Diabetic coma – Symptoms & causes

Overview

A diabetic coma is a life-threatening disorder that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma.

If you go into a diabetic coma, you’re alive — but you can’t wake up or respond purposefully to sights, sounds or other types of stimulation. If it’s not treated, a diabetic coma can result in death.

The idea of a diabetic coma can be scary, but you can take steps to help prevent it. One of the most important is to follow your diabetes treatment plan.

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Symptoms

Symptoms of high blood sugar or low blood sugar usually develop before a diabetic coma.

High blood sugar (hyperglycemia)

If your blood sugar level is too high, you may have:

• Increased thirst
• Frequent urination
• Blurred vision
• Tiredness or weakness
• Headache
• Nausea and vomiting
• Shortness of breath
• Stomach pain
• Fruity breath odor
• A very dry mouth

Low blood sugar (hypoglycemia)

If your blood sugar is too low, you may have:

• Shakiness
• Anxiety
• Tiredness or drowsiness
• Weakness
• Sweating
• Hunger
• A feeling of tingling on your skin
• Dizziness or lightheadedness
• Headache
• Difficulty speaking
• Blurry vision
• Confusion
• Loss of consciousness

Some people, especially those who’ve had diabetes for a long time, develop a condition known as hypoglycemia unawareness. That means they don’t have warning symptoms that signal a drop in blood sugar.

If you have any symptoms of high or low blood sugar, test your blood sugar right away. Based on the test results, follow your diabetes treatment. If you don’t start to feel better quickly, or you start to feel worse, get medical care right away.

When to see a doctor

A diabetic coma is a medical emergency. If you have symptoms of high or low blood sugar and you think you might pass out, call 911 or your local emergency number.

If you’re with someone with diabetes who has passed out, call for emergency help. Tell the emergency personnel that the unconscious person has diabetes.

Causes

Blood sugar that’s either too high or too low for too long may cause the following serious health problems, all of which can lead to a diabetic coma.

• Diabetic ketoacidosis. If your muscle cells become starved for energy, your body may start breaking down fat for energy. This process forms toxic acids known as ketones. If you have ketones (measured in blood or urine) and high blood sugar, the condition is called diabetic ketoacidosis. If it’s not treated, it can lead to a diabetic coma.

  Diabetic ketoacidosis is most common in people who have type 1 diabetes. But it can also occur in people who have type 2 diabetes or gestational diabetes.

• Diabetic hyperosmolar syndrome. If your blood sugar level goes above 600 milligrams per deciliter (mg/dL), or 33.3 millimoles per liter (mmol/L), the condition is called diabetic hyperosmolar syndrome.

  When blood sugar is very high, the extra sugar passes from the blood into the urine. That triggers a process that draws a large amount of fluid from the body. If it isn’t treated, this can lead to life-threatening dehydration and a diabetic coma.

• Hypoglycemia. Your brain needs sugar (glucose) to function. In severe cases, low blood sugar (hypoglycemia) may cause you to pass out. Low blood sugar can be caused by too much insulin or not enough food. Exercising too vigorously or drinking too much alcohol can have the same effect.

Risk factors

Anyone who has diabetes is at risk of a diabetic coma, but the following factors can increase the risk:

• Insulin delivery problems. If you’re using an insulin pump, you have to check your blood sugar frequently. Insulin delivery can stop if the pump fails or if the tubing (catheter) becomes twisted or falls out of place. A lack of insulin can lead to diabetic ketoacidosis.
• An illness, trauma or surgery. When you’re sick or injured, blood sugar levels can change, sometimes significantly, increasing your risk of diabetic ketoacidosis and diabetic hyperosmolar syndrome.
• Poorly managed diabetes. If you don’t monitor your blood sugar properly or take your medications as directed by your health care provider, you have a higher risk of developing long-term health problems and a higher risk of diabetic coma.
• Deliberately skipping meals or insulin. Sometimes, people with diabetes who also have an eating disorder choose not to use their insulin as they should, in the hope of losing weight. This is a dangerous, life-threatening thing to do, and it raises the risk of a diabetic coma.
• Drinking alcohol. Alcohol can have unpredictable effects on your blood sugar. Alcohol’s effects may make it harder for you to know when you’re having low blood sugar symptoms. This can increase your risk of a diabetic coma caused by hypoglycemia.
• Illegal drug use. Illegal drugs, such as cocaine, can increase your risk of severe high blood sugar and conditions linked to diabetic coma.

