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Diabetic Coma Treatments

By Dr Ananya Mandal, MD

Diabetic coma is a condition that poses a dangerous threat to individuals with diabetes. Treatment is more effective the earlier it is started but depends on the cause of the coma as this defines which type of diabetic coma a patient has.

The three causes of diabetic coma are severe hypolgycemia or lowering of the blood sugar level, diabetic ketoacidosis which causes high blood glucose levels, and hyperglycaemic hyperosmolar state which also causes raised blood glucose.

Therefore, when a diabetic patient is unconscious, the first action taken is blood sugar testing. If the cause is hypoglycemia, treatment is aimed at raising the blood sugar levels, whereas it is aimed at reducing the blood sugar with either of the other two conditions.

Treatment

Severe hypoglycemia

If the blood sugar levels in the blood and brain drop to below normal, the risk of losing consciousness and falling into a diabetic coma is increased. Coma due to severe hypoglycemia is more likely to occur if a patient has taken a large overdose of insulin or other anti-diabetic medications, if alcohol is present in the system while the patient is hypoglycemic or if exercise has reduced the body's supply of glycogen.

Glucagon may be administered to treat hypoglycemia. In healthy individuals, a fall in blood sugar is compensated for by the release of glucagon, which increases blood sugar levels. However, in the diabetic individual, this reaction fails to occur and exogenous glucagon needs to be administered. As an immediate measure, glucose rich foods such as glucose biscuits may be eaten or an injection of glucose solution may be administered. People with diabetes are advised to carry glucose biscuits with them to eat and counteract hypoglycemia as soon as symptoms manifest.

Diabetic ketoacidosis

This is more common among people who are taking insulin for their diabetes. Comas resulting from this condition are induced by a build-up of acidic compounds in the blood called ketones which may occur when the individual has missed an insulin dose. Ketoacidosis may also occur if a person has suffered an acute injury or infection, both of which can raise levels of hormones that counteract the effects of insulin. Anesthesia and surgery can also alter hormone levels in this way. Treatment includes administering isotonic intravenous fluids to correct dehydration and replacing lost electrolytes with sodium, potassium, magnesium and phosphate supplements. Insulin is administered intravenously to reduce blood glucose and reverse ketoacidosis.

Hyperglycaemic hyperosmolar state

Comas that result from HHS are characterized by severe dehydration and very high blood glucose. Treatment includes rapid administration of insulin to bring down blood sugar levels and correction of dehydration using intravenous fluids. Fluids should be given at least 30 to 60 minutes before insulin. Electrolytes may also be replaced as needed and some patients may require antibiotics to clear infection.

Reviewed by , BSc

Further Reading

Last Updated: Oct 25, 2013

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Comments
  1. meme tony meme tony U.A.E. says:

    Hello, I'm writing a screenplay about a person who has diabetes would be in coma for 4 years because of that. Is it realistic? i'm not sure if this kind of coma would put a person unconscious that long. Also,  how bad/good the person's health situation would be when they wake up? can they live normally? Is it possible that their life would still be in danger even after they woke up and recovered?

    • Ann Stanton Ann Stanton United States says:

      Just search around the web every so often looking at what's going on in the diabetes community and nursing homes.  After my sister died in July 2012, I guess it really had an effect on me about this condition and what people go through.  I've been at this for over 4 years now.  She had a brain injury from a severe hypoglycemic event on 4/16/12 while at a nursing home for rehab/wound care after an extended hospital stay.  She was to get a glucagon shot but they evidently didn't have it and didn't call 911, so gave oral glucose gel to a person rapidly becoming unresponsive. She ended up with anoxic brain injury, coma, respiratory arrest and aspiration pneumonia at the hospital.  It had been 35 min before the paramedics were called and got to her and she was near death.  She was on life support for three months and during that time felt only pain.  There had been times of some hope but I was eventually told she would remain in a vegetative state so I did the only human thing and removed her from life support.  The past four years, I've been disputing the nursing home and government authorities here who have tried to conceal what happened and refused to answer my questions about this. I just can't figure out why they refused to enforce laws that exist and cite them for what they did but that is why I continue on this course.  Hope you may have found someone who could give you the info you needed about a longer time on a coma.

  2. Louise Wakefield Louise Wakefield United Kingdom says:

    Hi, it is unlikely that someone in a diabetic coma would be unconscious for this length of time as once the imbalance in blood sugar & electrolytes has been corrected the patient usually regains consciousness. Unless of course they developed brain damage as a result in which case it's unlikely they would make a full recovery. If you want to base your play on someone who is in a coma for this long & recover it may be more credible to base it on someone who has sustained trauma to the head I.e. brain injury as there have been cases of patients who have regained consciousness after lengthy periods in a coma & made a relatively full recovery etc.

    Hope this helps

  3. Dave Barnes Dave Barnes Australia says:

    I had a diabetic coma when I was 21. I had been rock climbing all day and in the evening had too much insulin and too little carbs in an evening meal. Away from home and sleeping on a floor I went into coma. The ambulance were called and it took a large effort to keep me stable and inject glucose however I went out from that point and was out for three full days in hospital ( brain tests were done in that time and found I had not hit my head climbing etc). I woke up not all together with this really weird need to get out of hospital. I discharged myself, walked 5k through a strange town with no money to a friends place who gave me $20 to get home on a train. Four hours of travel later I arrived in my home town totally messed up in my head, my arm aching from the struggle I had given the ambos with that intravenous needle for glucose five days before and still not having my head together.
    Since that time (20 years ago) I believe I have had trouble concentrating, often need time alone, have small friendship groups and have lost friends too as they believe you character has been negative. In hindsite after battling through my diabetic life and surviving ( I have a pump and perfect hb1cs), I still feel that there are some unaswer d truths from this coma and the aftermath I went through. I was so stupid back then but as I said I was not right in the head. I am married have tow great kids and a stable enough life so I have bluffed my way through what could have been a catastrophic episode.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical.Net.
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