What are the symptoms of a diabetic coma. How can high or low blood sugar lead to a diabetic coma. What are the risk factors for developing a diabetic coma. How can diabetic coma be prevented.

What is a Diabetic Coma?

A diabetic coma is a severe, life-threatening condition that occurs in people with diabetes when their blood sugar levels become dangerously high or low. This state of unconsciousness prevents a person from responding to stimuli and, if left untreated, can result in death.

The primary causes of diabetic coma are:

• Hyperglycemia (extremely high blood sugar)
• Hypoglycemia (extremely low blood sugar)

Understanding the symptoms and causes of diabetic coma is crucial for prevention and early intervention. People with diabetes and their caregivers should be aware of the warning signs and risk factors associated with this serious complication.

Recognizing the Symptoms of High Blood Sugar (Hyperglycemia)

Hyperglycemia, or high blood sugar, can lead to a diabetic coma if left untreated. Recognizing the symptoms early is crucial for preventing this life-threatening condition.

Common symptoms of high blood sugar include:

• Increased thirst and frequent urination
• Blurred vision
• Fatigue or weakness
• Headache
• Nausea and vomiting
• Shortness of breath
• Abdominal pain
• Fruity breath odor
• Extreme dry mouth

Is there a specific blood sugar level that indicates hyperglycemia? While individual targets may vary, blood glucose readings above 180 mg/dL (10 mmol/L) are generally considered high. However, symptoms may not appear until levels reach 200-250 mg/dL (11.1-13.9 mmol/L) or higher.

Identifying Low Blood Sugar (Hypoglycemia) Symptoms

Hypoglycemia, or low blood sugar, can also lead to a diabetic coma if severe and prolonged. Recognizing these symptoms is essential for prompt treatment and prevention of further complications.

Common symptoms of low blood sugar include:

• Shakiness and anxiety
• Fatigue or drowsiness
• Weakness
• Excessive sweating
• Intense hunger
• Tingling sensations on the skin
• Dizziness or lightheadedness
• Headache
• Difficulty speaking
• Blurred vision
• Confusion
• Loss of consciousness (in severe cases)

When does hypoglycemia occur? Generally, blood sugar levels below 70 mg/dL (3.9 mmol/L) are considered low. However, some people may experience symptoms at slightly higher or lower levels, depending on their individual physiology and diabetes management.

Hypoglycemia Unawareness: A Silent Danger

Some individuals with long-standing diabetes may develop a condition called hypoglycemia unawareness. This means they don’t experience the typical warning signs of low blood sugar, putting them at greater risk for severe hypoglycemia and diabetic coma.

How can people with hypoglycemia unawareness protect themselves? Regular blood glucose monitoring, wearing a continuous glucose monitor (CGM), and working closely with healthcare providers to adjust treatment plans are essential strategies for managing this condition.

Understanding the Causes of Diabetic Coma

A diabetic coma can result from several underlying conditions related to blood sugar imbalances. Understanding these causes is crucial for prevention and management of diabetes complications.

Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis occurs when the body doesn’t have enough insulin to use glucose for energy, leading to the breakdown of fat for fuel. This process produces toxic acids called ketones, which can accumulate in the blood and urine.

Who is most at risk for DKA? While DKA is most common in people with type 1 diabetes, it can also occur in those with type 2 or gestational diabetes. It’s often triggered by illness, injury, or inadequate insulin intake.

Diabetic Hyperosmolar Syndrome (HHS)

Diabetic hyperosmolar syndrome is characterized by extremely high blood sugar levels, typically above 600 mg/dL (33.3 mmol/L). This condition leads to severe dehydration as the body attempts to flush out excess glucose through urine.

How does HHS differ from DKA? Unlike DKA, HHS doesn’t typically involve ketone production. It’s more common in older adults with type 2 diabetes and can develop more slowly over days or weeks.

Severe Hypoglycemia

While less common, severe hypoglycemia can also lead to a diabetic coma. This occurs when blood sugar drops to dangerously low levels, depriving the brain of necessary glucose.

What causes severe hypoglycemia? Common triggers include taking too much insulin, skipping meals, excessive alcohol consumption, or intense physical activity without proper fuel.

Identifying Risk Factors for Diabetic Coma

While anyone with diabetes is at risk for developing a diabetic coma, certain factors can increase this risk significantly. Understanding these risk factors can help individuals and healthcare providers take appropriate preventive measures.

1. Insulin Delivery Problems: For those using insulin pumps, malfunctions or catheter issues can lead to insulin deficiency and increased risk of diabetic ketoacidosis.
2. Illness, Trauma, or Surgery: These stressors can cause significant fluctuations in blood sugar levels, potentially leading to diabetic ketoacidosis or hyperosmolar syndrome.
3. Poor Diabetes Management: Inconsistent blood sugar monitoring and medication adherence increase the risk of long-term complications and diabetic coma.
4. Intentional Insulin Omission: Some individuals with diabetes and eating disorders may deliberately skip insulin doses to lose weight, a dangerous practice that significantly increases the risk of diabetic coma.
5. Alcohol Consumption: Alcohol can have unpredictable effects on blood sugar and may mask hypoglycemia symptoms, increasing the risk of severe low blood sugar episodes.
6. Illegal Drug Use: Substances like cocaine can interfere with blood sugar regulation and increase the risk of complications.

