What is a diabetic coma and what causes it?

Diabetic coma is a complication of diabetes which causes a loss of consciousness and is potentially fatal. It should be noted that 3 variants of this clinical event are conceived: severe diabetic hypoglycemia, diabetic ketoacidosis, and hyperglycemic hyperosmolar coma.

First of all, it is necessary to remember that in diabetes the body does not produce (or does not use) insulin correctly, which leads to an accumulation of glucose in the blood. In the world there are estimated to be more than 420 million diabetic patients, or 8.8% of the planetary population.

When it comes to diabetic coma, it is essential to explore all its variants separately, as the causes and symptoms can be very different. That is why today we tell you everything about each of the types and how to prevent them. Do not miss it.

1. Hypoglycemic coma

Hypoglycemic coma is a medical emergency characterized by a drastic reduction in glucose circulating blood (less than 2.8 millimoles per liter of blood). The brain consumes about 20% of metabolized glucose, so the effects of its absence translate into brain insufficiency.

As you can imagine, lack of brain activity leads to loss of consciousness, also known as eat.

What can cause a hypoglycaemic coma?

People with diabetes who need to take large amounts of insulin are at increased risk of hypoglycemic coma. According to the portal Better health, These are some of the possible causative agents:

  • The patient takes an extra dose of insulin: insulin reduces the percentage of circulating glucose in diabetic patients. In any case, if the patient exceeds the dose, he runs the risk of suffering from hypoglycemia.
  • Overtraining Without Eating First: Glucose is needed for muscles to receive energy and be able to perform physical activities. For a healthy person, exercising without eating is a very bad idea, but if you are diabetic, the risk of something going wrong is greater.
  • Drinking too much alcohol: Alcohol damages the liver, which is the main organ responsible for storing glycogen. Glycogen can be metabolized into glucose when needed, but if the liver does not follow this process properly due to the effects of alcoholism, hypoglycemia is promoted.

As you have seen, this type of coma is due to lack of glucose in the blood. A bit ironic, but likely in patients with diabetes who are not receiving adequate doses of insulin.

Insulin injections.
A poor insulin dosing strategy or incorrect placement can lead to a diabetic coma.


The main symptom of hypoglycemic coma is loss of consciousness. In any case, the patient may notice that something is wrong before collapsing if he perceives the following signs:

  • Tiredness, weakness, disorientation, difficulty speaking and forming thoughts.
  • Very intense hunger because the brain requires glucose from the rest of the body.
  • Sweating, paleness and heart palpitations.
  • Nervousness and anxiety.
  • Dizziness and lightheadedness.

How to avoid a hypoglycaemic coma

As indicated by Association of Diabetics of Alcalá and Corredor de Henares (ADACH), an insulin overdose can be combated by eating carbohydrate-rich foods. A sugary soda, natural juice, and candy can do the trick. You need to sit back and rest, always with your phone at hand in case something goes wrong.

After eating (and waiting 15 to 20 minutes), the patient should use the blood glucose meter to check that the levels have indeed risen. If this is not the case, it’s time to call 911.

In a person who has already fallen into a coma, the emergency department chooses to inject glucagon or dextrose intravenously. Both raise blood sugar levels.

2. Diabetic ketoacidosis coma

Diabetic ketoacidosis is a life-threatening complication in diabetics. On many occasions, in those with type 1 diabetes. As indicated by the United States National Library of Medicinethis is the product of an excessively low percentage of circulating insulin.

The lack of insulin means that cells cannot use glucose as an energy source. Thus, the body begins to metabolize fatty acids at a rapid rate, which gives rise to ketone bodies. The drastic increase in the concentration of these bodies is what causes diabetic ketoacidosis. Ketone bodies cause the pH of the blood to become acidic.

As indicated by the National Center for Biotechnology Information (NCBI extension for its acronym in English), this clinical entity affects 8 out of 1,000 diabetics, which translates into approximately 168,000 hospitalizations per year in the United States. In severe cases, ketoacidosis leads to a life-threatening coma.

What can cause a diabetic ketoacidosis coma?