Complications

If it is not treated, a diabetic coma can lead to permanent brain damage and death.

Prevention

Good day-to-day control of your diabetes can help you prevent a diabetic coma. Keep these tips in mind:

• Follow your meal plan. Consistent snacks and meals can help you control your blood sugar level.
• Keep an eye on your blood sugar level. Frequent blood sugar tests can tell you whether you’re keeping your blood sugar level in your target range. It also can alert you to dangerous highs or lows. Check more frequently if you’ve exercised. Exercise can cause blood sugar levels to drop, even hours later, especially if you don’t exercise regularly.
• Take your medication as directed. If you have frequent episodes of high or low blood sugar, tell your health care provider. You may need to have the dose or the timing of your medication adjusted.
• Have a sick-day plan. Illness can cause an unexpected change in blood sugar. If you are sick and unable to eat, your blood sugar may drop. While you are healthy, talk with your doctor about how to best manage your blood sugar levels if you get sick. Consider storing at least a week’s worth of diabetes supplies and an extra glucagon kit in case of emergencies.
• Check for ketones when your blood sugar is high. Check your urine for ketones when your blood sugar level is over 250 milligrams per deciliter (mg/dL) (14 millimoles per liter (mmol/L)) on more than two consecutive tests, especially if you are sick. If you have a large amount of ketones, call your health care provider for advice. Call your health care provider immediately if you have any level of ketones and are vomiting. High levels of ketones can lead to diabetic ketoacidosis, which can lead to coma.
• Have glucagon and fast-acting sources of sugar available. If you take insulin for your diabetes, have an up-to-date glucagon kit and fast-acting sources of sugar, such as glucose tablets or orange juice, readily available to treat low blood sugar levels.

• Consider a continuous glucose monitor, especially if you have trouble maintaining stable blood sugar levels or you don’t feel symptoms of low blood sugar (hypoglycemia unawareness).

  Continuous glucose monitors are devices that use a small sensor inserted underneath the skin to track trends in blood sugar levels and send the information to a wireless device, such as a smart phone.

  These monitors can alert you when your blood sugar is dangerously low or if it is dropping too fast. But you still need to test your blood sugar levels using a blood glucose meter even if you’re using one of these monitors. Continuous glucose monitors are more expensive than other glucose monitoring methods, but they may help you control your glucose better.

• Drink alcohol with caution. Because alcohol can have an unpredictable effect on your blood sugar, have a snack or a meal when you drink alcohol, if you choose to drink at all.
• Educate your loved ones, friends and co-workers. Teach loved ones and other close contacts how to recognize the early symptoms of blood sugar extremes and how to give emergency injections. If you pass out, someone should be able to call for emergency help.
• Wear a medical identification bracelet or necklace. If you’re unconscious, the bracelet or necklace can provide valuable information to your friends, co-workers and emergency personnel.

Continuous glucose monitor and insulin pump

A continuous glucose monitor, on the left, is a device that measures blood sugar every few minutes using a sensor inserted under the skin. An insulin pump, attached to the pocket, is a device that’s worn outside of the body with a tube that connects the reservoir of insulin to a catheter inserted under the skin of the abdomen. Insulin pumps are programmed to deliver specific amounts of insulin continuously and with food.

Diabetic coma – Symptoms & causes

Overview

A diabetic coma is a life-threatening disorder that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma.

If you go into a diabetic coma, you’re alive — but you can’t wake up or respond purposefully to sights, sounds or other types of stimulation. If it’s not treated, a diabetic coma can result in death.

The idea of a diabetic coma can be scary, but you can take steps to help prevent it. One of the most important is to follow your diabetes treatment plan.

Products & Services

Symptoms

Symptoms of high blood sugar or low blood sugar usually develop before a diabetic coma.

