What Happens When You Go Into Diabetic Coma?

What Happens When You Go Into Diabetic Coma?

Diabetes mellitus or the sugar disease is a clinical syndrome of a number of conditions rather than just a single disease condition known by abnormally high blood sugar due to deficient insulin. Globally, there has been a sharp rise in the incidence of diabetes in the last decade. It has emerged to become a major burden for health-care systems all over the world. The incidence of diabetes has reportedly increased the under-developed and developing countries.

“Researchers in India have recognized diabetes as the fastest growing disease in India with over 72 million cases of diabetes recorded in the year 2017”

Diabetes Can Be Classified as

  1. Type I Diabetes – Results from the destruction of beta-cells of the pancreas (beta-cells secrete insulin) which causes an absolute deficiency of insulin
  2. Type II diabetes – Results from impaired insulin secretion or function
  3. Gestational Diabetes Mellitus – Diabetes develops during pregnancy
  4. Other Types – Drug related, neonatal diabetes, related to HIV/ AIDs, related to genetic syndromes and related to viral infections like rubella, mumps and Coxsackie virus B.

Type-II Diabetes Particularly is the Commonest Type and It Can Occur Due to the Following Risk Factors

  1. Strong family history of type-II diabetes
  2. Obesity
  3. Sedentary lifestyle
  4. History of gestational diabetes
  5. Previous history of impaired glucose tolerance
  6. Hypertension
  7. Dyslipidemia (High Cholesterol Levels)
  8. Polycystic Ovarian Syndrome
  9. History of having vascular disease

Lack of insulin causes disturbances in the balance of water and electrolytes in the body. It also adversely affects the metabolism of carbohydrates, fats and proteins. Long standing metabolic abnormalities along with poorly controlled blood sugar levels can cause complications like blindness, diabetic nephropathy or kidney failure, heart attacks, strokes, impaired sexual function, and also affects the body’s ability to heal wounds and fight infections.

Among the list of complications related to diabetes mellitus, the two major life-threatening complications are Diabetic Ketoacidosis and Diabetic Coma. If you are a diabetic, this article will take you through the most dreaded complication of diabetes and help you understand what happens to you when you go into diabetic coma.

What is Coma?

Coma is a persistent loss of consciousness due to disorders of arousal mechanisms in brain-stem or due to brain-stem disease. Coma can occur due to several reasons and the causative event is of special importance to understanding the cause of coma.

What is Diabetic Coma?

Although diabetic coma may sound like a dangerous term, it is often reversible in contrast to other types of coma which may result in death.

Types of Diabetic Coma

  1. Diabetic Ketoacidosis (DKA)
  2. Severe Hypoglycemia
  3. Hyperglycemic Hyperosmolar State (HHS)

Certain Clinical Conditions Which work as Triggers for Diabetic Coma in Patients Having Diabetes are

  • Acute myocardial infarction (heart attack)
  • Acute liver injury
  • Hypoxic states (conditions where the body or a single part or organ receives less oxygen)
  • Septicemia (widespread infection in the body)
  • Stroke

What Happens When you go into Diabetic Coma?

What happens to you when you go into diabetic coma depends entirely upon the causative factors and type of coma. This can be better understood by segregating the types of coma.

Type of diabetic coma  Description
Diabetic Ketoacidosis

 

It is the leading causeofr diabetes-related deaths in children and adolescents having type-I diabetes.

 

 

It is a metabolic disorder and a medical emergency due to

  • Reduced insulin in circulation
  • Insulin resistance
  • Increased production of regulatory hormones.

Infection is the most common cause for deficient insulin.

Clinical Features of Diabetic Ketoacidosis Are

  • Polyuria(passing abnormally large quantities of urine)
  • Leg cramps and weakness
    Blurred vision
  • Nausea and vomiting
  • Dehydration
    Reduced blood pressure
  • Coldness or bluish discoloration of extremities
  • Air hunger (urge to breath due to high levels of carbon dioxide in the blood)
  • Rapid heartbeat (tachycardia)
  • Confusion, drowsiness and eventually coma
Hypoglycemic Coma

There are abnormally low blood sugar levels (less than 40 mg/dL).

 

Presentation of hypoglycemic coma includes varied degree of neurological dysfunction which responds to glucose therapy.

 

Untreated hypoglycemia which lasts longer than 6 hours can cause permanent brain damage.