How can individuals mitigate these risk factors? Maintaining open communication with healthcare providers, adhering to treatment plans, and developing strategies to address potential triggers are essential steps in reducing the risk of diabetic coma.

Prevention Strategies for Diabetic Coma

Preventing a diabetic coma involves a multifaceted approach to diabetes management. By implementing these strategies, individuals with diabetes can significantly reduce their risk of experiencing this life-threatening complication.

Consistent Blood Sugar Monitoring

Regular blood glucose checks are crucial for maintaining optimal levels and detecting potential problems early. How often should blood sugar be monitored? This varies depending on the individual’s diabetes type, treatment plan, and overall health status. Many people benefit from checking at least 4-6 times daily, while others may use continuous glucose monitors for real-time data.

Medication Adherence

Taking insulin and other diabetes medications as prescribed is essential for maintaining stable blood sugar levels. Why is consistency so important? Skipping doses or taking incorrect amounts can lead to dangerous fluctuations in blood glucose, increasing the risk of complications like diabetic coma.

Balanced Diet and Meal Planning

A nutritious, well-balanced diet helps maintain stable blood sugar levels. What does a diabetes-friendly diet look like? It typically includes a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats, with careful attention to carbohydrate intake and portion sizes.

Regular Physical Activity

Exercise can help improve insulin sensitivity and overall blood sugar control. How much exercise is recommended? The American Diabetes Association suggests at least 150 minutes of moderate-intensity aerobic activity per week, spread over at least three days, with no more than two consecutive days without exercise.

Stress Management

Chronic stress can affect blood sugar levels and overall diabetes management. What are effective stress-reduction techniques? Options include meditation, deep breathing exercises, yoga, regular physical activity, and seeking support from mental health professionals when needed.

Alcohol Moderation

If choosing to drink alcohol, moderation is key. How can people with diabetes drink safely? Limit alcohol intake, never drink on an empty stomach, and monitor blood sugar closely before, during, and after consuming alcoholic beverages.

Sick Day Management

Illness can significantly impact blood sugar levels. What should people with diabetes do when they’re sick? Continue taking medications as prescribed, monitor blood sugar more frequently, stay hydrated, and have a sick day plan developed with their healthcare provider.

Emergency Response to Diabetic Coma Symptoms

Recognizing the signs of an impending diabetic coma and knowing how to respond can be life-saving. It’s crucial for people with diabetes, their family members, and caregivers to be prepared for such emergencies.

Immediate Actions for Suspected Diabetic Coma

If someone with diabetes shows signs of severe high or low blood sugar and appears to be losing consciousness, take these steps:

1. Call emergency services immediately (911 in the US).
2. Do not attempt to give food or drink to an unconscious person.
3. If trained and if glucagon is available, administer it for suspected severe hypoglycemia.
4. Place the person in the recovery position if unconscious but breathing.
5. Provide emergency responders with information about the person’s diabetes and any medications they take.

Why is rapid response so crucial in cases of suspected diabetic coma? Quick intervention can prevent brain damage and other serious complications associated with prolonged periods of extreme blood sugar levels.

The Importance of Diabetes Education and Support

Comprehensive diabetes education plays a vital role in preventing diabetic coma and other complications. What should diabetes education cover? Key topics include blood sugar monitoring, medication management, nutrition, exercise, stress management, and how to recognize and respond to diabetes emergencies.

Support from family, friends, and diabetes care teams is also crucial. How can loved ones help? They can learn about diabetes management, recognize warning signs of blood sugar extremes, and provide emotional support for the challenges of living with diabetes.

Technological Advancements in Diabetes Management

Recent years have seen significant technological developments that can aid in preventing diabetic coma and improving overall diabetes management. These innovations offer new tools for monitoring blood sugar levels and delivering insulin more effectively.

Continuous Glucose Monitoring (CGM) Systems

CGM devices provide real-time blood sugar data, allowing for more proactive management. How do CGMs work? A small sensor inserted under the skin measures glucose levels in interstitial fluid, transmitting data to a receiver or smartphone app. Many CGMs can alert users to dangerous highs or lows, potentially averting crisis situations.

Insulin Pump Technology

Advanced insulin pumps, some integrated with CGM systems, can automatically adjust insulin delivery based on blood sugar trends. What are the benefits of these “closed-loop” systems? They can help maintain more stable blood sugar levels, reducing the risk of extreme highs and lows that could lead to diabetic coma.

Smartphone Apps and Digital Health Platforms

Various apps and digital tools can help people with diabetes track their blood sugar, medications, diet, and exercise. How can these technologies improve diabetes management? By providing easy data logging, trend analysis, and even predictive insights, these tools empower users to make informed decisions about their diabetes care.

While technology can greatly assist in diabetes management, it’s important to remember that it complements, rather than replaces, the fundamental aspects of diabetes care. Regular medical check-ups, adherence to treatment plans, and a healthy lifestyle remain crucial components of effective diabetes management and diabetic coma prevention.

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.