What is diabetic coma and what're the first aid measures?Diabetic coma is a medical emergency in which a person with diabetes is unconscious because the blood glucose level is too low or too high. If the glucose level is too low, the person has hypoglycemia and if the level is too high, the person has hyperglycemia. Hyperglycemia is just a term for raised blood glucose but in some cases it can lead to a life-theathening condition called diabetic ketoacidosis. Patients with diabetes mellitus type 1 are especially prone to this condition.
Causes for this condition vary; in the case of diabetes, it could be due to too much food too quickly or forgetting to inject oneself with insulin, while in the case of hypoglycemia it could be due to a lack of food, too much exercise for current conditions, or to an insulin or other medication overdose.
While no particular amount of sugar in the blood is generally recognized as the starting point to acute problems of glucose management (people vary), usually the person who has hyperglycemia has a blood glucose reading of 500 mg/dL (28 mmol/L) or more is at risk of hyperglycemic osmotic coma (the high gluocse sort), while a patient whose blood glucose level is 50 mg/dL (3 mmol/L) or less is at risk of a hypoglycemic diabetic coma. Without performing a blood glucose test, it is difficult to tell with certainty whether the coma is caused by hypoglycemia or hyperglycemia as symptoms can be similar.
In both cases, the coma is caused by brain cell malfunction. In the case of hypoglycemia, there simply isn't enough glucose in the blood, leaving brain cells without enough glucose to satisfy their metabolic needs. In the case of hyperglycemia, while glucose is plentiful, indeed too plentiful, the consequences of so much blood glucose produce chemistry abnormalities which cause brain cells to malfunction. These include cell dehydration due to osmotic pressure, electrolyte balance problems both inside brain cells and in the blood, and in some cases acidosis.
First aid for diabetic coma includes the following:
- Call for help. Use an emergency telephone number, or transport to an emergency room or clinic or doctor's office for immediate medical care.
- If working equipment (ie, glucose meters) are available, a blood glucose level reading should be taken immediately. NEVER GIVE INSULIN unless you are completely confident you know what you're doing and are sure the patient is NOT HYPOGLYCEMIC. Mistakes with insulin can kill, and quickly.
- If the patient is conscious and suffering from hypoglycemia, administer sugar (fruit or orange juice, glucose or white sugar dissolved in juice or water), glucose tablets or gel, sugary drinks (NOT diet drinks), etc. Artificial sweetners DO NOT WORK. Avoid fatty, oily, or protein rich foods if possible, for digestion and absorption of the sugar will be delayed. A chocolate bar is not as good as a sugary tea, for instance, nor is regular milk (high fat content) in comparison to skim milk (much lower fat content). If suffering from hyperglycemia, do not feed the patient. Push water while conscious instead. And get the patient to medical treatment promptly.
- If the patient is unconscious and suffering from hypoglycemia, glucose gel may be rubbed on the lips and gums in the hopes that it will be absorbed through the mucous membranes. Even a hard sugar candy might help, placed between cheek and gum. To avoid choking, no other food or drink should be given to any unconscious person. Regardless of whether they are hypoglycemic or hyperglycemic.
- If a blood test is not possible, and sugars are given, immediate improvement after administering sugars should begin (within five to fifteen (5-10) minutes). If this does not occur, it wasn't hypoglycemia. The diabetic coma was (is) probably the result of hyperglycemia. This requires quite different and prompt medical treatment. Failure to receive that treatment may result in acidosis, perhaps ketoacidosis and death. The additional sugars given should not immediately harm the patient, but they must receive medical treatment as quickly as possible.
First aid providers are encouraged to test blood glucose if possible. If not, give sugar in some form. Never give insulin without compelling evidence that the problem is hyperglycemia. Giving too much sugar is less dangerous to the hyperglycemic patient than giving insulin to the hypoglycemic patient.
Paramedics are familiar with the treatment of diabetic coma and will treat it with administration of sugars, blood test for glucose, administration of insulin and rapid transport to a hospital if necessary.
Doctors recommend that:
- Diabetic patients should always carry glucose tablets and/or a tube of glucose gel in case of hypoglycemia. Another good place for emergency glucose is in the refrigerator, if you are at home.
