What is a diabetic coma? Varieties, symptoms, first aid

The normal functioning of many organs and systems of the human body largely depends on the production of insulin by the pancreas. The slightest failure in the synthesis of the hormone leads to a change in important blood parameters, a violation of protein and water metabolism of cells. It is especially important to maintain insulin levels for people with diabetes. Against the background of its lack and complications of the treatment process, a diabetic coma can develop – a very dangerous condition that ends in death if the patient is not provided with timely assistance.

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Varieties of diabetic lumps

A diabetic coma affects body systems in different ways. Depending on what type of diabetes a person suffers and against the background of which a coma develops, the following types are distinguished:

• Ketoacidotic – high levels of glucose and ketone bodies are observed in the blood; 
• Hypoglycemic – manifested by impaired nervous activity; 
• Hyperlactacidemic – diagnosed with a high concentration of lactic acid; 
• Hyperosmolar – characterized by serious metabolic disorders in the body, severe dehydration and cellular exsicosis. More often observed in patients over 50 years old. 

At the first symptoms of a diabetic coma, it is necessary to take urgent measures and seek medical help.

Ketoacidosis

Ketoacidosis or ketoacidotic coma occurs in patients with type 1 diabetes mellitus and manifests itself against the background of a lack of insulin. In this case, the breakdown of glucose occurs very slowly or is completely reduced to zero. The result of this condition is a violation of cellular metabolism and a disorder in the work of many vital organs. The reason for this type of coma is the lack of insulin injected, or the lack of the latter. The result is a sharp jump in blood glucose levels (up to 33 mmol / L), which leads to deep fainting with a gradual worsening of the symptoms of ketoacidosis.

Features of ketoacidotic coma

This type of coma in diabetes mellitus can develop in 1-2 days. But, in the presence of provoking factors, this process goes much faster. Ketoacidosis can be caused by:

• The patient’s ignorance of his diagnosis and underestimation of the symptoms indicative of diabetes mellitus;
• Insufficient insulin dose or poor quality;
• Gross non-compliance with the conditions of a strict diet;
• Regular non-compliance with the recommendations of the attending physician;
• Conscious refusal to inject insulin (observed in people with suicidal tendencies).

The rate of insulin injected into the body should increase:

• After suffering stress;
• With significant physical exertion;
• During pregnancy;
• After suffering an injury or surgery;
• During acute infectious diseases;
• When taking diuretics or glucocorticosteroid medications.

The main symptoms of ketoacidosis

A diabetic coma of a ketoacidotic nature has the following symptoms:

• The characteristic smell of acetone from the patient’s mouth;
• Noisy and rapid breathing;
• Nausea and vomiting;
• Severe dehydration of the body;
• Pale skin with a lot of dying cells;
• Flabby muscles with no reflexes;
• Low body temperature;
• The eyeballs become tactilely soft, the pupils are narrowed;
• Frequent and involuntary urination, even in a coma;
• Urine smells like acetone;
• Diarrhea;
• Distended, tight stomach;
• Poor functioning of the large and small intestines;
• Drowsiness, indifference to what is happening, confused consciousness;
• Low blood pressure;
• Delusional states, hallucinations, epileptic seizures caused by severe intoxication of the brain.

If medical care for a patient in a diabetic coma is not provided in a timely manner, the symptoms may be complicated by cerebral edema, heart attack or pneumonia.

Non-ketoacidotic coma

Patients with type 2 diabetes should be well aware of the symptoms of hyperosmolar or non-ketoacidotic coma. Against the background of significant insulin deficiency in such patients, the level of glucose, sodium and urea in the blood rises, which leads to malfunctions of organs and systems. The main cause of a coma is dehydration, caused by:

• Inability to quench your thirst;
• Diarrhea, severe vomiting;
• The use of diuretics.

The following factors significantly influence the formation of a hyperosmolar coma:

• Lack of insulin in the blood;
• Excess blood glucose;
• Eating foods rich in carbohydrates;
• Diabetes insipidus;
• Large blood loss.

Thus, in order to avoid the negative consequences of a coma, it is necessary to accurately follow all the recommendations of doctors.

Symptoms of a non-ketoacidotic coma

Non-ketoacidotic coma is accompanied by hyperosmolar syndrome, which is characterized by high glucose levels (up to 30 mmol / L). Often this condition develops into ketoacidosis. Compulsory hospitalization is recommended for experienced diabetics and elderly people. A hyperosmolar coma begins to manifest itself as a frequent urge to urinate. Further, the following symptoms are observed:

• Thirst;
• General malaise;
• Nystagmus;
• Difficulty urinating;
• Slurred speech;
• Convulsions;
• Partial paralysis.