High blood sugar (hyperglycemia)

If your blood sugar level is too high, you may have:

• Increased thirst
• Frequent urination
• Blurred vision
• Tiredness or weakness
• Headache
• Nausea and vomiting
• Shortness of breath
• Stomach pain
• Fruity breath odor
• A very dry mouth

Low blood sugar (hypoglycemia)

If your blood sugar is too low, you may have:

• Shakiness
• Anxiety
• Tiredness or drowsiness
• Weakness
• Sweating
• Hunger
• A feeling of tingling on your skin
• Dizziness or lightheadedness
• Headache
• Difficulty speaking
• Blurry vision
• Confusion
• Loss of consciousness

Some people, especially those who’ve had diabetes for a long time, develop a condition known as hypoglycemia unawareness. That means they don’t have warning symptoms that signal a drop in blood sugar.

If you have any symptoms of high or low blood sugar, test your blood sugar right away. Based on the test results, follow your diabetes treatment. If you don’t start to feel better quickly, or you start to feel worse, get medical care right away.

When to see a doctor

A diabetic coma is a medical emergency. If you have symptoms of high or low blood sugar and you think you might pass out, call 911 or your local emergency number.

If you’re with someone with diabetes who has passed out, call for emergency help. Tell the emergency personnel that the unconscious person has diabetes.

Causes

Blood sugar that’s either too high or too low for too long may cause the following serious health problems, all of which can lead to a diabetic coma.

• Diabetic ketoacidosis. If your muscle cells become starved for energy, your body may start breaking down fat for energy. This process forms toxic acids known as ketones. If you have ketones (measured in blood or urine) and high blood sugar, the condition is called diabetic ketoacidosis. If it’s not treated, it can lead to a diabetic coma.

  Diabetic ketoacidosis is most common in people who have type 1 diabetes. But it can also occur in people who have type 2 diabetes or gestational diabetes.

• Diabetic hyperosmolar syndrome. If your blood sugar level goes above 600 milligrams per deciliter (mg/dL), or 33.3 millimoles per liter (mmol/L), the condition is called diabetic hyperosmolar syndrome.

  When blood sugar is very high, the extra sugar passes from the blood into the urine. That triggers a process that draws a large amount of fluid from the body. If it isn’t treated, this can lead to life-threatening dehydration and a diabetic coma.

• Hypoglycemia. Your brain needs sugar (glucose) to function. In severe cases, low blood sugar (hypoglycemia) may cause you to pass out. Low blood sugar can be caused by too much insulin or not enough food. Exercising too vigorously or drinking too much alcohol can have the same effect.

Risk factors

Anyone who has diabetes is at risk of a diabetic coma, but the following factors can increase the risk:

• Insulin delivery problems. If you’re using an insulin pump, you have to check your blood sugar frequently. Insulin delivery can stop if the pump fails or if the tubing (catheter) becomes twisted or falls out of place. A lack of insulin can lead to diabetic ketoacidosis.
• An illness, trauma or surgery. When you’re sick or injured, blood sugar levels can change, sometimes significantly, increasing your risk of diabetic ketoacidosis and diabetic hyperosmolar syndrome.
• Poorly managed diabetes. If you don’t monitor your blood sugar properly or take your medications as directed by your health care provider, you have a higher risk of developing long-term health problems and a higher risk of diabetic coma.
• Deliberately skipping meals or insulin. Sometimes, people with diabetes who also have an eating disorder choose not to use their insulin as they should, in the hope of losing weight. This is a dangerous, life-threatening thing to do, and it raises the risk of a diabetic coma.
• Drinking alcohol. Alcohol can have unpredictable effects on your blood sugar. Alcohol’s effects may make it harder for you to know when you’re having low blood sugar symptoms. This can increase your risk of a diabetic coma caused by hypoglycemia.
• Illegal drug use. Illegal drugs, such as cocaine, can increase your risk of severe high blood sugar and conditions linked to diabetic coma.

Complications

If it is not treated, a diabetic coma can lead to permanent brain damage and death.

