Are we fully aware of Diabetes-Related Coma?

You may remember someone with diabetes, perhaps a family member or friend. Sometimes we have heard of such people suddenly losing consciousness, not being able to speak, and sometimes falling down. This is actually a very dangerous and life-threatening condition. That is why, today we thought of talking about this condition that can be caused by diabetes, or as doctors call it, `(Diabetes-Related Coma)`. Knowing this properly will help us take care of our loved ones.

What is a Diabetes-Related Coma? Simply put...

Simply put, a diabetic coma is a serious, life-threatening condition that occurs when our blood sugar levels suddenly become too high (hyperglycemia) or too low (hypoglycemia). A "coma" is a state of complete unconsciousness, like falling into a deep sleep, and unable to be awakened by speech. However, they are still alive despite their loss of consciousness. This is a condition that requires emergency medical attention.

There are three main reasons for this dangerous situation.

There are three main ways that a person with diabetes can fall into a coma. Let's take a look at what they are:

1. Hyperosmolar Hyperglycemic State (HHS)

2. Diabetes-Related Ketoacidosis (DKA)

3. Severe hypoglycemia

Now let's talk about each of these in a little more detail, okay?

1. What is Hyperosmolar Hyperglycemic State (HHS)?

This condition, called HHS, is most common in people with Type 2 Diabetes. It occurs when your blood sugar (glucose) levels are very high (usually above 600 mg/dL) for a long time. This can cause your body to lose too much water, leading to severe dehydration, confusion, and other symptoms. If not treated promptly, it can lead to a coma.

2. What is Diabetes-Related Ketoacidosis (DKA)?

A condition called ``DKA'' is also life-threatening. It most commonly affects people with ``Type 1 Diabetes'' (it can affect people who already have it, as well as those who don't know they have it). However, it can sometimes develop in people with Type 2 Diabetes as well.

DKA occurs when your body doesn't have enough insulin (either natural or taken from outside). As you know, insulin is essential for the sugar in our blood, glucose, to enter our cells and be used for energy. So when insulin is missing or not enough, the body starts to break down fat for energy. When fat is broken down, chemicals called ketones are released into the blood.

When the amount of `(ketones)` in the body of a person with diabetes increases, the blood gradually becomes `(acidic).` If this is not treated in time, a coma can occur. The blood sugar level of a person with `(DKA)` is usually higher than 250 mg/dL. But remember, the main cause of `(DKA)` is a lack of `(insulin)` and an increase in `(ketones)`, not just blood sugar. Some diabetics can go through `(DKA)` even if their sugar is higher than 250 mg/dL.

3. What is severe hypoglycemia?

This is the third reason. If the blood sugar level drops below 40 mg/dL, it is considered a severe ``hypoglycemia`` condition. This is also very dangerous for life.

You know, the main source of energy for our body and especially the brain is `(glucose)`. So when the blood sugar level decreases, the body cannot function properly. If the sugar level drops below 40 mg/dL, as mentioned, you may experience changes in your body and mind, making you unable to do anything. If this severe `(hypoglycemia)` condition is not treated for a long time, you may go into a coma.

This severe hypoglycemia condition is most common in people who take insulin for diabetes or certain diabetes pills such as sulfonylureas.

What are the symptoms of a diabetic coma? How do we recognize it?

There are three main characteristics of a coma:

• Unconsciousness: It's like being in a very deep sleep. No matter how much you talk, it's very difficult, almost impossible, to wake you up.
• Lack of eye response: The eyes remain closed. There is no response when someone opens their eyes. However, sometimes there may be some reflex responses in the eyes to things like light.
• Lack of motor response: No conscious movement. However, some reflex movements may be present.

Now let's see what are the symptoms that appear before going into a coma in the aforementioned `(DKA)`, `(HHS)` and severe `(hypoglycemia)` conditions. If you recognize these early, you can avoid a big accident.

Symptoms that precede coma in DKA:

• Nausea and vomiting.
• Stomach ache.
• Rapid, deep breathing (doctors call this ``Kussmaul breathing''). It can be in a single rhythm.
• A fruity smell on the breath.
• Feeling very tired and weak.
• Feeling disoriented or confused, as if one's mind is disturbed.
• Decreased alertness.

Symptoms that precede coma in `(HHS)` condition:

• Mental changes: confusion, delirium, hallucinations.
• It's like you're about to lose consciousness.
• Dry mouth and excessive thirst (polydipsia).
• Frequent urination.
• Blurred vision or loss of vision.
• Numbness, sometimes more on one side of the body.

Symptoms that precede coma in severe hypoglycemia include:

• Blurred vision or double vision.
• Getting words mixed up when speaking.
• Losing balance and having difficulty doing things.
• Disorientation.
• Seizures are like a fit.

If you notice any of these symptoms, don't ignore them. It's best to seek medical advice immediately.

What do we do if someone loses consciousness due to diabetes? (First aid)

Imagine that someone in your area suddenly loses consciousness due to diabetes. There are a few things you can do:

• Call 1990 immediately and get an ambulance. If you know that the person has diabetes, tell the 1990 operator that too.
• Don't give them anything to eat or drink. They could choke.
• Carefully turn the person on their side so that saliva or vomit does not block the airway.
• Until the ambulance arrives, follow the instructions given by the 1990 operator.

If done correctly, this can be a great help in saving that person's life.

