Course And Prognosis Of 86 Episodes Of Diabetic Coma A Five Year Experience With A Uniform Schedule Of Treatment
Abstract The admission data and the course of 58 episodes of severe diabetic ketoacidotic coma and of 28 episodes of non-ketotic coma are compared. The non-ketotic patients were older; initial blood glucose, osmolarity, blood urea and serum sodium concentration were higher than in the ketotic patients. Treatment in the first 24 hrs consisted of similar amounts of insulin in both coma forms, the presence of acidaemia did not increase the insulin needs. Acidaemia was corrected only when pH was below 7.20. The disadvantages of alkali therapy are emphasized. A comparison of the age groups of survivors and those patients who died within 72 hrs showed an increase in mortality with age. However, the mortality rates from ketotic and non-ketotic coma were similar in the age groups above 50 years. On admission, blood glucose, osmolarity and blood urea were higher in the fatal cases. Blood urea was the most important indicator of a fatal outcome. The response of blood glucose to insulin was impaired in the subsequently fatal cases. Insulin was given in “moderate” doses by constant infusion. The use of “small” doses is discussed. Early mortality was 14% in the ketotic and 29% in the non-ketotic cases. The most frequent causes of death were circulatory failure of undetermined origin, infections and thromboembolic complications.Continue reading >>
How Is Diabetic Coma Treated
Diabetic coma is caused by three major reasons:
- Severe hypolgycemia i.e., low blood sugar level
- Diabetic ketoacidosis i.e., high blood sugar level
- Hyperglycaemic hyperosmolar state
Thus the immediate action to be taken for a person found unconscious is to check his level of blood sugar. Therefore, when a diabetic patient is unconscious, the first action taken is blood sugar testing. If the loss of consciousness is determined to be due to hypoglycemia, the treatment objective should be to raise the level of blood sugar. For the rest two conditions, the treatment objective should be lowering the level of blood sugar.
What Is A Diabetic Coma
Diabetic coma is a life-threatening emergency that can happen to you if you have diabetes. In a diabetic coma, youre unconscious and unable to respond to your environment. Youre either suffering from high blood glucose or low blood glucose . You need immediate medical attention if you go into a diabetic coma.
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Coma Period Of Patients Before Death
Comas in people last from many days to multiple weeks. In some of the severe cases, coma will last for more than five weeks, which a few people experience coma for many years. After this period, a few patients overcome from the coma state gradually, a few of them went to vegetative state and others suffer death.
Outcome for coma depends primarily on the specific location, cause, extent and severity associated with neurological damages of a person. Deep coma alone does not essentially indicate less chance of recovery. This is because; many people deal with deep coma succeeding to recover in a well manner, while others even though stay in mild type of coma fail to achieve any improvement.
People may overcome/emerge from coma with a combination of many physical, psychological and intellectual difficulties, all of which require special attentions. Recovery in this case takes place in a gradual manner, so that patients may gain higher ability to give responses properly. Some of the patients do not able to show progress beyond the basic ones, but most of them recover complete awareness.
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What You Should Know About Diabetic Seizures
A diabetic seizure can be a life-threatening event. As such, the more you know about this subject in advance the more likely you will be to know exactly what to do if one does occur. Being well-informed and prepared may save a life!
A diabetic seizure can be a life-threatening event. As such, the more you know about this subject in advance the more likely you will be to know exactly what to do if one does occur. Being well-informed and prepared may save a life!
A diabetic seizure may result from excessively high blood sugar or excessively low blood sugar; as the best method is prevention, any person who has been diagnosed with high, low, or irregular levels of blood sugar should follow his or her physicians recommendations for keeping the blood sugar level as stable and consistent as possible.
Although some patients and even some doctors disagree, there is not really much difference between a diabetic seizure and other forms of seizures, such as those which are caused by epilepsy. While the symptoms are generally the same, there is one very significant difference the blood sugar irregularities which can cause a diabetic seizure can also cause the diabetic patient to lapse into a coma.
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Tips For Managing End
Keeping blood glucose levels within the target range may be difficult during this time and therefore is not as much of a priority at the end-of-life. Instead, youll ideally want to focus on the patients comfort, and doing what you can to manage the immediate symptoms associated with diabetes and accompanying comorbid and secondary conditions rather than worry about keeping blood sugars within a certain range.
How Is Dka Diagnosed And Treated
If youre suffering from acute DKA, youll be admitted to the ICU for frequent glucose and vital-sign monitoring, and to begin the process of restoring electrolytes via fluid IV. Youll also have constant insulin infusions until the levels of ketones are reduced and your blood-sugar levels return to normal. Once this treatment is underway, recovery is rapid. A typical hospital stay for DKA is only a few days.
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Causes Of High Blood Sugar Levels
A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It’s a three-way balancing act of:
All of these need to be balanced to keep blood sugar levels under control. If any one is off, blood sugar levels can be, too.
