Diabetes, in itself, is already pretty sinister-sounding. Add coma and you got yourself a real scare.

Comatose is a state of unconsciousness for an indefinite period of time, mostly the result of illness or injury. During this time, the comatose patient will be unable to communicate or respond to outside stimuli. Unexpected injuries or accidents, especially those that impacted the head, can make the patient trapped inside a brain-dead body.

Diabetic coma, for lack of any better term, is comatose caused by diabetic complications, namely: hyperglycemia (very high blood sugar level) or hypoglycemia (really low blood sugar level). Same with the comatose induced by other complications, diabetic coma can reduce a person to a half-alive state where they can’t respond purposefully to sights, sounds, and other types of stimulation.

Without treatment, diabetic coma is fatal.

Causes and Symptoms

Hyperglycemia or hypoglycemia precedes diabetic coma. Those who go through diabetic coma are usually the diabetics who ignored the warning signs of either of those two.

The former, hyperglycemia is one of the most recognizable signs of diabetes, both types 1 and 2. Although recognized as one of the warning signs of diabetic coma, it’s not only diabetes that can cause hyperglycemia. Pancreatitis, Pancreatic Cancer, Cushing’s syndrome, and other conditions that involve hormone-secreting tumors can also cause this.

Hyperglycemia can be identified with the following symptoms:

• Frequent urination
• Increased thirst
• Nausea and vomiting
• Fatigue
• Stomach pain
• Shortness of breath
• Very dry mouth
• Fruity breath odor
• Rapid heartbeat

For hypoglycemia, we’re going to the other extreme end of the pendulum. Abnormally low blood sugar, hypoglycemia usually means blood glucose at less than 70 mg/dl levels. This can also be referred as insulin reaction or insulin shock. Although the symptoms might be the same across all hypoglycemics, each person’s reaction to extremely low blood glucose is different. Thus, it is important that you know your own hypoglycemic signs and symptoms.

These are the most common symptoms of hypoglycemia:

• Shakiness
• Nervousness or anxiety
• Sweating, chills, and clamminess
• Irritability or impatience
• Confusion, including delirium
• Rapid heartbeat
• Lightheadedness or dizziness
• Hunger and nausea
• Sleepiness
• Blurred/impaired vision
• Tingling or numbness in the lips or tongue
• Headaches
• Weakness or fatigue
• Anger, stubbornness, or sadness
• Lack of coordination
• Nightmares or crying out during sleep
• Seizures
• Unconsciousness

If you experience any of the symptoms of high or low blood sugar, quickly test your blood and follow the diabetes treatment plan that your doctor prescribed. Call for emergency help if you don’t start to feel better or if you start feeling worse. Immediately call for help if you feel like passing out or if your companion who has diabetes passed out.

Risk Factors and Complications

All diabetics, whether type 1 or type 2, are at risk of a diabetic coma. For those with type 1 diabetes, their diabetic coma is more likely to be caused by:

• Low blood sugar (hypoglycemia)
• Diabetic ketoacidosis (Happens when your muscle cells are deprived of energy, thus resorting to breaking down fat stores. Acids known as ketones are formed during this process.)

For those with type 2 diabetes, they are more at risk of a diabetic coma caused by:

• Diabetic hyperosmolar syndrome (Blood sugar level over 600 mg/dL or 33.3 mmol/L – the blood gets thick and syrupy)

For either type 1 and type 2 diabetics, the following factors can increase the risk of a diabetic coma:

• Poorly managed diabetes
• Drinking alcohol
• Illegal drug use
• Insulin delivery problems
• Illness, trauma, or surgery
• Deliberately skipping insulin

Left untreated, a diabetic coma can lead to either permanent brain damage or death.

Prevention

This is pretty basic, just good old day-to-day control of your diabetes. To guide you, follow the tips below:

1. Keep an eye on your blood sugar level. If you test yourself daily, you’ll have a good idea whether you’re keeping your blood sugar level within the target range your doctor set.
2. Take your medication as prescribed. Follow the prescription of your doctor to the letter. If you feel that the medication given to you isn’t that much effective, inform the doctor immediately. Refrain from self-medicating.
3. Follow your meal plan. You can manage your blood sugar better by following the meal plan set by your nutritionist or doctor.
4. Look for ketones when your blood sugar is high. If your blood sugar is more than 240 mg/dL, check your urine for ketones. Call your doctor immediately if there are ketones and if you are vomiting.
5. Always have handy fast-acting sources of sugar. If you’re taking insulin for diabetes, always bring a glucagon kit and fast-acting sources of sugar such as glucose tablets or orange juice.
6. Drink alcohol with caution. Or better yet, don’t drink at all. Alcohol can have an unpredictable effect on your blood sugar.
7. Consider getting a continuous glucose monitor. This is a small sensor that is inserted underneath the skin to track trends in your blood sugar levels. It also transmits information to a wireless device.
8. Wear a medical ID bracelet or necklace. This can help you if you’re unconscious and need immediate medical attention.
9. Educate your loved ones, friends, and co-workers. Tell them what signs or symptoms to look out for, how to administer cures (glucagon injection, etc.), and how to summon emergency help of you pass out.

References:

Nordqvist, C. (2017, November 20). Coma: Causes, diagnosis, treatment, and outlook. Retrieved March 05, 2018, from https://www.medicalnewstoday.com/articles/173655.php

Mayo Clinic. (n.d.). Diabetic coma. Retrieved March 5, 2018, from https://www.mayoclinic.org/diseases-conditions/diabetic-coma/symptoms-causes/syc-20371475

Stöppler, M. C., MD. (n.d.). Hyperglycemia (High Blood Sugar) (J. R. Balentine DO, FACEP, Ed.). Retrieved March 5, 2018, from https://www.medicinenet.com/hyperglycemia/article.htm

American Diabetes Association. (n.d.). Hypoglycemia (Low Blood Glucose). Retrieved March 5, 2018, from http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html

Hamdy, O., MD, PhD. (2018, February 23). Diabetic Ketoacidosis (R. Khardori MD, PhD, FACP, Ed.). Retrieved March 06, 2018, from https://emedicine.medscape.com/article/118361-overview#a1