Why does diabetes cause such loss of consciousness? (The reasons are simple)

As we've discussed before, there are three main causes of a diabetic coma, right? They are:

• Hyperosmolar hyperglycemic state `(HHS)`.
• Diabetic ketoacidosis (DKA).
• Severe hypoglycemia (very low blood sugar).

Both HHS and DKA are conditions where the body's water levels drop significantly, leading to severe dehydration. This dehydration can lead to a coma.

On the other hand, in severe hypoglycemia, the brain doesn't get the amount of glucose (sugar) it needs. Sugar is essential for the brain to function properly. When it's gone, the brain "shuts down" and you can go into a coma. Got that?

Who is at higher risk of developing a diabetic coma?

Anyone with diabetes (even those with undiagnosed diabetes) is at risk of developing a diabetic coma. However, this risk varies slightly depending on the type of diabetes:

• People with Type 1 Diabetes are at higher risk of going into a coma, either from DKA or severe hypoglycemia. This is because people with Type 1 Diabetes require insulin all the time and their blood sugar levels fluctuate more than people with Type 2 Diabetes.
• People with Type 2 Diabetes are more likely to go into a coma due to HHS than to DKA or severe hypoglycemia.

What are other risk factors?

In addition to these things, some other things can increase the risk of a diabetic coma:

• Developing other diseases.
• Undergoing surgery.
• Physical injuries (Trauma).
• Problems with the insulin delivery system (e.g., insulin pen, pump malfunctioning).
• Forgetting, skipping, or taking too much insulin.
• Not managing diabetes properly (e.g. not checking blood sugar levels daily, not taking medication properly).
• `(Hypoglycemia unawareness)` (that is, not knowing the early signs of low blood sugar).
• Drinking alcohol.
• Drug use.

How do doctors accurately diagnose a diabetic coma?

A diabetic coma is a medical emergency that requires immediate treatment. Anyone in a coma requires hospitalization.

Doctors can usually quickly diagnose a diabetic coma by taking your medical history, checking your blood sugar levels (blood glucose test), and performing other tests to check for ketones and your overall health.

That's why it's important for people with diabetes to wear a medical alert bracelet or necklace. In the event of an emergency, doctors can see it and make quick decisions. It's also important to let your family, friends, and coworkers know that you have diabetes. That way, they know what to do in an emergency.

How do you treat a diabetic coma?

The treatment for a diabetic coma varies depending on the cause , but hospitalization is always necessary.

Treatment for a coma caused by `(DKA)` or `(HHS):

• IV fluids: These are given to correct dehydration and electrolyte imbalances.
• Insulin: The medical team may give you insulin either through an IV or as a subcutaneous shot.
• Other treatments: Other treatments may be given to help you recover. These may include treating any underlying medical conditions or infections that may be causing your high blood sugar levels.

Treatment for a coma caused by severe hypoglycemia:

• Emergency glucagon: This is a synthetic form of the hormone glucagon. It can be given by a loved one or a doctor as an injection or as a nasal spray (depending on the type). Synthetic glucagon works by releasing glucose stored in the liver, increasing blood sugar levels.

Most importantly: Even if someone close to you gives you `(glucagon)`, you definitely need hospital treatment. They should give you `(glucagon)` and call 1990 immediately.

If further complications occur, such as organ failure, they may also require additional medical treatment.

What can we do to prevent a diabetic coma?

To prevent a diabetic coma, it's important to be aware of the early warning signs of hypoglycemia (DKA), hypoglycemia (HHS), and hypoglycemia. Talk to your doctor about what steps you can take to treat these conditions before they become serious.

See a doctor immediately if:

• If your blood sugar level is 300 mg/dL or higher on two consecutive occasions for no apparent reason.
• If you have a low blood sugar event (below 70 mg/dL) and it does not return to normal after three attempts at treatment (e.g., glucose tablets, sugary drinks), call your doctor or 911 immediately.

Can someone survive a diabetic coma? Are there any long-term effects?

Yes, a diabetic coma can be avoided if the underlying cause is treated quickly. However, some people can also suffer permanent brain damage. If not treated promptly and properly, death can even occur.

The mortality rate for DKA is between 0.2% and 2.5%. Those who go into a coma, have hypothermia, and have reduced urine output (oliguria) have the worst outcomes.

About 20% of people with HHS die from the condition. Those who develop a coma and/or low blood pressure have a poor prognosis.

How long can you stay in a diabetic coma?

The length of time you spend in a diabetic coma depends largely on how quickly you get the right treatment. The only way to end a coma like this is to bring your blood glucose and insulin levels back to healthy levels. This can only be done with the help of medical professionals. A person in a diabetic coma will not regain consciousness on their own.

If someone in a coma like this doesn't get treatment in time, they're likely to die. "In time" varies from case to case and person to person. That's why it's so important to get help as soon as possible.

In summary, here are the things we need to remember (Take-Home Message):

Although diabetic coma is a very dangerous thing, it is often preventable.

• The key is to be aware of the warning signs of `(DKA)`, `(HHS)`, and low blood sugar and to act quickly when you see them.
• If you have symptoms of this condition, call your doctor immediately.
• Diabetes complications are truly scary, but being aware and prepared is the best way to prevent them.
• Never hesitate to ask your doctor any questions you have about managing your diabetes or these complications. Your health is valuable to you.

` Diabetes, Coma, DKA, HHS, Hypoglycemia, Blood Sugar, Insulin, First Aid, Diabetes Complications, Loss of Memory