- Diabetic patients should wear a "Medic-Alert" (TM) or other bracelet or jewelry identifying them as diabetic. Otherwise, a diabetic coma could be mistaken for drunkenness, especially by the uninformed. Undertrained police have been known to place patients into the local 'drunk tank' instead of obtaining medical attention for them. This can result in death. Diabetics have died because they were treated as intoxicated instead of suffering from a medical emergency.
- Friends and family of diabetic patients should learn how to give first aid in a diabetic emergency, and how to operate the diabetic person's blood glucose meter. If possible, they should also learn how and when and why to give insulin injections if necessary.
If a diabetes patient has young children living with him/her, it is also very important to teach them the appropriate local emergency telephone number
More information on diabetes mellitusWhat is diabetes mellitus? - Diabetes mellitus is a a condition characterized by hyperglycemia resulting from the body's inability to use blood glucose for energy. Diabetes mellitus can result in coma. Over time, complications can include nerve injury, blindness, kidney failure, and premature atherosclerosis with all of its complications.
What causes diabetes mellitus? - Diabetes mellitus is a disorder caused by insufficient production of the hormone insulin by the pancreas, or insensitivity of cells to the effects of insulin. Insulin is responsible for the absorption of glucose into cells for their energy needs and into the liver and fat cells for storage.
What is insulin? - Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood.
What types of diabetes mellitus are there? - There are four main types of diabetes mellitus. They are type 1 diabetes mellitus, type 2 diabetes mellitus, type 3, and Gestational diabetes mellitus (type 4).
What is type 1 diabetes? - Formerly known as juvenile diabetes or insulin-dependent diabetes, type 1 diabetes is a life-long condition in which the pancreas stops making insulin. Type 1 diabetes develops most often in young people but can appear in adults.
What is type 2 diabetes? - Type 2 diabetes is the most common form of diabetes mellitus. People with type 2 diabetes produce insulin, but either do not make enough insulin or their bodies do not use the insulin they make. Type 2, also known as non-insulin dependent diabetes, typically occurs after the age of 40 years.
What're signs and symptoms of diabetes mellitus? - Type 2 diabetes almost always has a slow onset (often years). Early symptoms of Type 1 diabetes are often polyuria (frequent urination) and polydipsia (increased thirst, and consequent increased fluid intake).
What is diabetes insipidus? - Diabetes insipidus (DI) is a disease characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced.
What is diabetic coma? - Diabetic coma is a medical emergency in which a person with diabetes is unconscious because the blood glucose level is too low or too high. Patients with diabetes mellitus type 1 are especially prone to this condition.
What are the complications of diabetes mellitus? - Many people with diabetes mellitus eventually develop complications. A very common short-term complication of diabetes mellitus is hypoglycemia (abnormally low blood sugar levels).
How to diagnose diabetes mellitus? - The diagnosis of type 1 diabetes is usually prompted by recent symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. The diagnosis of other types of diabetes is made in many other ways.
Diagnosis protocol for diabetes - People over age 45 should be tested for diabetes. If the first blood glucose test is normal, they should be re-tested every three years. A diagnosis of diabetes is made when any three of these tests is positive, followed by a second positive test on a different day.
What is the treatment for diabetes? - Diabetes is a chronic disease with no cure, but it can almost always be managed effectively. Nowadays, the goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia.
What type of diabetes diet is suggested? - For some people with diabetes mellitus, a healthy diet and weight loss is enough to keep glucose levels in the blood normal.
What medications are available for diabetes? - Oral diabetes medicines, or oral hypoglycemics, can lower blood glucose in people who have diabetes, but are able to make some insulin. Six FDA-approved oral diabetes medications are now on the market.
How to prevent diabetes? - Diabetes prevention is proven, possible, and powerful. Studies show that people at high risk for type 2 diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of their body weight.
What should a child diabetes do every day? - To control diabetes and prevent complications, blood glucose levels must be as close to a "normal" range as safely possible. Families should work with a health care provider to help set a child's or teen's targets for blood glucose levels.
Smoking and diabetes - There is a growing body of evidence to suggest that smoking is an independent risk factor for diabetes and that among people with diabetes, smoking aggravates the risk of serious disease and premature death.