 

Recurrent hypoglycemic episodes can cause deranged cognitive function due to progressive brain damage.

 

Hypoglycemia can occur due to a variety of pre-disposing factors. Some of them are

  • Delayed meals or skipped meals
  • Reduced carbohydrate in the diet
  • High dose of insulin or OHA (oral hypoglycemic agents)
    During acute illnesses
  • Reduced insulin requirement
  • Alcohol consumption
  • Unusual physical exertion after taking insulin or OHA dose.

Clinical presentation of hypoglycemic coma:

  • Yawning
    Increased hunger
  • Increase in sweating
    High blood pressure and palpitations
    Anxiety
  • Unconsciousness or fainting
  • Generalized weakness
  • Tingling sensation and tremors in extremities
    Visual disturbances
  • Mental confusion and disorientation
  • Seizures and coma

 

Hyperglycemia Hyperosmolar State

 

It is commonly seen among elderly patients with type-II diabetes.

 

It is a condition of hyperglycemic emergency (extremely high blood sugar levels) in diabetic patients.

 

The mortality related to hyperglycemic hyperosmolar coma is about 20%.

 

In this condition, patients present with

  1. Severe hyperglycemia
  2. Hyperosmolarity (concentration of body fluids increases abnormally)
  3. Dehydration without keto-acidosis with loss of water and electrolytes

In this condition, hyperglycemia develops due to

  • Increased formation of glucose by liver
  • Increased conversion of glycogen to glucose
  • Inadequate utilization of glucose by body tissues

Acute infections are responsible for about 30-60% of cases. Other causes include:

  • Strokes
  • Heart attack
  • Acute pancreatitis
  • Intestinal obstruction
  • Peritoneal dialysis
  • Kidney failure
  • Subdural hematoma and cerebral edema
  • Severe burns
  • Drugs like beta blockers, calcium channel blockers, diuretics, immunosuppressive agents, anti-epileptic drugs and steroids.

 

How to Treat Diabetic Coma?

Treatment for diabetic coma will depend on the type of coma. Treatment can be differentiated accordingly

Type of diabetic coma Treatment
Diabetic keto-acidosis

 

Treatment for DKA aims at

  1. Fluid replacement because dehydration can worsen acidosis
  2. Insulin has several effects in managing DKA. It reduces formation and release of glucose and ketones in the blood. Insulin also allows utilization of glucose by the body tissues.
  3. Potassium replacement since there is a steady reduction in potassium during treatment for DKA. Potassium levels however need to be monitored regularly.
  4. Bicarbonate therapy if patient’s blood pH is below 6.9.
  5. Antibiotics may be needed in case of diabetic keto-acidosis due to infections.
Hypoglycemic Coma

 

Hypoglycemia needs prompt treatment irrespective of the degree of hypoglycemia.

 

Treatment criteria for hypoglycemic coma are – “when in doubt, treat.”

Treatment for hypoglycemia in a conscious patient includes

  • Administration of 10-20 grams of glucose or easily digestible form of carbohydrates orally.
  • This is followed by a snack of more slowly digestible form of carbohydrates (like bread or biscuits).
  • Maintain normal blood sugar levels until the next meal.

Treating an unconscious hypoglycemic patient

  • Intravenous glucose (50% or 25% dextrose)
  • Carbohydrates are given orally as soon as the patient regains consciousness.
  • Long term intravenous glucose infusion may be required.
  • Patients who do not regain consciousness within half an hour of therapy may take longer time to recover.
Hyperglycemic hyperosmolar state Treatment aims at

  • Improving circulating fluid volume and tissue perfusion
  • Regulation of electrolytes
  • Reducing blood glucose levels and Hyperosmolarity

Treatment strategies include

  1. Hydration – Choice of fluid depends upon serum electrolytes
  2. Insulin therapy is not started unless serum potassium levels are back to normal range.

Maintaining a healthy diet and weight with regular physical activity and curbing the use of tobacco and alcohol can prevent or delay the occurrence of diabetes in high-risk individuals.

For diabetics, following a diabetic diet having a low-glycemic index, regular exercise, timely monitoring of blood sugar levels, HbA1C levels and following regular medications can control diabetes and prevent its complications.

Educating the patient and their relatives about regular monitoring and managing abnormal blood sugar levels is of utmost importance. This helps them in identifying emergency conditions which cause diabetic coma early and what happens when they go into a diabetic coma so that they can contact their doctor immediately to seek treatment.