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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Recommended sources of information

What is the norm of blood sugar and what to do if it is high or low

Likbez

Health

January 25, 2022

Get your glucose tested at least every three years.

Why blood sugar is needed

In fact, we are not talking about sugar, but about glucose. Sugar, like any other carbohydrate, is not absorbed by the body directly: it is broken down in the intestines to simple sugars (monosaccharides) and enters the blood in the form of glucose.

A healthy 70 kg person has approximately 1 teaspoon (4 grams) of glucose in their blood at all times.

This substance is the main source of energy for all body cells. It is thanks to him that we have the strength to breathe, move, learn and think.

How blood sugar is measured and what is considered normal

In international practice, blood sugar (glycemia) is measured in the so-called molar concentration – millimoles per liter (mmol/l). In the United States, Germany, and some other countries, mass concentrations are also common, in milligrams per deciliter (mg/dL). To convert one concentration to another, it is enough to remember this equality: 1 mmol / l \u003d 18 mg / dl.

A blood sugar test is done on an empty stomach, usually in the morning. This is important because any food you eat can raise your glucose levels.

The sample can be taken from a finger or from a vein. Venous blood tests give a more accurate result.

Fasting blood glucose from a vein is between 3.9 and 5.6 mmol/L (70-100 mg/dL).

If the test result is different from the norm, this means the following:

• From 5.6 to 6.9 mmol / l – the so-called prediabetes. This is a slight increase in blood sugar levels, which means that something is going on in your body that increases the risk of developing diabetes.
• 7 mmol/l and above – hyperglycemia (increased blood glucose level). Most often, the violation speaks of diabetes mellitus.
• Below 3.9 mmol/l – hypoglycemia (low blood glucose). This is also an unhealthy condition that can be a sign of a number of disorders in the body.

Please note: when testing blood from a finger, the normal values ​​shift – up to the range of 3. 3-5.5 mmol / l.

Why blood sugar changes

The body regulates the amount of glucose in the blood by:

• enzymes that help break down carbohydrates in the intestines and thus affect the rate at which glucose enters the bloodstream;
• hormones that determine how quickly the cells of the body will consume sugar from the blood.

Essential enzymes are produced by the pancreas. It also produces insulin, a key hormone that allows cells to absorb glucose. If there is too little insulin, or, for example, cells stop responding to it for some reason (this is called insulin resistance), blood sugar levels rise. In the first situation, they speak of type 1 diabetes, in the second, of type 2 diabetes.

Glycemia is also affected by the work of:

• the liver and kidneys, which purify the blood from excess glucose and remove the substance from the body;
• thyroid gland: hormones secreted by it determine the rate at which cells consume sugar from the blood;
• adrenal glands. This paired endocrine gland also produces hormones (such as adrenaline) that regulate metabolic rate.

What is the danger of abnormal sugar levels

Both hypo- and hyperglycemia affect well-being. First of all, the brain suffers, since its cells consume about half (up to 60% – if we are talking about a hungry or inactive person) of all the energy supplied by glucose.

Dizziness, loss of concentration, weakness, blurred vision, trembling hands are common symptoms for both low and high blood sugar levels. But abnormal glycemia, in addition to feeling unwell, has other, more serious consequences.

With constant hyperglycemia, glucose accumulates in organs and tissues and becomes toxic – it begins to destroy the liver, kidneys, retina, blood vessels, heart, and nervous system. With a lack of sugar, the cells of the body are chronically lacking nutrition, and this also leads to damage to vital organs.

Why blood sugar levels are high

Most often this indicates a pre-diabetic state or diabetes mellitus that has already occurred. However, other medical problems can also lead to an increase in glycemia.

• Hyperthyroidism. This is a condition in which the thyroid gland produces too many hormones.
• Pancreatitis is an inflammation of the pancreas.
• Severe stress.
• Trauma or surgery.
• Diseases of the liver.
• Stroke.
• Pancreatic cancer, as well as other rarer tumors.

Why blood sugar is low

Hypoglycemia is also a common companion of diabetes. It occurs when a person suffering from this disease takes too much insulin by mistake. But other reasons for low blood glucose levels are also possible.

• Insufficient nutrition. The amount of sugar in your blood drops if you are on a too rigid diet or suffer from an eating disorder such as anorexia or bulimia.
• Too strenuous and long exercise. Let’s say you just ran a marathon, rode a few tens of kilometers on a bike, or just dug a garden, forgetting about lunch.
• Hypothyroidism. This is a condition in which the thyroid gland produces too little hormone.
• Diseases of the adrenal glands, pituitary gland, liver or kidneys.

How to know if your blood sugar level is abnormal

It is almost impossible to do this without a blood test. The fact is that the characteristic symptoms of a decrease or increase in glucose levels can be easily confused with ordinary fatigue or, for example, a reaction to weather changes.

In order not to miss the developing hypo- or hyperglycemia and the diseases that caused it, doctors – both Western and Russian – recommend regularly testing blood sugar levels.

Donate blood for sugar at least once every three years. This is especially important for people over 45.

In addition, it is recommended to do the analysis as soon as possible if you have signs of diabetes:

• frequent urination;
• you have put on a lot of weight;
• your eyesight is getting worse;
• weakness regularly rolls up, up to darkening in the eyes.