In general, problems controlling blood sugar levels are due to one or more of the following:
- not getting enough insulin or other diabetes medicine
- not following the meal plan
- not getting enough exercise
- use of certain medicines that can raise blood sugar, like steroids used to treat inflammation
Treatment For Diabetic Coma
Treatment options for diabetic coma include:
- ketoacidotic coma intravenous fluids, insulin and administration of potassium
- hyperosmolar coma intravenous fluids, insulin, potassium and sodium given as soon as possible
- hypoglycaemic coma an injection of glucagon to reverse the effects of insulin or administration of intravenous glucose.
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Are There Any Possible Complications From Dka
As DKA is life-threatening, its important to seek emergency care as soon as you suspect youre suffering from the condition. Fluid loss from DKA can lead to kidney and organ damage, brain swelling that can eventually cause a coma, and fluid buildup in your lungs. The sooner youre treated for DKA, the less likely you are to suffer from these major complications.
What Are The Symptoms Of Dka
Beware the fruity breath. This tell-tale sign of diabetic ketoacidosis is caused by the body breaking down ketones, which become acetone which we then excrete through breathing. If you see someone whos breathing rapidly and their breath smells like fruit or a nail salon, they probably have DKA, says Dr. Klonoff.
Heavy breathing, known as Kussmaul breathing, is a reflex to try to bring up the pH that has gotten to be too low, according to Dr. Klonoff. Its named after Adolph Kussmaul, a German physician who first observed it in his patients with severe diabetes in 1874. You could be breathing really hard, and not even realize necessarily that youre doing it, Klonoff says.
Diabetic ketoacidosis affects the brain, making it work through what feels like mental sludge, according to Dr. Christofides. Confusion and irritability are major signs to watch out for.
As a result of your brain swelling, DKA can make you feel as if youre drunk and act just as irrationally. Ive seen situations where people have gotten into fights, or have become a risk to themselves physically, or had an intervention by law enforcement while driving because they appear to be acting drunk or are incoherent when stopped, says Dr. Christofides.
The main warning signs of DKA are:
- Heavy breathing
- Blurred vision
- High blood-sugar levels
The three Ps of DKA:
- Polydipsiathirst
- Polyuriaurination
- Polyphagiaappetite
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What Are The Risk Factors For Diabetic Coma
While anyone who has diabetes is at risk for a diabetic coma, the causes depend on the type of diabetes:
- People with Type 1 diabetes have a greater chance of going into a diabetic coma as a result of diabetic ketoacidosis or hypoglycemia. This is because people with Type 1 diabetes always need insulin and have a wider range in their blood glucose levels than people with Type 2 diabetes.
- People with Type 2 diabetes have a greater chance of going into a diabetic coma from diabetic hyperosmolar syndrome than from diabetic ketoacidosis or hypoglycemia.
Other risks that can lead to diabetic coma in anyone who has diabetes include:
- Surgery.
Diabetic Coma Caused Due To Diabetic Hyperosmolar Syndrome
Diabetic hyperosmolar syndrome can cause diabetic coma. Diabetic hyperosmolar syndrome is determined in a person if the level of sugar in the blood is more than six hundred mg per deciliter . Blood turns syrupy and thick with larger sugar content. A lot of water supply is required in the body as the blood sugar enters the urine through the filtration process.
Diabetic hyperosmolar syndrome can be fatal if treatment is denied. It can also turn in to diabetic coma in some cases. Diabetic hyperosmolar syndrome is more recorded in mid age patients and older individuals. People who have both the types of diabetes are more likely to be affected by diabetic hyperosmolar syndrome.
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Diabetic Coma At Diagnosis Of Type 1 Diabetes
If the symptoms of type 1 diabetes are not spotted soon enough, ketoacidosis can develop leading to coma before a diagnosis is made.
It is possible that doctors may not correctly diagnose diabetes at first presentation. Approximately 1 in 4 patients diagnosed with type 1 diabetes are recorded as demonstrating signs of ketoacidosis.
What Is The Prognosis Or Outlook For Diabetic Coma
Diabetic coma can be fatal. Late attention may prolong the period of treatment. A person who has been treated for long for diabetic coma is recorded to experience a brain damage. This is a dire situation but can be avoided by taking precautionary measures.
Remain alert and aware to save yourself from diabetic coma. Manage your diabetic syndromes effectively to save your life.
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How Do You Handle A Diabetic Coma
5 min Read Time
If a friend or loved one has diabetes, making sure the condition is properly managed can sometimes be a matter of life or death.
Imagine this: During an afternoon at home with your parents, your father who has Type II diabetes all of a sudden says he is very thirsty.
You leave the room to get him a glass of water. When you return, you find him slumped over and unconscious. He has slipped into a diabetic coma.
Here’s what you should know about a diabetic coma regarding risk factors, causes, treatment, and prevention.
