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    Diabetic Coma

    Diabetic coma is a reversible form of coma found in people with diabetes mellitus. It is a
    medical emergency. Fortunately, most episodes of diabetic hypoglycemia, DKA, and extreme
    hyperosmolarity do not reach unconsciousness before a family member or caretaker seeks
    medical help.

    Three different types of diabetic coma are identified:

            1. Severe diabetic hypoglycemia
            2. Diabetic ketoacidosis
            3. Hyperosmolar nonketotic coma


    Severe Hypoglycemia

    An estimated 2 to 15 percent of diabetics will suffer from at least one episode of diabetic
    coma in their lifetimes as a result of severe hypoglycemia.  People with type 1 diabetes
    mellitus who must take insulin in full replacement doses are most vulnerable to episodes of
    hypoglycemia. Hypoglycemia is usually mild enough to reverse by eating or drinking
    carbohydrates, but blood glucose occasionally can fall fast enough and low enough to
    produce unconsciousness before hypoglycemia can be recognized and reversed. Although,
    hypoglycemia can be severe enough to cause unconsciousness during sleep.  Some factors
    that can attribute to hypoglycemia can include eating less than usual, prolonged exercise
    earlier in the day, and heavy drinking.

    Unconsciousness due to hypoglycemia can occur within 20 minutes to an hour after early
    symptoms and is not usually preceded by other illness or symptoms. Twitching or
    convulsions may occur. A person unconscious from hypoglycemia is usually pale, has a
    rapid heart beat, and is soaked in sweat: all signs of the adrenaline response to
    hypoglycemia. The individual is not usually dehydrated and breathing is normal or shallow. A
    meter or laboratory glucose measurement at the time of discovery is usually low, but not
    always severely.


    Advanced Diabetic Ketoacidosis

    Diabetic ketoacidosis (DKA), if it progresses and worsens without treatment, can eventually
    cause unconsciousness, from a combination of severe hyperglycemia, dehydration, shock,
    and exhaustion. Coma only occurs at an advanced stage, usually after 36 hours or more of
    worsening vomiting and hyperventilation.

    In the early to middle stages of DKA, patients are typically flushed and breathing rapidly and
    deeply, but visible dehydration, pallor from diminished perfusion, shallower breathing, and
    rapid heart rate are often present when coma is reached. However these features are
    variable and not always as described.

    If the patient is known to have diabetes, the diagnosis of DKA is usually suspected from the
    appearance and a history of 1–2 days of vomiting. The diagnosis is confirmed when the
    usual blood chemistries in the emergency department reveal hyperglycemia and severe
    metabolic acidosis.


    Nonketotic Hyperosmolar Syndrome

    Nonketotic hyperosmolar syndrome usually develops by extreme hyperglycemia is
    accompanied by dehydration due to inadequate fluid intake. When a persons blood sugar
    gets higher than 600 mg/dL, your blood becomes thick and syrupy. The excess sugar passes
    from your blood into your urine, which triggers a filtering process that draws tremendous
    amounts of fluid from your body. Left untreated, diabetic hyperosmolar syndrome can cause
    life-threatening dehydration and coma. Diabetic hyperosmolar syndrome is most common in
    middle-aged and older adults who have type 2 diabetes. Coma from Nonketotic
    hyperosmolar syndrome occurs most often in patients who develop type 2 or steroid
    diabetes.
    DIABETES COMPLICATIONS
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