- Umesh Masharani, MB, BS, MRCP(UK)
Introduction
Coma may be due to a variety of causes not directly related to diabetes. Diabetic coma is a state of unconsciousness that can put a patient at risk of brain damage or even death. It is triggered by either persistent and extreme elevations in glucose (blood sugar) levels (hyperglycemia) or abnormally low glucose levels (hypoglycemia).
If the glucose level is too low, the person has hypoglycemia and if the level is too high, the person has hyperglycemia. Hyperglycemia is just a term for raised blood glucose but in some cases it can lead to a life-theathening condition called diabetic ketoacidosis. Patients with diabetes mellitus type 1 are especially prone to this condition.
Causes for this condition vary; in the case of diabetes, it could be due to too much food too quickly or forgetting to inject oneself with insulin, while in the case of hypoglycemia it could be due to a lack of food, too much exercise for current conditions, or to an insulin or other medication overdose.
Controlling glucose is the best way to prevent diabetic coma. Patients should consult with a physician about their appropriate glucose level and closely monitor this level to make sure it is not too high or too low. Changes in diet, exercise and medication may be necessary to manage glucose. A sick-day plan devised by a physician can also help prevent diabetic coma.
Certain causes directly related to diabetes require differentiation: (1) Hypoglycemic coma resulting from excessive doses of insulin or oral hypoglycemic agents. (2) Hyperglycemic coma associated with either severe insulin deficiency (diabetic ketoacidosis) or mild to moderate insulin deficiency (hyperglycemic hyperosmolar state). (3) Lactic acidosis associated with diabetes, particularly in diabetics stricken with severe infections or with cardiovascular collapse.
Diabetic coma is a condition in which a patient loses consciousness because of excessively high or excessively low glucose (blood sugar). A person in a diabetic coma is still breathing but is in a profound state of unconsciousness and cannot be aroused by stimuli.
A coma is a deep, prolonged state of unconsciousness caused by an injury or disease. A region deep within the brain stem stimulates the brain to various levels of wakefulness and alertness, depending on signals received from the eyes, ears, skin and other sensory organs. When this area of the brain is disturbed, a person’s consciousness may be impaired.
In most cases, a diabetic coma lasts a few days. Rarely, some patients may remain in a persistent coma (sometimes called “awake coma”). Patients in this state may have open eyes, and they may make grunting sounds or other vocalizations. However, the higher brain functions are absent.
Diabetic Coma
Hyperglycemic coma
The Hypoglycemic States
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