Diabetic ketoacidosis has multiple possible causes. THE mayonnaise clinic and other sources already mentioned show us some of them:

  • Infections and other diseases: some pathologies favor the production of certain hormones, such as cortisol or adrenaline. Cortisol, for example, makes the tissues less sensitive to insulin, counteracting its effect.
  • Not taking insulin correctly: If the insulin pump malfunctions or diabetes is not treated properly, levels of this polypeptide hormone can end up being low in the circulation.
  • Shots: these events, which are dangerous enough in themselves, can trigger diabetic ketoacidosis.


The symptoms of diabetic ketoacidosis are relatively different from those of hypoglycemia. For example, the patient usually experiences extreme thirst, lethargy, frequent urination (due to excess blood glucose), abdominal pain and a desire to vomit.

One of the most striking symptoms that indicate the danger of a diabetic coma of this type is that the patient has fruity breath. This is a clear abnormal indicator of an increase in ketone bodies.

How to avoid diabetic ketoacidosis coma

On this occasion, you need emergency treatment in hospital, Well, it’s not worth eating or resting. In the medical center, the patient will be given intravenous fluids and electrolytes, as dehydration is very common in this condition as we have seen previously.

Intravenous insulin therapy is always necessary to combat blood acidosis.. When circulating sugar levels are adequate (less than 11.1 millimoles per liter) and blood pH returns to normal, the person can leave the medical facility and continue normal insulin therapy at home.

3. Hyperglycemic hyperosmolar coma (HHS)

95% of patients suffering from hyperosmolar hyperglycaemic coma are type 2 diabetics, as indicated by the portal Stat Pearls. On this occasion, there is insulin resistance in the patient’s peripheral tissue, in most cases caused by states of obesity. An estimated 1% of all hospitalized diabetics have HHS.

Diabetic coma of this type results from an excessive presence of glucose in the blood (600 milligrams per deciliter), since insulin is unable to act on this sugar so that the cells metabolize it. It is, so to speak, the best expectedtaking into account the characteristics of diabetes.

HHS is relatively similar to diabetic ketoacidosis, as the deficiency of insulin action marks the beginning of both. In any case, on this occasion the production of ketone bodies is very low.

What can cause a hyperglycemic hyperosmolar coma?

Among the events that can cause a hyperosmolar hyperglycaemic coma, we find some already mentioned and some new ones. We list them quickly:

  • Forget about taking medications for diabetes.
  • present obesity after being diagnosed with type 2 diabetes.
  • get an infection, Like the flu or pneumonia.
  • Eat foods high in sugardespite having been previously advised against by a doctor.
Woman with obesity and type 2 diabetes.
Obesity is an important risk factor for coma in diabetic patients.


Hyperglycemia (excessive concentration of glucose in the blood) causes increased thirst, stomach pain, dehydration, dry mouth, rapid heart rate, shortness of breath, and nausea and vomiting. As you may have noticed, symptoms are similar to those of diabetic ketoacidosisbut in this case without the characteristic fruity puff.

Up to 50% of patients with HHS will eventually go into a coma, mainly due to aggressive dehydration caused by hyperglycemia.

How to avoid a hyperglycemic hyperosmolar coma

As with diabetic ketoacidosis, treatment should be responsible for fluid and electrolyte replenishment in the patient, since dehydration appears as a secondary clinical sign after hyperglycemia. In addition, intravenous insulin administration is also required until the condition normalizes.

Diabetic coma: 3 sides of the same coin

All types of diabetic coma are manifested by loss of consciousness in people with type 1 and 2 diabetes, but the epidemiology, causes, symptoms and treatments are different.

Most importantly, diabetic ketoacidosis and hypoglycemia are completely different, so they must be addressed as individual clinical events.

If you are a diabetic person and perceive a sign of hypoglycemia, it is best to stay calm, eat, rest and monitor your blood glucose levels well. If, on the other hand, you experience signs of hyperglycemia or ketoacidosis, call a medical center urgently, because there is little you can do from home.

The post What is a diabetic coma and what causes it? first appeared on research-school



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