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. 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 hyperglycemia, 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.

Other first aid measures include:

• 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.