related coma, is a life-threatening situation.

With hypoglycemia, blood sugar levels fall below 70 milligrams per deciliter (mg/dl) and blood sugar is insufficient for the basic needs of the brain.[1]If you have diabetes, hyperglycemia or high blood sugar is usually considered to be a blood glucose level greater than 180 mg/dL one to two hours after eating. [2] Failure to catch hypo- or hyperglycemia early can elevate blood sugar levels to dangerous levels and create a situation where a diabetic coma can occur.[3]

Other causes that increase coma and diabetes risk

Other conditions that can increase coma and diabetes risk include: [4]^,[5],[6]

·         Not taking the right amount of insulin: If you need insulin, taking too much or too little or skipping doses can lead to a diabetic coma.

·         Faulty insulin pump: Your insulin pump stops working the way it should without you noting the problem early enough to fit it can increase the coma and diabetes risk.

·         Alcohol: Drinking alcohol can lower your blood sugar raising your coma and diabetes risk.

·         Medications: Certain medications, such as steroids, can change your blood sugar.

·         Illness or infection: An illness or infection can change your insulin levels and increase your coma and diabetes risk.

·         Exercise: Physical activity can lower blood glucose up to 24 hours or more, increasing your body’s sensitivity to insulin. You need to find out how your blood glucose levels respond to exercise.

·         Poor diabetes management: You need to know what makes your blood sugar rise and fall – food, exercise, medicine, and stress among them – and make sure to stay on top of proper management.

Diabetic coma symptoms

The main diabetic coma symptoms include:[7]

·         Unconsciousness: Like a deep sleep, difficult for someone to wake you up.

·         Lack of eye response: Another of the diabetic coma symptoms is lack of eye response, which means your eyes stay closed and so someone opening your eye does not cause a reaction from you.

·         Lack of motor response: You do not consciously move, although you may have reflex responses.

Know warning signals of a diabetic coma

Symptoms stemming from hypoglycemia (low blood sugar) that can precede a diabetic coma include: [8]^,[9]

·         Confusion

·         Anxiety

·         Fast heart rate

·         Tiredness

·         Sweating

·         Hunger

·         Dizziness

·         Headache

·         Difficulty speaking

·         Blurry vision

·         Tingling skin

·         Fast heart rate

Diabetic coma symptoms related to hyperglycemia that can precede loss of consciousness include: [10]^,[11]

·         Increased thirst

·         Frequent urination

·         Tiredness

·         Nausea and vomiting

·         Shortness of breath

·         Abdominal pain

·         Fruity breath odor

·         Headache

·         Very dry mouth

·         Blurred vision

Severe hyperglycemia can result in diabetic ketoacidosis (DKA), which can occur with or without a coma. It develops if your body lacks sufficient insulin to allow blood sugar into your cells to be used for energy. Instead, your liver breaks down fat for fuel. The process produces acids called ketones. Dangerous life-threatening levels can build up when too many are produced too fast. DKA is more common among those with Type 1 diabetes.

Prevent diabetic coma

Take the following step to prevent a coma and diabetes risk [12]

·         Check your blood sugar frequently

·         Detect signs of hypo- or hyperglycemia to avoid symptoms worsening

·         Stay hydrated

·         Stick to your diet

·         Exercise regularly

·         Moderate alcohol consumption

Make sure to maintain appointments with your healthcare team.  Also ask your health care team about securing the medication glucagon (a peptide hormone that raises the concentration of glucose and fatty acids in the blood stream) or ketone tests in case you have a diabetes-related emergency.[13]

A diabetes emergency checklist

The American Association of Clinical Endocrinology (AACE) suggests having a checklist you keep with you that contains all the items you need to have to manage your diabetes should you find yourself in an emergency and need help. Information should include: [14]

·         Type of diabetes 

·         All your medical conditions, allergies, and prior surgeries

·         All medications (include pharmacy contact information, active prescription information, and eligible refills) 

·         Previous diabetes medications and reason for discontinuation  

·         Contact information for all your health care professionals and at least two emergency contacts 

·         Letter from your diabetes health care professionals with most recent diabetes medication regimen (especially if taking insulin), health insurance card, living will, healthcare power of attorney, etc.

·         Recent laboratory results, especially A1C, kidney and liver tests

It also is a good idea to wear medical identification that will enable colleagues or emergency medical personnel – and even a good Samaritan - to identify and address your medical needs.

Managing diabetes can help prevent a diabetic coma. Still, you want to be sure your friends and family understand the symptoms and what to do to ensure you get the proper treatment if you pass out due to extremely high or extremely low blood glucose.