Diabetic Coma Can Be Caused By Diabetic Ketoacidosis
Diabetic Ketoacidosis can be the reason for diabetic coma. The fat stored in the body cells begins to break down when the muscle cells run out of energy. Ketones are produced during such process. Diabetic ketoacidosis results in to diabetic coma when left untreated. People who suffer from type 1 diabetes are more likely to get affected with diabetic ketoacidosis. However, people suffering from gestational diabetes or type 2 diabetes can also suffer from diabetic ketoacidosis
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How Do People Die From Diabetes
Q.How do people die from diabetes?
A. People who have diabetes cannot regulate their blood sugar levels and if the disease isnt tightly controlled, blood sugar can spike to abnormally high levels, a condition called hyperglycemia, or dip below normal, a condition called hypoglycemia. Both conditions are potentially life-threatening and can lead to coma and death if not promptly treated.
But complications resulting from the disease are a more common cause of death. Heart disease strikes people with diabetes at significantly higher rates than people without diabetes, and we dont fully know why, said Dr. Robert Gabbay, chief medical officer at Joslin Diabetes Center in Boston. People with diabetes develop heart disease at younger ages and are nearly twice as likely to die of heart attack or stroke as people who do not have diabetes.
People with Type 2 diabetes, which is the more common form of the disease, are more likely to have elevated cholesterol, high blood pressure and obesity, Dr. Gabbay said, all risk factors for cardiovascular disease. The good news, he said, is that a lot of treatments, like those for lowering cholesterol, are even more effective at lowering risk in people with diabetes than in people without. Some new classes of diabetes medications used for Type 2 diabetes have also been shown to reduce cardiovascular risk, he said.
People with Type 1 diabetes are also at increased risk for heart disease, though the reasons are less clear.
How Diabetic Coma Is Treated
Treating hyperglycemia requires intravenous fluids to improve fluid levels throughout your body. You may also receive insulin to help your cells absorb the extra circulating glucose. If your sodium, potassium, or phosphate levels are low, you may get supplements to help bring them up to healthy levels. The treatment will be similar for DKA.
A glucagon injection will help increase your blood sugar levels if youre experiencing hypoglycemia.
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What Do Ketones In Urine Mean
Ketones are generated in the human body when it uses body fat for energy. Ketones are also generated when there is minimum insulin present in the human body which is not enough to convert sugar for energy. The glucose hence mixes with the blood since there is not enough insulin present to help it. This excess glucose breaks down the fat and thus Ketones are released in urine.
Ketones at a high level can be poisonous for the body. Diabetic ketoacidosis is recorded in a person with high levels of Ketones. Diabetic ketoacidosis occurs more to people affected with low blood sugar rather than people affected with high blood sugar.
Symptoms Causes Diagnosis And Treatments
For those with Type 1 Diabetes, this is an insulin emergency, developing in mere hours and having life-threatening consequences. Scary? Yes. Can you prevent it? Absolutely. Were here to empower you with clear answers to all your pressing Qs.;
In This Article:;
Elena Christofides MD,;David Klonoff MD, and;Guillermo Umpierrez MD
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What Is Insulin Shock
âInsulin shockâ is a common term for low blood sugar, or hypoglycemia. It may also be called an insulin reaction.
The exact blood sugar level that leads to symptoms varies, but is generally less than 70 mg/dL. A low blood sugar level triggers your body to release the hormone epinephrine, also called adrenaline. That causes the early symptoms of insulin shock, which can come on quickly.
If you donât treat your dropping blood sugar ASAP, your brain will stop getting glucose and your symptoms will get worse. If levels stay low for too long, you can have a seizure or go into a diabetic coma.
What Is The Recovery Period Or Healing Time For Diabetic Coma
Even after the sugar level is normalized in a person, he or she will still experience nervous disorders like seizures or talking problems. Problems still persists even after recovering from diabetic coma. The recovery time cannot be predicted and depends on individual case.
When immediately attended and given glucose biscuits, a person can be quickly wakened up. Late attention might take more glucose to be given to the person for better healing.
Following Up With Diabetic Conditions
Consult your doctor and take necessary guidelines on how to prevent any incident of diabetic coma or any other complexities if you are diabetic. Your doctor may prescribe you tests to determine the exact dos and donts to you on how to manage diabetes.
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Can A Diabetic Coma Be Prevented
You can help yourself prevent a diabetic coma by taking steps to keep your blood sugar in the target ranges. Meeting with a Certified Diabetes Educator is an important part of understanding how to care for your diabetes. The CDE will help you be aware of symptoms for high and low blood sugar levels and how best to manage your condition.
It’s also important for your family, friends and coworkers to understand how to help you if you need help. Let them know about the symptoms of high and low blood sugar.
In terms of food and drink, here are some tips for preventing diabetic coma:
- Learn about foods that affect your blood sugar and the best meal plan for you.
- Dont skip meals.
- Keep treatment for a low blood sugar with you at all times .
- Avoid drinking too much alcohol.
- Ask your healthcare provider to prescribe a glucagon kit and teach a support person how to use it in case you ever have severe low blood sugar.
These are other recommendations to help you manage your blood glucose levels:
Last reviewed by a Cleveland Clinic medical professional on 12/02/2020.
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