Diabetic coma: causes, treatment and prevention

People living with diabetes know that to properly manage their condition, they must balance both the highs (hyperglycemia) and lows (hypoglycemia) of the disease.

However, they often hear the words “diabetic coma” without a proper definition of what it means for their lives.

Many people think that the risk of falling into a diabetic coma is low and only applies to people with uncontrolled diabetes – this is not true.

This article describes what diabetic coma is, the causes of diabetic coma, the risks, how to treat it, and what you can do to prevent it.

What are the different types of diabetic coma?

Technically, there are three types of diabetic coma:

  • Coma due to diabetic ketoacidosis (DKA): As a result of high blood sugar (hyperglycemia).
  • Hypoglycemic coma or “diabetic shock”: As a result of low blood sugar (hypoglycemia).

People with type 1 diabetes usually suffer from the first two types of diabetic coma.

Diabetic coma, although rare, is extremely dangerous. People suffering from a diabetic coma will be unresponsive and will require immediate medical attention to prevent death.

Coma due to diabetic ketoacidosis (DKA).

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the blood in the body becomes acidic due to the high amount of ketones in the blood.

This is often due to very high blood sugar levels and a complete lack of insulin in the body.

This is why it usually happens to people with type 1 diabetes. It often occurs during diagnosis. About 25% of people have DKA when they are diagnosed with type 1 diabetes.

DKA is a medical emergency and requires immediate attention – including insulin and fluids in hospital. Without proper medical care, it can quickly turn into a coma.

DKA can occur quite quickly due to incidents such as insulin pump failures, illness, an uncontrolled infection, or forgetting to take a bolus of insulin with a meal.

It can progress over several days, such as when someone is using expired insulin or is rationing their insulin.

DKA can also occur in people without diabetes. This condition can be caused by starvation, fasting (like intermittent fasting), alcoholism, and hyperthyroidism.

However, the vast majority of cases occur in people with insulin-dependent diabetes.

Symptoms of DKA

The typical symptoms of DKA are listed below. Seek immediate medical attention if you or a loved one experiences any of these symptoms.

  • High blood sugar
  • Ketones in the urine
  • Dry mouth
  • Dyspnoea
  • Fast heart rate
  • Fruity breath smell
  • Extreme thirst
  • Body pain and headache
  • Blurred picture
  • Frequent urination
  • Nausea
  • Vomiting
  • Extreme fatigue
  • Confusion
  • Sudden weight loss
  • Redness of the face

Be aware if you experience these symptoms and persistent high blood sugar with moderate or high ketones for several hours and insulin is not helping. You can fall into a DKA-induced coma very quickly.

DKA treatment

DKA and DKA-induced coma require immediate medical attention. This usually includes an intravenous insulin drip and fluids administered in a hospital setting.

Doctors will want to closely monitor blood sugar and other vital signs such as heart rate, temperature, kidney function, electrolyte levels, blood pressure, and urine levels.

Some cases of DKA require a stay in the intensive care unit (ICU), and many people spend more than a week recuperating.

If you experience any of the above symptoms, along with high blood sugar (>250 mg/dL) and moderate or high ketones that persist for several hours or days, seek medical attention immediately.

DKA-induced coma usually does not occur until blood sugar levels are at least 600 mg/dL, but it is necessary to seek medical attention well before these levels are reached.

hyperosmolar coma

Hyperosmolar coma is a type of diabetic coma experienced by people with type 2 diabetes.

It is caused by very high blood sugar levels for a long time, usually due to illness or infection.

During this type of coma, the body tries to get rid of excess sugar by flooding the urine with glucose, often to no avail.

The condition can develop over a few days or weeks, usually with a steady blood sugar level above 600 mg/dL.

Symptoms of hyperosmolar coma

Hyperosmolar coma has similar symptoms to DKA. Some signs to watch out for include:

  • Blood sugar level 600 mg/dl for a long time
  • Excessive thirst
  • Dry mouth
  • Increased urination
  • Warm, dry skin
  • Fever or redness
  • Somnolence
  • Confusion
  • Hallucinations
  • Loss of vision
  • convulsions

Treatment of hyperosmolar coma

This condition should be treated early. It can quickly lead to complications such as heart attack, stroke, seizures, permanent coma and even death. Immediate professional medical help is essential.

Patients will need to recover in the hospital for a few days or weeks until all levels return to normal. As with DKA, patients will require intravenous insulin and fluids.

