Diabetics should pay special attention to their blood glucose levels and adjust their insulin dose according to their meals and activities. If the metabolism is derailed, diabetic coma may result.
What is diabetic coma?
Diabetic coma can occur in patients who have diabetes mellitus. After a metabolic derailment, they lose consciousness and go into a coma. This condition is an emergency situation that requires urgent treatment. If a patient with the condition, also known as coma diabeticum, remains untreated, it can lead to death. There are a number of signs that the patient should respond to as early as possible to avoid diabetic coma. These include loss of appetite and vomiting, as well as an increased feeling of thirst accompanied by an increase in the amount of urine excreted. General weakness, increased respiratory rate, and signs that the body is beginning to dry out are also among the warning signs of diabetic coma.
Causes
The causes of diabetic coma vary. However, it is always a problem related to the underlying diabetes mellitus. Coma is caused by either hypoglycemia or excess sugar. In hypoglycemia, also known as severe hypoglycemia, the cells in the brain as well as the red blood cells can no longer access sufficient glucose. This form occurs mainly in type 1 diabetics when their insulin dose was too high or they ate insufficiently. Diabetic ketoacidosis is another cause of coma and can be noticed even before its onset by the breath of the affected person. This smells strongly of acetone. As a result, there is hyperacidity of the blood, which leads to coma if left untreated. Type 2 diabetics are more likely to have high glucose levels, which can lead to hyperosmolar coma. The body excretes too much fluid and becomes dehydrated in the long term. If left untreated, a permanent excess of sugar also leads to diabetic coma.
Symptoms, complaints, and signs
Diabetic coma results in severe symptoms that have a very negative impact on the health of the affected person. For this reason, it is imperative that this condition be treated by a physician. First and foremost, the affected person suffers from a very strong and, above all, unpleasant bad breath. The patient’s mouth smells like rotten apples. The patient’s thirst also increases, so that he or she has to go to the toilet more often. Therefore, there is also an increased urge to urinate at night, which may lead to sleep problems and irritability of the patient. Furthermore, this disease can also lead to permanent nausea and exhaustion, so that the affected person can no longer actively participate in everyday life. Frequently, vomiting and severe abdominal pain also occur. The heart is also negatively affected by the disease, which can lead to low blood pressure. As a result, some patients suffer from disorders of consciousness and further loss of consciousness. The muscles of the affected person are significantly weakened, so that there can be severe limitations in everyday life. If the disease is not treated, it can also reduce the patient’s life expectancy.
Diagnosis
Diagnosis of diabetic coma is usually made by the emergency physician who is summoned. If the patient is alert, he or she may already be able to recognize from the warning signs that his or her metabolism is derailed and already take appropriate countermeasures. In the case of severe hypoglycemia, this is the immediate supply of sugar such as glucose. In any case, the doctor will first measure the blood glucose level to determine whether hypoglycemia or hyperglycemia exists. In addition, various blood values will be analyzed to determine what type of diabetic coma is involved.
Complications
Dialectical coma causes a variety of symptoms and complications that can be extremely limiting to the daily life of the affected person. In most cases, unpleasant bad breath occurs, which cannot be avoided by brushing the teeth or using mouthwashes. Likewise, the patient suffers from frequent urination, which occurs due to increased thirst. There is a general feeling of illness and also fever.Due to the occurring fatigue, many activities in everyday life are limited and no longer possible. The fatigue cannot be compensated by sleep. Often there is also muscle atrophy and pain in the abdominal region. The patient’s quality of life is extremely reduced by the dialectic coma. Furthermore, unconsciousness can occur in the worst case. During the course of treatment, the patient usually receives infusions and medications to alleviate symptoms. An emergency physician is also usually called and the affected person must stay in the hospital for a few days. If the diabetes continues to be treated properly, there will be no further complications or discomfort.
When should you go to the doctor?
Patients suffering from diabetes mellitus may experience a derailment of metabolism accompanied by impaired consciousness or even complete unconsciousness. Often, an incorrect insulin dosage is the cause. Diabetic coma can also affect people who do not know they are diabetic and are therefore not receiving treatment. Once diabetic coma manifests itself, the affected person is usually incapable of acting and relies on those around him or her to react properly. A diabetic coma is a medical emergency. First responders must call an ambulance immediately so that the patient can be taken to the nearest hospital as soon as possible. If the patient is unconscious, he or she should be placed in the recovery position until the emergency services arrive. However, first aiders must not administer insulin on their own authority under any circumstances. People who know that they suffer from diabetes mellitus should not let it get that far and should consult a doctor at the first signs of an acute metabolic disorder. A diabetic coma usually announces itself through a series of symptoms. Typical symptoms are, for example, foul breath, great thirst, which usually only occurs after highly salty or very spicy meals, or a frequent urge to urinate. Diabetics who notice such signs in themselves should always see a doctor promptly.
