Diagnosis of diabetic coma

The diagnosis of diabetic coma is suspected by the appearance of the typical signs and symptoms and is confirmed by measuring the blood sugar level. In ketoacidotic coma, blood sugar levels are moderately elevated (>300mg/dl), and ketone bodies can also be found when examining the urine. Acidosis can also be determined by a blood sample with acidic pH (<7.3). In a hyperosmolar coma, the blood sugar levels are significantly elevated (often >1000mg/dl), no ketone bodies are found in the urine and the blood pH is in the normal range.

Signs of diabetic coma

A typical sign of diabetic coma is the increase in the amount of urine and the frequency of toilet visits, which increase over several days. As a result, there is a significant increase in the amount of drinking, but the patients are still rather dehydrated, which is shown by dry mucous membranes, dry skin and, in older patients, standing skin folds. Other signs are rapid fatigue, reduced performance, nausea and vomiting, which always develop during the course of diabetic coma.

Concomitant symptoms of diabetic coma

The diabetic coma does not develop suddenly, but over several days. During these days, diabetic coma can lead to a clouding of the state of consciousness. Approximately 10% of the patients become completely unconscious, the majority (70%) experience at least a clouded or limited consciousness, which is manifested for example by increasing confusion.

About 20% of the patients do not experience a disturbance of consciousness. Due to the lack of fluid in diabetic coma, in addition to the above-mentioned signs (increased urine and drinking volume, dehydration), low blood pressure can occur, which in the worst case can lead to a volume deficiency shock with sudden unconsciousness. A typical accompanying symptom of ketoacidotic coma is the so-called “kissing mouth breathing“, a deep breathing, which counteracts the hyperacidity of the blood through increased exhalation of CO2 and acetone. These patients often have a fruit-like acetone smell.In some cases, patients in a ketoacidotic coma experience severe abdominal pain, which can resemble appendicitis (pseudoperitonitis diabetica).