Obvious signs of a coma are formed in a few days, but slower processes are also noted .

Hyperosmolar coma occurs much less frequently than other similar pathological conditions. However, 50% of its manifestations end in death.

Hyperlactacidemic coma

As in other cases of diabetic coma, hyperlactacidemic pathology develops against the background of negative changes in blood composition. For this case, this is a jump in lactic acid indicators. The reason is the same – lack of insulin. Among the factors that can contribute to the increase in lactic acid, the main ones are:

• Lack of oxygen caused by cardiac or respiratory problems. It can be asthma, heart disease, bronchitis, difficulty in venous circulation;
• Infectious diseases;
• Inflammatory processes;
• Severe kidney disease;
• Cirrhosis, hepatitis, or liver failure;
• Chronic forms of alcoholism.

Features of hyperlactacidemic coma

Acute hypoxia is the main feature of coma, which occurs in a hyperlactacidemic form. In this case, a lack of insulin in the patient’s blood is necessarily diagnosed. The result of the pathology is anaerobic glycolysis caused by a lack of oxygen. The specificity of this condition is also determined by the large amount of lactate, which the liver cannot process due to oxygen starvation. All this leads to disruption of the heart muscle and vasoconstriction. Hyperlactacidemic coma develops in a few days and manifests itself in the form of the following symptoms:

• Severe muscle pain;
• Confused consciousness;
• Angina pain;
• Nausea;
• Vomiting urge.

If you do not provide the patient with timely medical care, the probability of death is 50%.

Hypoglycemic coma

All of the above forms of diabetic coma occur in the presence of insulin deficiency and a significant increase in glucose volume. But, this is not the only reason for the occurrence of pathology. Hypoglycemic coma is the opposite condition. It is characterized by high insulin and low glucose levels. In this case, the causes of dangerous pathology are:

• Choosing the wrong dose of insulin or drugs that lower blood sugar;
• Failure to comply with recommendations for the introduction of insulin into the body. For example, after the injection, the patient did not eat;
• Severe stress;
• Great physical activity.

The consequences of hypoglycemic coma are disruptions in protein metabolism in the body, carbohydrate metabolism in the nervous system, and problems with the functioning of the brain. Symptoms of hypoglycemia:

• Severe hunger;
• Cold sweat;
• Aggression, feelings of anxiety;
• Tachycardia;
• Low blood pressure;
• Pallor of the skin;
• Trembling limbs;
• Temperature rise, complete atony.

At the initial stage of coma development, you can help the patient on the spot by giving him a sweet drink. For example, tea or fruit drink with jam. If the glucose level is between 2.77-1.66 mmol / L, a glucose injection will be needed. An ambulance will be needed if the glucose readings approach 1.66-1.38 mmol / L.

First aid for diabetic coma with insufficient insulin

No matter how a diabetic coma manifests itself, at the first symptoms it is necessary to call an ambulance. The diabetics should be laid on their side and covered with a blanket. The patient’s legs especially need warmth. You do not need to inject insulin yourself. In such cases, it is more likely to worsen the patient’s condition. The arrived doctors will conduct an express blood test and, on its basis, will inject the required amount of insulin and put on a drip with 0.9% sodium chloride solution. Depending on the type of coma, first aid may differ slightly in ways and methods.

It is possible to determine the type of diabetic coma only with a glucometer, according to the test results. The ketoacidotic state is characterized by the presence of glucose in a volume of at least 35-40 mmol / l, the hyperosmolar coma gives 45-55 mmol / l. In the first case, the test strip for acetone is positive, in the second – negative.

What to do in case of comatose diabetic conditions

The general algorithm for first aid in diabetic coma is as follows:

• Stop dehydration of the body;
• Normalize the composition of the blood for insulin and glucose;
• Normalize acid-base balance;
• Restore carbohydrate metabolism;
• Correct the electrolyte composition of cells.

You need to understand that diabetes mellitus is a serious illness. It is impossible to ignore even the simplest recommendations of doctors in such cases. If the patient has fallen into a coma, it is necessary to immediately call a doctor, otherwise irreversible consequences that threaten a fatal outcome will begin to develop in the diabetic’s body.