Prevention

Good day-to-day control of your diabetes can help you prevent a diabetic coma. Keep these tips in mind:

• Follow your meal plan. Consistent snacks and meals can help you control your blood sugar level.
• Keep an eye on your blood sugar level. Frequent blood sugar tests can tell you whether you’re keeping your blood sugar level in your target range. It also can alert you to dangerous highs or lows. Check more frequently if you’ve exercised. Exercise can cause blood sugar levels to drop, even hours later, especially if you don’t exercise regularly.
• Take your medication as directed. If you have frequent episodes of high or low blood sugar, tell your health care provider. You may need to have the dose or the timing of your medication adjusted.
• Have a sick-day plan. Illness can cause an unexpected change in blood sugar. If you are sick and unable to eat, your blood sugar may drop. While you are healthy, talk with your doctor about how to best manage your blood sugar levels if you get sick. Consider storing at least a week’s worth of diabetes supplies and an extra glucagon kit in case of emergencies.
• Check for ketones when your blood sugar is high. Check your urine for ketones when your blood sugar level is over 250 milligrams per deciliter (mg/dL) (14 millimoles per liter (mmol/L)) on more than two consecutive tests, especially if you are sick. If you have a large amount of ketones, call your health care provider for advice. Call your health care provider immediately if you have any level of ketones and are vomiting. High levels of ketones can lead to diabetic ketoacidosis, which can lead to coma.
• Have glucagon and fast-acting sources of sugar available. If you take insulin for your diabetes, have an up-to-date glucagon kit and fast-acting sources of sugar, such as glucose tablets or orange juice, readily available to treat low blood sugar levels.

• Consider a continuous glucose monitor, especially if you have trouble maintaining stable blood sugar levels or you don’t feel symptoms of low blood sugar (hypoglycemia unawareness).

  Continuous glucose monitors are devices that use a small sensor inserted underneath the skin to track trends in blood sugar levels and send the information to a wireless device, such as a smart phone.

  These monitors can alert you when your blood sugar is dangerously low or if it is dropping too fast. But you still need to test your blood sugar levels using a blood glucose meter even if you’re using one of these monitors. Continuous glucose monitors are more expensive than other glucose monitoring methods, but they may help you control your glucose better.

• Drink alcohol with caution. Because alcohol can have an unpredictable effect on your blood sugar, have a snack or a meal when you drink alcohol, if you choose to drink at all.
• Educate your loved ones, friends and co-workers. Teach loved ones and other close contacts how to recognize the early symptoms of blood sugar extremes and how to give emergency injections. If you pass out, someone should be able to call for emergency help.
• Wear a medical identification bracelet or necklace. If you’re unconscious, the bracelet or necklace can provide valuable information to your friends, co-workers and emergency personnel.

Continuous glucose monitor and insulin pump

A continuous glucose monitor, on the left, is a device that measures blood sugar every few minutes using a sensor inserted under the skin. An insulin pump, attached to the pocket, is a device that’s worn outside of the body with a tube that connects the reservoir of insulin to a catheter inserted under the skin of the abdomen. Insulin pumps are programmed to deliver specific amounts of insulin continuously and with food.

Topic 8. Compensation criteria for diabetes

In a person without diabetes, the fasting blood glucose level does not exceed 5.5 mmol / l in capillary blood, after eating – 7.8 mmol / l.

Ideally, a diabetic patient should aim for the same level of glycemia, allowing rises to 10 mmol/l at the peak of a meal. However, this is not always possible or necessary. Maintaining glucose levels close to normal is often associated with the risk of hypoglycemia. A diabetic patient receiving insulin therapy constantly balances the risk of complications due to high glycemia and the risk of hypoglycemia. And in some cases, this balance is shifted towards a higher level of glycemia. This is especially common in the elderly, for whom hypoglycemia is extremely dangerous.

Target glycemic levels are therefore individual!

The younger the patient, the less comorbidities he has, the closer to normal his glycemic control should be. But what is given to the young can be harmful to the elderly.

glycated hemoglobin ( HbA1c) is currently used as a criterion for diabetic compensation.

Glycated hemoglobin shows what was the compensation for the last 2-3 months. It must be determined at least 2 times a year.

