What Causes Diabetic Coma?

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What causes diabetic coma?

Blood glucose levels that are too low (hypoglycemia) or too high (hyperglycemia) can both result in diabetic coma. Causes of diabetic coma are:

* severe hypoglycemia
* advanced diabetic ketoacidosis (from hyperglycemia, shock, and dehydration)
* hyperosmolar coma (from hyperglycemia and dehydration)
* lactic acidosis
* metabolic acidosis.

Coma from Insulin Shock (severe hypoglycemia)

When coma is induced from low blood glucose levels, it may also be referred to as "insulin shock." Insulin shock, an extreme episode of hypoglycemia (low blood glucose) is caused by too much insulin in the body. Untreated, insulin shock can lead to coma, seizures, and death.

Severe hypoglycemia can occur rapidly, even over minutes, and should always be treated immediately. 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.

Important IOH Health Tips: Most hypoglycemia severe enough to cause unconsciousness occurs during sleep. It is important to know the signs of nighttime hypoglycemia (i.e., waking with high fasting glucose levels, headache, or being drenched in sweat), and to check your blood glucose levels around 3 a.m. at least once a week. College students should show roommates how to inject glucagon and what to do if the roommate detects a nighttime seizure. ALWAYS carry glucagon and medical identification and emergency contact information.

Know your bedtime target range and read our tips for preventing nighttime hypoglycemia.

Coma from Hyperglycemia

Hyperglycemia can lead to complications that can result in coma include diabetic ketoacidosis, nonketotic hyperosmolar coma, lactic acidosis., and/or metabolic acidosis.

Chronic, or severe hyperglycemia can lead to coma and death but is more likely to takes hours or days of being in a state of DKA before coma results. Those that have been newly diagnosed, young children, the elderly, and those on insulin pump therapy may experience DKA at sooner, and at lower blood glucose levels than other persons with diabetes.


Diabetic Ketoacidosis (DKA)

When not enough insulin is present blood sugar runs too high. The body begins to use fat stores as an energy source. Ketones, a byproduct of burned fat, are produced and quickly reach dangerous levels. High ketones lead to a state called diabetic ketoacidosis (DKA) which can result in coma, or death.

Newly diagnosed persons with type 1 diabetes are often in a state of DKA and need to be hospitalized in order to be stabilized. DKA is something that you should never attempt to treat on your own. If you detect moderate or higher ketones in your urine, be sure to immediately call your doctor for instructions.

Insulin Shock

When too much insulin is given, too little food is eaten with insulin, or during exercise, blood sugar levels can drop dangerously low resulting in "insulin shock." Untreated, a person can lose consciousness, slip into coma, or die.

Different people may have various “normal” ranges of blood sugar that feel comfortable to them, and not everyone experiences symptoms of insulin shock at the same range. However, any reading of 50 mg/dL or lower can quickly lead to a situation where a person can lose consciousness, or become confused and disorder to the extent they are unable to care for themselves.

Contrary to what many that are uneducated about diabetes may think, sugar does not present the most imminent danger to someone with diabetes – insulin and insulin enhancing/sensitizing drugs do. This is because a person on shot therapy “feeds” the insulin. That is, they eat in accordance to how much insulin is given, and when it cycles through the body. A person on an insulin pump has greater flexibility and no longer has to eat to support the insulin, but can still experience hypoglycemia if basal rates are set too high, or the meal bolus is not calculated correctly.

When too much insulin is present blood sugar levels will drop too low. Cells don’t get the sugar energy that they need because not enough glucose is present in the bloodstream and cells can eventually be damaged.

Symptoms of insulin shock (hypoglycemia) include

* hunger
* nervousness and shakiness
* perspiration
* dizziness or light-headedness
* sleepiness
* confusion
* difficulty speaking
* feeling anxious or weak

Hypoglycemia can also happen while you are sleeping. You might

* cry out or have nightmares
* find that your pajamas or sheets are damp from perspiration
* feel tired, irritable, or confused when you wake up

Seizures and Coma

When blood sugar falls too low, seizures can result. Insulin shock, an extreme episode of hypoglycemia (low blood sugar) is caused by too much insulin in the body. Untreated, insulin shock can lead to coma and death. Severe hypoglycemia can occur rapidly, even over minutes, and should always be treated as an emergency. High blood sugar levels can also lead to coma and death but generally takes hours, or days of being in a state of DKA (see above) before coma results.

A seizure (or convulsion) occurs as a result of a burst of simultaneous, contradictory signals from brain cells. There are many causes of seizures including head trauma, fever, illness, and in the case of people with diabetes, both hyperglycemia (high blood glucose) and hypoglycemia (low blood glucose) can cause seizure, convulsion, coma, and even death.

During a seizure a person is unaware of their surroundings even if they may seem alert on some level. If the seizure is a result of low blood sugar (hypoglycemia) do not attempt to feed the person who can easily choke. Instead, give a shot of glucagon and call 911 if necessary.