Contact your doctor if you have difficulty lowering your blood sugar for several days despite increased insulin doses and you test positive for medium or high ketones.

hypoglycemic coma (“diabetic shock”)

A hypoglycemic coma is the onset of a coma when blood sugar levels drop too low. It is usually diagnosed when a person is unresponsive and their blood sugar has dropped below 49 mg/dL.

People with diabetes, especially type 1 diabetes, are most at risk of hypoglycemic coma during sleep. This is one of the reasons why it is important to continuously monitor your glucose levels throughout the night.

One study found that the average person with type 1 diabetes suffers an average of two episodes of low blood sugar per week.

Causes of this type of coma include:

  • Accidentally taking too much insulin
  • Insufficient carbohydrate intake relative to insulin dose
  • Doing extreme exercise and not taking less insulin beforehand
  • Drinking alcohol after recently taking insulin
  • Insulin overdose

Nearly 40% of people with type 1 diabetes suffer from hypo-unconsciousness and are most at risk for this type of diabetic coma. This is an extremely dangerous condition that can lead to death.

Symptoms of dangerously low blood sugar

Help prevent diabetic coma by capturing blood sugar levels when they are too low. Normally, anything below 49 mg/dL is considered extremely low.

Symptoms of sudden low blood sugar include:

  • Confusion
  • Exploitation
  • No response or slow response
  • Fast heart rate
  • Hunger
  • Trembling
  • Tiredness
  • Irritability
  • Nausea
  • Dizziness
  • Difficulty speaking or communicating
  • Weak muscles

Seek immediate medical attention if you have very low blood sugar, experience these symptoms, and have insulin on board.

It can be life-threatening if left untreated and can lead to a diabetic coma.

Treatment of hypoglycemic coma

Hospital care will be needed if a diabetic coma occurs due to low blood sugar.

Your medical team will closely monitor your blood sugar and other vital signs such as heart rate, blood pressure, fluid retention, urine, kidney function, and brain activity.

Upon arrival at the hospital, a patient in a diabetic coma will be given intravenous glucose and intramuscular glucagon to restore normal blood sugar levels as quickly as possible.

The stay in the hospital of a person who has fallen into a hypoglycemic coma can last from a few days to a week. If the condition does not improve, it is possible that recovery may take several months.

Many people who have a diabetic coma due to low blood sugar make a full recovery.

Unfortunately, if the condition is not treated quickly enough, it can cause irreversible brain damage and sometimes even death.

Prevention of diabetic coma

While not all diabetic comas are 100% preventable, below are things you can do to reduce your risk.

  • Wear a continuous glucose meter that alerts you to both high and low blood sugar levels
  • Carefully check all insulin doses before giving a pre-meal bolus
  • Eat all the carbs you’ve been dosing for
  • Eat meals at regular times and intervals
  • Visit your doctor regularly to recalibrate your insulin
  • If an infection develops, see your doctor quickly for antibiotics (blood sugar is harder to control when you have an infection)
  • Always carry a snack (to treat low blood sugar) with you when you leave the house
  • Regularly check expiration dates on insulin vials and make sure you don’t take expired insulin, which may not work as well
  • If you suffer from hypo-unconsciousness, consider getting a diabetic dog
  • Check your blood sugar often: especially at night when you are sick, before, during and after exercise
  • Check your blood sugar 90 minutes after changing your insulin pump site to ensure that the cannula has been inserted correctly
  • Limit your alcohol intake and always have a snack on hand if you drink
  • Avoid excessive alcohol consumption after strenuous exercise
  • Don’t drink alcohol alone
  • Wear a diabetes ID bracelet when you go out
  • Have an emergency contact with someone to contact if you need immediate help
  • Let friends and family know how to treat low blood sugar
  • Always take your insulin or diabetes medications as directed
  • Have ketone strips and get a ketone test if your blood sugar stays above 250mg/dL for several hours and doesn’t seem to respond to insulin (ketone strips are available over the counter from pharmacies)
  • Get tested regularly and treat both high and low blood sugar early and often


There are three types of diabetic coma: diabetic ketoacidosis coma, hyperosmolar coma, and hypoglycaemic coma (“diabetic shock”).

Hyperosmolar coma affects people with type 2 diabetes.

Other types of coma affect people with insulin-dependent type 1 diabetes. Although rare, diabetic coma can be life-threatening, especially if not treated early.

A diabetic coma can be scary! However, knowing preventive tactics and seeking treatment early is key to preventing long-term complications or death.

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