January 25th, 2012 | 
Author: What is a diabetic coma?
It is a healing crisis and an acute life-threatening event that occurs in citizen with Diabetes Mellitus.
What causes a diabetic coma to occur?
1) diabetes that is undiagnosed
2) failure to take insulin as prescribed
3) rehabilitation that is not adequate
4) infection
5) surgery
6) trauma
7) stress
What happens with a diabetic coma?
There is not sufficient insulin to metabolize glucose so fats are used for energy. When these fats are broken down it causes ketone waste to build up causing metabolic acidosis. The body attempts to react to counteract the state of acidosis. What happens is that the alkali preserve is depleted causing water, potassium and sodium chloride to be lost. The respiratory rate increases, in a process called kussmaul breathing, as the body attempts to blow off excess carbon dioxide that will finally cause hypoxia. Urinary urination is also increased prominent to dehydration.
What are the warning signs and symptoms of a diabetic coma?
1) headache that is dull
2) fatigue
3) thirst
4) nausea/vomiting
5) epigastric pain
6) facial flushing
7) lips are parched
eyes sunken
9) increased body temp to begin with then decreased
10) drop in systolic blood pressure
11) circulatory collapse
The rehabilitation for a diabetic coma includes the immediate management of short-acting insulin and replacing electrolytes and fluids to counteract the acidosis and dehydration.
There are five types of diabetic coma a man with diabetes must be aware of
1. Diabetic Ketoacidosis (Dka; Diabetic Coma)
Diabetic Ketoacidosis occurs when there is a severe growth in blood sugar connected with poorly controlled diabetes. As a ensue there is an growth in the metabolism of fat and protein for power sources. When fats are metabolized this results in the production of fatty acids that are converted into ketone bodies. An growth in the whole of circulating ketone bodies leads to acidosis. This occurs generally with type 1 diabetics. The onset can be rapid or over some days. This can be caused from stress, surgery, infection, or lack of insulin control.
With Dka (diabetic ketoacidosis) there is severe hyperglycemia 300 to 1500 mg/dl. Dka is often caused due to infection, emotional stress, fever, increased food intake, fertilization or inadequate insulin dose. Hyperkalemia (increased potassium), metabolic acidosis, weakness, thirst, urine ketones and sugar are increased, nausea, vomiting, diarrhea, fruity breath, kussmaul respirations, abdominal pain, level of consciousness decreases, blurring expanding to coma, skin will be warm dry and flushed. Kussmaul respirations are very deep respirations that occur as the body attempts to blow off carbon dioxide.
Heart rate will be increased. Urine production is increased. Due to the dehydration there will be an increased body temp, polyuria, polydispia, weight loss, dry skin, sunken eyes. Large amounts of ketones will be in urine and serum Ph will be below 7.25 (acidotic). Hematocrit will be high due to dehydration. Bun and creatinine will be elevated due to dehydration. Dka occurs in all age groups with primarily type 1 diabetes but can occur with severe distress with type 2 diabetics. If left untreated Dka leads to coma and death.
2. Hhnc – Hyperosmolar Hyperglycemia Non Ketotic Coma
This is a condition where there is sufficient insulin produced to prevent the breakdown of fat but severe hyperglycemia occurs. Hhnc can be caused by infection, diarrhea, vomiting, failure to comply with dietary and medication regimen, stress, continued exposure to drugs that induce hyperglycemia such as steroids or poor fluid intake. In the absence of the acidotic state there is a severe dehydration and electrolyte imbalance. With Hhnc hyperglycemia ranges from 700 to 2000 mg/100dL. This is seen mostly with geriatric type 2 diabetics. Because the body is able to sound a very low level of insulin production this keeps the fat from being broken down resulting in ketone bodies and acidosis.
What does happen is osmotic diuresis because of the hyperglycemia causing the inpatient to come to be dehydrated quickly. Hhnc will gift with skin that is warm and flushed, lethargy, decreased Loc ( Level of Consciousness), weakness, thirst, increased body temp due dehydration, hematocrit will be high due to dehydration, increased heart rate, hypertension ( increased blood pressure), hyperglycemia, increased urine output, and glycosuria. Bun (Blood, Urea, Nitrogen) and creatinine levels will be increased. Hhnc occurs often in elderly citizen that are undiagnosed type 2 diabetics. Elderly are also at a greater risk for dehydration due to their altered thirst perception.
As the inpatient becomes acidotic potassium moves out of the cell leaving the cell depleted of potassium, serum potassium remains normal due to the immoderate excretion. With the hyperglycemia/hyperosmolar state osmotic diuresis is the ensue causing the serum potassium to be excreted. With dehydration the serum potassium becomes concentrated and does not show the loss of cellular potassium. When the acidosis and osmolarity are corrected and insulin is given the potassium will shift back into the cells causing hypokalemia (decreased potassium) to occur.
3. Exogenously induced hypoglycemia (insulin coma)
This occurs when the blood glucose level falls below 60 mg/dl. This can be a side ensue of insulin therapy or hypoglycemic medications taken by mouth. It can occur when a meal is skipped, diabetic inpatient takes too much insulin, vomits a meal, or is over exercising. The signs and symptoms that are seen are a ensue of the sympathetic nervous theory being stimulated or due to the reduced supply of glucose to the brain. What will be felt by the inpatient is muscle weakness, diplopia, feeling faint, tingling and dullness of the fingers lips and tongue. What will we be able to see? Diaphoresis, shaking, increased heat rate, and confusion. The inpatient should be given glucose orally if alert. Glucagon may be given intravenously to stimulate glycogenolysis. inpatient maybe given 50% dextrose via Iv if necessary.
4. Endogenously induced Hypoglycemia (Reactive Hypoglycemia)
Blood glucose falls below 60 mg/dl. This is caused by an overproduction of insulin or an insulin-like substance. This maybe caused by a tumor with the potential to furnish insulin, or an autoimmune disease. This can be brought on by the under production of glucose due the hormonal deficiency along with Acth, glucagon and catecholamine’s. This can be the ensue of liver disease or brought on by drugs such as alcohol, propranolol and salicylate’s.
Depending on the cause the inpatient may need surgical operation to take off the insulin producing tumor, diazoxide therapy to suppress insulin production or hormone change to accurate deficiencies. inpatient should terminate drugs that cause hypoglycemia. If inherent improvement of liver disease will also mitigate this condition. Patients should eat a low carbohydrate diet with high protein and avoid straightforward sugars and fasting.
5. Reactive (functional) Hypoglycemia
Reactive Hypoglycemia is due to rapid gastric emptying and often occurs after gastric surgery. This rapid gastric emptying stimulates the production of immoderate amounts of insulin resulting in a low blood sugar. The inpatient will feel anxious, irritable, weak, fatigued. You will be able to search for hypoglycemia, pallor, and diaphoresis. Rapidly absorbed sugars should be avoided. Frequent meals are helpful. Patients who sense reactive hypoglycemia should growth protein, complicated carbohydrates and fiber due to their potential to slow gastric emptying and slow glucose absorption.
A diabetic coma is a life threatening condition that needs to be dealt with quickly. Knowing the signs and symptoms is the first step to preventing this deadly occurrence.
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