16628 Diabetic Coma

Overview

Diabetic coma is a life-threatening emergency that happens when a person with diabetes becomes unconscious. It is caused by blood sugar levels that are either dangerously high or dangerously low. It can be treated, but it needs urgent medical help right away.

Diabetic coma is rare, but it is very serious. It can happen to anyone with diabetes, but it is more likely if diabetes is not well managed or during a serious illness.

It mostly affects people with type 1 diabetes, but people with type 2 diabetes can also be at risk. You are more at risk if you take insulin, miss doses, have an infection, or have other health conditions.

Symptoms

Common symptoms

• Feeling very thirsty
• Urinating a lot
• Feeling weak or dizzy
• Confusion or trouble concentrating
• Fruity-smelling breath
• Nausea or vomiting
• Fast or deep breathing
• Losing consciousness

Symptoms in children

• Bedwetting or urinating more often
• Feeling very tired or weak
• Mood changes or irritability
• Stomach pain
• Nausea or vomiting

Symptoms in older adults

• Confusion that looks like dementia
• Dehydration
• Feeling faint or unsteady
• Very dry mouth and skin
• Weakness or fatigue

Causes

Main causes

• Blood sugar that is too low (hypoglycemia) – usually from taking too much insulin, skipping meals, or heavy alcohol use
• Blood sugar that is too high (hyperglycemia) – can lead to diabetic ketoacidosis, especially in type 1 diabetes
• A severe infection or illness, like pneumonia or a urinary tract infection, that makes blood sugar swing out of control

Risk factors

• Type 1 diabetes
• Missing insulin doses
• Being ill or having an infection
• Drinking too much alcohol
• Kidney or heart disease
• Older age
• Not checking blood sugar regularly

When to see a doctor

See a doctor urgently if:

• If you feel very confused, very weak, or have trouble staying awake
• If you have vomiting and cannot keep fluids down
• If your blood sugar is very high or very low and does not improve after following your sick-day plan

Book a routine appointment if:

• If you have diabetes, book regular review appointments with your diabetes team
• If you notice repeated high or low blood sugar readings, talk to your doctor

Diagnosis

A doctor or emergency team will check your blood sugar level right away. They may also test your urine and take blood samples to find the cause of the coma.

Tests that may be done

• Blood sugar test
• Urine test for ketones
• Blood tests for electrolytes and kidney function
• Tests for infection

What to expect at your appointment

In the emergency department, you will be monitored closely. The care team will work quickly to bring your blood sugar back to a safe level. After you are stable, you may need to stay in the hospital for a day or more.

Treatment

Treatment for diabetic coma always takes place in a hospital. It depends on whether your blood sugar is too high or too low. The goal is to correct the blood sugar level and treat the cause.

Self-care at home

• Never try to treat a diabetic coma at home – this is an emergency
• If you feel early warning signs, like shaking, sweating, or confusion, follow your diabetes sick-day plan and check your blood sugar
• If you are not sure what to do, call your local emergency number or your diabetes team right away

Medical treatments

In the hospital, you may receive fluids through a vein (IV), electrolytes such as potassium, and insulin or glucose solutions to bring your blood sugar back to a safe range. The team will also treat any infection or other condition that triggered the coma.

When is surgery considered?

Surgery is not needed for diabetic coma itself, but if an infection requires surgery, your team will manage your diabetes carefully around the procedure.

Living with this condition

Living with diabetes means being aware of your blood sugar levels every day. Check your blood sugar as recommended, take your medicines as prescribed, and have a sick-day plan ready.

Lifestyle tips

• Wear a medical alert bracelet or necklace that says you have diabetes
• Keep fast-acting sugar with you, as advised by your diabetes team
• Teach family and friends what to do if you pass out
• Avoid heavy drinking, especially on an empty stomach

Diet and exercise

Eat balanced meals with carbohydrates spread throughout the day. Regular physical activity helps keep blood sugar levels stable, but check with your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

Living with the fear of a diabetic coma can be stressful and overwhelming. It is normal to feel anxious. Talk to your diabetes team if you are having a hard time coping. If you need immediate emotional support, call a crisis line or talk to a trusted person.

Prevention

Most diabetic comas can be prevented. Regular blood sugar monitoring, taking your medicines as prescribed, and acting quickly when you feel unwell are the best ways to stay safe.

Vaccines

Recommended vaccines, such as the flu and pneumonia vaccines, help prevent infections that can make blood sugar levels dangerous.

Screening programmes

Regular check-ups with your diabetes team, including blood sugar and kidney or eye checks, help catch problems early and reduce the chance of a coma.

Complications

If left untreated

• Seizures
• Brain damage
• Long-term disability
• Death

Long-term outlook

A diabetic coma is a serious emergency, but if you get medical help quickly, the outlook is often good. Many people recover fully. With good diabetes management, you can greatly lower your risk of it happening again. Your healthcare team is there to help you every step of the way.

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