Treatment and therapy
Treatment of diabetic coma is usually performed by the emergency physician as well as later by the internist. In severe hypoglycemia, glucose must be given immediately. This is usually done via an infusion or via a so-called emergency injection that the patient carries for this purpose. If the affected person is still able to take something in, the administration of glucose also helps against the symptoms of hypoglycemia. In this type of diabetic coma, a relative can take the necessary measures even before the emergency physician arrives. In a ketoacidonic coma, insulin is administered first and the hyperacidity of the blood is then compensated for by infusions of electrolytes. In hyperosmolar coma, it is also important, in addition to the administration of insulin, to give the patient additional fluids via infusion to counteract further dehydration. In both ketoacidonic and hyperosmolar coma, the presence of a physician is mandatory for first aid, because there are no emergency measures that medical laypersons can take in these types of diabetic coma.
Outlook and prognosis
Diabetic coma is an emergency situation. The prognosis depends on the timing of medical care as well as the duration of the coma. In severe cases, the patient will die. Approximately 10% of those affected experience complete loss of consciousness. In 20%, no disturbances of consciousness are perceived. The remaining 70% of patients are awake but have limited or clouded consciousness. The prognosis worsens if fluid deficiency, acidosis, high loss of electrolytes, and persistently high blood glucose levels are present. Diabetic coma develops over several days. During this increase, there is a gradual increase in all symptoms until they ultimately lead to a collapse. There is a risk of dehydration as loss of appetite is evident over several days and patients take in too little fluid. Once diabetic coma is fully developed, immediate action must be taken to ensure the patient’s survival. If a significant drop in blood glucose levels can be achieved within 4-8 hours, the patient has a favorable prognosis.The fluid deficiency should be compensated slowly within 48 hours in order not to trigger an overload of the organism. The prospect of recovery should always be assessed on an individual basis. If renal failure occurs, the prognosis worsens.
Prevention
To prevent diabetic coma, diabetics should monitor their blood glucose levels very closely and adjust their daily insulin dose to their meals and activities. In addition, it is important to remember the warning signs of diabetic coma when changes occur in their condition and to take immediate countermeasures, seek medical attention, or call emergency services.
Follow-up
Diabetic coma is a possible acute sequela of diabetes mellitus. In this case, the patient should be monitored for some time after treatment with insulin and fluids to see if the change to a lower level of sugar in the blood is well tolerated and the patient remains stable. In general, the patient should also be educated about a recurrence of diabetic coma and provided with medication accordingly to be prepared in an acute case. Relatives should also be educated about the disease in order to recognize a recurrence of diabetic coma and to be able to act if the patient does not respond. Furthermore, when diabetes is first diagnosed, the patient should be well adjusted and educated about the use of medications. The patient should also be educated about regular follow-up appointments. These include, for example, annual check-ups with the ophthalmologist, who can use fundoscopy to detect changes in the back of the eye, the retina, in order to prevent possible blindness due to diabetes mellitus. Likewise, the patient should have his or her foot inspected more often by the primary care physician, as diabetic foot is not a rare complication of unadmitted diabetes mellitus. Likewise, follow-up visits by the nephrologist or by the neurologist are necessary, as diabetes can be damaging in these organs as well.
What you can do yourself
Adjusting the behavior in everyday life in persons suffering from diabetes contributes significantly to preventing diabetic coma. It results from a metabolic derailment due to hyperglycemia that cannot be cleared for lack of insulin or because of insulin resistance in the body’s cells. It is therefore particularly important that severe hyperglycemia – the triggering factor for diabetic coma – be avoided at all costs. Diabetic coma is an immediately life-threatening condition that corresponds to an acute emergency situation and requires clinical treatment. In addition to good adjustment and control of blood glucose and urinary acetone, it is recommended to pay attention to certain warning signs of the body that appear immediately before the onset of coma. If the usual symptoms such as a strong feeling of thirst, urge to urinate and unusual tiredness are joined by other signs such as nausea, vomiting and abdominal pain, which can also be misinterpreted, then the highest level of alert applies. If possible, blood glucose can be measured as a control. If a value of more than 250 milligrams per deciliter is indicated, immediate action is required. To avert the life-threatening situation, emergency care must be provided in a clinic. Due to the hyperacidity, there is an accumulation of acetone in the air breathed, which gives off an odor reminiscent of rotting apples.
