Diabetic Coma: Everything You Need to Know
“Is there absolutely nothing I can do to help?”
– “Of course; please just stay here with me.”
There are few things we can say to a loved one in distress, and even less we can say to a loved one in an indefinite state of distress – such as in the age-old case of diabetes. The best kind of support we can offer them during these trying times is the comfort of understanding their position and learning about their agony. It may be difficult for us to implement from the get-go, but it is tonnes more difficult for the people suffering. So read on with us and learn about everything you need to know regarding a dangerous diabetes complication – the diabetic coma.
“Rest assured that we’ll get through this together.”
What is a Coma?
A medical condition in which a patient persists in a prolonged state of unconsciousness is called a coma or a comatose state. Visibly, it resembles a deep sleep or state of hibernation where the patient cannot be awakened. However, comatose patients cannot be awakened and exhibit certain symptoms that differentiate their state from mere unconsciousness, including:
- Lack of response to stimuli such as pain, light and sound.
- Lack of voluntary actions such as speaking and moving.
- Lack of normal sleep-wake cycles.
What is a Diabetic Coma?
A diabetic coma is a reversible comatose state that presents as a complication within diabetic individuals due either to hyperglycemia (high blood glucose) or hypoglycemia (low blood glucose). Notice the word reversible, indicative of the fact that a diabetic coma is not terminal. This type of comatose state is usually seen in patients suffering diabetes mellitus (hence the term diabetic coma). It is of three major types depending on the physiological cause and as a result of the underlying type of diabetes:
| Type of diabetes Observed
| Type 1
| Severe hypoglycemia
| Type 1
| Diabetic ketoacidosis
| Type 2
| Hyperosmolar nonketotic
A diabetic coma is often confused with insulin shock due to their similar causes. Insulin shock refers to the body’s reaction to a sudden hypoglycemic (low blood sugar) state which throws the body into a disorienting spiral, causing the brain to respond using our natural fight or flight instinct to compensate. This drains the body of its glucose (sugar) reserves and can rapidly lead to a state of unconsciousness. Comas due to diabetes, on the other hand, are a result of the body’s response to a much longer, slower state of hypoglycemia. This also leads to a state of unconsciousness but is far more severe and are more difficult to anticipate.
Severe Hypoglycemia-Induced Coma
Patients suffering from Type 1 diabetes mellitus are vulnerable to episodes of hypoglycemia. This means that their bodies are unable to produce functional insulin at all or are unable to produce sufficient amounts of functional insulin, which result in an overall low blood sugar level (typically < 250 mg/dL). In such cases, glucagon supplements are prescribed as treatment and are also a prominent preventative strategy for the ensuing coma. Additionally, patients are advised to avoid prolonged fasting and any prolonged exercise in a fasted state to avoid utilising any more blood glucose than what is required.
Treatment: Patients are treated with intravenous glucose or are injected with the pancreatic enzyme glucagon to raise the blood glucose level back to its normal range.
Advanced Diabetic Ketoacidosis-Induced Coma
Diabetic ketoacidosis (or DKA) is scientific jargon for decreased blood pH level resulting from an underlying diabetic state – in this particular form of a diabetic coma, due to type 1 diabetes mellitus. Our body naturally maintains a constant pH level through a series of chemical buffering systems. But due to the lack of insulin in patients with diabetes or diabetic patients, the body replaces glucose with fatty acids to derive energy. The process by which these fatty acids get broken down (beta-oxidation) gives rise to substances called ketone bodies which decrease the blood pH in large quantities, resulting in a condition called acidosis. Since this is induced due to a lack of insulin in the body, the overall condition is termed Diabetic ketoacidosis. Prolonged experiences of DKA results in a comatose state.
Treatment: Isotonic fluids and various electrolytes (i.e. saline, potassium and other salts) are administered intravenously to reverse the acidosis and subsequent coma.
Nonketotic Hyperosmolar Coma
This form of coma is exhibited by patients suffering from type 2 diabetes, shows very gradual symptoms and is generally unsuspected. Unlike the other causes, the increased glucose level in the blood (typically ~600 mg/dL) in this condition is accompanied by lethargy (tiredness), obtundation (decreased alertness) and dehydration. Due to the nature of the underlying steroid (type 2) diabetes, patients are unable to identify feelings of thirst and rehydrate themselves, which creates a sort of positive feedback loop, causing further dehydration. The result of this loop is a slow weakening of the patient into a comatose state.
Treatment: Intravenous insulin injections coupled with rehydration therapy to replenish intravenous fluids are administered to reverse the high blood glucose concentration and dehydration respectively.
Are Diabetic Comas Common?
The foremost and most obvious risk factor is an underlying condition of diabetes. However, not all diabetic patients experience a coma even though all diabteic comas have an underlying cause of diabetes. Coupling this with poor management of diabetes, overindulging in alcohol, irregular insulin administration and being afflicted by certain illnesses (not necessarily co-morbid conditions), however, can greatly increase one’s chances of delving into a diabetic coma.
The bottom line: Comas are largely uncommon if a patient’s lifestyle is kept in check.
Can You Die From a Diabetic Coma?
Diabetic comas are rarely fatal, notably due to their reversibility. Among the major types, however, DKA was observed to be the leading lethal form. Recent studies report the mortality rates for DKA to range from 0.2 – 2%, non-varied between sexes (O. Hamdy, 2021). But due to the small sample space recorded and the fact that most fatalities in diabetes patients are usually due to a more forefront lethal condition, these numbers should not be taken at face value.
The bottom line: Yes, it is possible to die from a diabetic coma. But it is highly unlikely.
Diabetic Coma Treatment
Diabetic comas arising from type 1 complications can typically be treated by administering intravenous glucagon to counteract the decrease in blood glucose concentration or through direct administration of glucose. Conditions that commonly lead to fluid imbalances like dehydration or electrolyte deficiencies also require the administration of intravenous fluids and salines in order to replenish the loss.
The bottom line: Reverse the cause to reverse the coma. Yes, it’s just that simple.
The Road to Recovery From a Diabetic Coma
Patients will generally recover quickly from a diabetic coma as soon as the treatment is administered. The sooner the patient is treated, the less likely it is for any complications to arise in post. Although full recovery is typically expected, common complications are limited to brain damage – the extent of which depends on the duration of administering the treatment.
The bottom line: Patients tend to make a complete recovery the sooner they are treated for a diabetic coma.
Diabetic comas are highly unlikely when the diabetes is well-managed, and death is even less likely. It is important to carefully manage the lifestyle of those afflicted by diabetes in order to avoid complications. Since this condition can easily be reversed, affected individuals tend to make complete recovery the sooner they are treated
And as medicine progresses, numerous breakthrough treatment options are available to reverse even underlying diabetes, such as our Whole Body Digital Twin technology that safely helps you reverse Diabetes and improves your other chronic conditions too in the long run.
The bottom, bottom line: Prevention is better, even for an easy cure.