Approximate targets for glycemic control by age and disease are shown in the table. Under certain conditions, treatment goals may be less stringent

If glycated hemoglobin was initially high at the time of diagnosis of diabetes (this is especially common in type 2 diabetes), glycemic control should not be quickly brought to the target level, especially in the elderly, as well as in people with changes in the fundus. Insulin-independent organs (brain, blood vessels, retina) are accustomed to a high level of glycemia, and if they suddenly “cut their rations”, they may not endure this without damage. Glycated hemoglobin in this case should decrease gradually, by about 0.5% in 3 months.

To assess compensation for the last 2-3 weeks, an analysis for fructosamines is prescribed. The normal level of fructosamines is up to 280 µmol/L. At a level of up to 320 µmol / l, diabetes is considered compensated in the last 2-3 weeks, 320-370 – subcompensated, more than 370 – decompensated.

However, even if you have ideal HbA1c, but there are daily fluctuations in blood sugar of more than 5 mmol/l, this cannot in any way protect you from the development of complications.

Glycated hemoglobin is like the average temperature in a hospital. And if the target value of glycated hemoglobin is achieved due to frequent hypoglycemia, then this has a very bad effect on target organs.

Recently, TIR (time in range) has been used as the main indicator of diabetes compensation. TIR shows how many percent of the time a person had a blood glucose level within acceptable limits. There are also other indicators that reflect daily fluctuations in blood glucose levels. But all these indicators can only be determined by continuous monitoring of blood glucose.

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How often should blood glucose be checked in type 2 diabetes

Some people with type 2 diabetes test their blood sugar too frequently with a home meter. Approximately one in five people with type 2 diabetes (i.e. those who do not need insulin and are not at high risk of hypoglycemia) check their blood sugar levels at home at least twice a day. It takes a little time to analyze this indicator with a home glucometer, but the excitement during this procedure is often present and money for test strips is usually spent in vain.

Doctors’ opinion on unnecessary home sugar tests

American scientists believe that frequent home testing with a glucometer does not improve health and does not provide any additional benefits. This opinion is shared, for example, by organizations such as the American Academy of Family Physicians, the Society for General Internal Medicine, and the Society of Endocrinologists. This does not mean that you can stop measuring your blood sugar tomorrow if you were given other recommendations. However, talk to your endocrinologist about the frequency of check-ups needed—every person is different.

Michigan study in 2013

In 2013, the Society of Endocrinologists and the Society of Internal Medicine issued guidelines that called frequent home blood sugar testing inappropriate. The Michigan researchers initially noticed that people record their blood sugar daily and for years and think they are in control of their condition. They studied the medical history of 370 thousand patients, referring to the data of insurance companies, and compared those patients who wrote prescriptions several times a year for 90 test strips, and those who did not receive prescription test strips.

It turned out that a third of the participants in the study bought 90 test strips three or more times a year. At the same time, 20% of them did not take diabetes medications at all, and 43% took only metformin or other drugs that do not cause hypoglycemia. Once a patient has been dosed with medication to maintain a stable sugar level, they do not need to do daily home tests. However, despite this, many patients still used an average of two test strips per day. At the same time, it is noted that some patients received such instructions from the doctor. In fact, instead of it being a year, abetics can do other more important tests every 2-3 months.

Cochrane review

Scientists reviewed 12 randomized clinical trials involving about 3000 patients. As a result, they found that there is no statistical difference between the condition of patients who do not control their blood sugar levels at home, and the condition of those who independently carry out such control several times a day . There are also no statistical differences in the quality of life of the two groups and the incidence of hypoglycemia.

It is important to understand that regular monitoring of blood sugar is essential while therapy is being studied and adjusted based on the results of home monitoring. Once blood sugar targets have been achieved as a result of therapy and self-monitoring results are predictable, there is little benefit for most people from frequent retests with a home glucometer.

However, it should be noted that there are exceptions when more frequent sugar control is still necessary for such patients:

• for colds;
• when taking new medicines for acute illnesses;
• when changing the target level of glycated hemoglobin.