Diabetic coma symptoms are something every diabetic should be aware of. It is true that type 1 diabetics are much more likely to experience them than type 2, but diabetics are living longer, so the chances of experiencing symptoms is greater. One statistic is that up to 15% of diabetics will go into diabetic coma because of severe hypoglycemia.
What Is a Diabetic Coma?
Coma means unconscious. A person is in a coma if he cannot be wakened and can’t respond to sounds and sights. It does not mean the person in a coma will die. These days, with swift blood test results and and treatment, a diabetic will come out of a coma very fast. Diabetic medical alert bracelets and neck chains keep us from being misdiagnosed as drunk or epileptic when we cannot speak.
But just knowing you are a diabetic is not enough when patients are taken to an emergency room and the doctor reads their diabetic alert charms. The diabetic coma symptoms need to be diagnosed correctly so the proper treatment is started, because the complications are brain damage and death.
Oddly, either chronic high blood sugar or sudden low blood sugar can trigger diabetic coma symptoms. That’s why it’s good to know how we react to both of them.
With high blood sugar, or hyperglycemia, you feel thirsty and have to urinate more often. You feel fatigue, and there is always nausea and vomiting, often for days. You can feel short of breath and have stomach pain. There is a fruity or acetone smell to your breath and a fast heartbeat. The symptoms are not sudden.
But low blood sugar comes on very swiftly and can wake you out of a sound sleep. You feel shaky, nervous, tired and either hungry or nauseated. You sweat a lot and your heart races. You can get irritated and even aggressive for no reason, and confusion makes it hard to think. Blurred vision can keep you from being able to read your meter as you try to check your blood sugar.
Get help fast. Someone needs to test your blood sugar, and if it is low, below 70, you are in a hypoglycemic reaction and need some orange juice or other sugary drink, or any quick source of glucose right now. Test your blood sugar again in 15 minutes, and if it is not responding and your confusion, sweating and blurred vision remain, you need to be taken to the hospital. Paramedics can begin treating you as soon as they arrive, so call 9-1-1.
Diabetic Coma Symptoms, the Three Sources
At the hospital, emergency room doctors will need to find out the source of your diabetic coma symptoms. There are three possibilities:
- Diabetic ketoacidosis (diabetic acidosis)
- Diabetic hyperosmolar syndrome
- Hypoglycemia
In diabetic ketoacidosos, the muscle cells are starving for energy because insulin is not available to them. So they break down fat cells for energy which produces ketones, leading to ketoacidosis.
Meanwhile sugar is building up in the blood because it is not being used by the muscle cells. Severe hyperglycemia (high blood sugar) causes the diabetic’s body to dump sugar into the urine, and it takes a lot of water with it. That is the cause of dehydration, unquenchable thirst and going to the bathroom constantly.
Dehydration leads to shock and exhaustion. There will be vomiting that can go on for 36 hours, so these symptoms are not sudden. As it gets worse you will see flushing and rapid breathing (hyperventilation), and you can slip into a coma.
In the hospital the doctor diagnoses by blood tests that show high blood sugar and metabolic acidosis with dehydration. You would be treated with IV fluids including electrolytes to restore the balance of fluid in your blood, and given insulin and monitored carefully to make sure you do not become hypoglycemic (low blood sugar). Patients wake up quickly with rehydration.
With diabetic hyperosmolar syndrome the ketoacidosis is missing. But extremely high blood sugar that is not controlled over time leads to lethargy, confusion and sleepiness, slipping into coma. This is seen in nursing homes among older diabetics, but it can happen to anyone who lets his blood sugar stay out of control. The patient does not recognize thirst, and dehydration will lead to a coma if not treated.
In this type of coma blood tests show extremely high blood sugar, sometimes above 1,800, and dehydration. It is treated with IV fluids and insulin therapy, and the patient recovers.
Then there is hypoglycemia. Our brains need glucose to function. If there is too little, we pass out. It’s that simple, and it can happen fast. The cause is too much insulin or too little food. Doing a lot of exercise that you are not used to, or drinking alcohol without food can drop blood sugar drastically, even two days after drinking.
Here are three things that, if you do them, could save your life:
- Wear a diabetic ID bracelet or necklace all the time.
- Be careful with alcohol. Eat a snack with it or don’t drink at all.
- Teach your friends and family about the symptoms of low blood sugar and tell them to call for help if you get confused, sweat profusely, or pass out. If anyone in my family sees me sweating, they want to know why, and I’d better be able to explain clearly or they will take me to the hospital, period.
If you wear an insulin pump, you need to keep an eye on the tubing. Kinks or disconnects will stop insulin delivery, and for type 1 diabetics this can be fatal. If you have an illness, trauma or surgery, know what to do to protect yourself from high or low blood sugar. Congestive heart failure and kidney disease lead to hyperosmolar syndrome. GI tract flu and diarrhea can cause blood sugar to bottom out quickly in some people.
Manage your diabetes. Take your medicines and use your glucose monitor. Don’t ever skip insulin to lose weight. Some have actually done this. Don’t ever, ever take illegal drugs. You could get severe high blood sugar, and you will neglect your health. Diabetics can’t take that chance.
What should you do if you are faced with a diabetic in a coma? Call 9-1-1. If you are trained in diabetes treatment, while you are waiting you can test the person’s blood sugar. If it is low, give an injection of glucagon. If there is no glucagon you can rub honey or syrup on the inside of her cheek, but do NOT pour anything into her mouth. If the sugar is not low, do nothing. Do not give insulin to an unconscious person.
I hope you never need this information. If you take care of your diabetic chores daily, you probably won’t.