Diagnosis Of Diabetic Coma
A coma is a medical emergency. A quick diagnosis can save the persons life. The cause of a diabetic coma is diagnosed using a number of tests including:
- medical history
- physical examination the person may be wearing an emergency bracelet identifying their medical condition
- blood tests including tests for glucose and ketone levels.
Darker Area Of Skin That Feels Like Velvet
A dark patch of velvety skin on the back of your neck, armpit, groin, or elsewhere could mean that you have too much insulin in your blood. This is often a sign of prediabetes.The medical name for this skin condition is acanthosis nigricans.
Acanthosis Nigricans
Often causing darker skin in the creases of the neck, AN may be the first sign that someone has diabetes.
Take action
- Get tested for diabetes
Symptoms And Risk Factors
It can take months or years before symptoms of type 1 diabetes are noticed. Type 1 diabetes symptoms can develop in just a few weeks or months. Once symptoms appear, they can be severe.
Some type 1 diabetes symptoms are similar to symptoms of other health conditions. Dont guess! If you think you could have type 1 diabetes, see your doctor to get your blood sugar tested. Untreated diabetes can lead to very seriouseven fatalhealth problems.
Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes. However, studies show that family history plays a part.
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What Are Symptoms Of Hypoglycemia
The symptoms may vary from one person to another, but most common symptoms include:
-
excessive hunger
-
loss of consciousness
Some patients with longstanding diabetes or recurrent hypoglycemia may have no symptoms at all. This is called hypoglycemia unawareness, which is a serious condition. Using a continuous glucose monitor can help with detection and alarms.
When Is Blood Sugar Considered To Be Too High Or Too Low
Slight fluctuations in blood sugar levels are completely normal, and also happen every day in people who dont have diabetes, in response to the food they eat. Between around 60 and 140 milligrams of sugar per deciliter of blood is considered to be healthy. This is equivalent to a blood sugar concentration of between 3.3 and 7.8 mmol/l. Millimoles per liter is the unit that blood sugar is measured in. It describes the amount of a certain substance per liter.
If someone has readings over 7.8 mmol/l , they are considered to have hyperglycemia. These high blood sugar levels mainly occur if there isn’t enough insulin or the insulin doesn’t work properly. Without the effect of insulin, the organs can’t make good use of the sugar in the blood, so the sugar builds up. If type 1 diabetes is left untreated, blood sugar levels can increase to over 27.8 mmol/l . Such high levels tend to be uncommon in type 2 diabetes.
Blood sugar levels below 3.3 mmol/l are considered to be too low. But, as you can see in the illustration below, there are no clear-cut borders between normal blood sugar levels and too high or too low blood sugar levels.
Blood sugar: Normal range between hyperglycemia and hypoglycemia
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First Aid For Diabetic Coma
First aid for someone who has lapsed into a diabetic coma includes:
- Dont try to give them anything to eat or drink, as they may choke.
- Turn them onto their side to prevent obstruction to breathing.
- Follow any instructions given to you by the operator until the ambulance officers arrive.
- Dont try to give them an insulin injection.
- If available, administer 1 mg of glucagon for rapid reversal of hypoglycaemia.
Causes Of Type 1 Diabetes
Type 1 diabetes is an autoimmune condition, where the immune system mistakes the cells in your pancreas as harmful and attacks them.
Without insulin, your body will break down its own fat and muscle, resulting in weight loss. This can lead to a serious short-term condition called diabetic ketoacidosis. This is when the bloodstream becomes acidic, you develop dangerous levels of ketones in your blood stream and become severely dehydrated.
This results in the body being unable to produce insulin, which is required to move glucose out of the blood and into your cells to be used for energy. This is called Type 1 diabetes.
Read more about the causes of type 1 diabetes
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How Can I Prevent Low Blood Glucose
Your best bet is to practice good diabetes management and learn to detect hypoglycemia so you can treat it earlybefore it gets worse.
Monitoring blood glucose, with either a meter or a CGM, is the tried and true method for preventing hypoglycemia. Studies consistently show that the more a person checks blood glucose, the lower his or her risk of hypoglycemia. This is because you can see when blood glucose levels are dropping and can treat it before it gets too low.
If you can, check often!
- Check before and after meals.
- Check before and after exercise .
- Check before bed.
- After intense exercise, also check in the middle of the night.
- Check more if things around you change such as, a new insulin routine, a different work schedule, an increase in physical activity, or travel across time zones.
You Notice Tingling And Numbness In Your Hands Or Feet
As mentioned, uncontrolled blood sugar can cause nerve damage, also known as diabetic neuropathy. What you may notice is a tingling sensation or even numbness in your hands and feet. Some people experience pain in their hands and feet as well. Though neuropathy is most common in people who have had diabetes for a long time, it can occur in anyone with poorly controlled diabetes.
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What Are The Symptoms Of Hyperglycemia
Its especially important to know the early signs of hyperglycemia if you have type 1 diabetes. If hyperglycemia is left untreated in people with type 1 diabetes, it can develop into ketoacidosis, where ketones, which are toxic acids, build up in the blood. This condition is an emergency situation that can lead to coma or death.
Early symptoms of hyperglycemia include:
- High blood sugar.
- Unusual fruity smell on the breath.
- Deep labored breathing or hyperventilation.
- Rapid heartbeat.
When To Seek Medical Care For An Insulin Reaction
Most people with diabetes have experienced an insulin reaction early after their initial diagnosis as diet and medication or insulin dosing are being adjusted to fit into their lifestyle.
Whenever a person is unconscious, regardless of the cause, call 911 or your local emergency telephone number to activate emergency medical service responses.
If the affected individual remains confused, even after eating or drinking to correct low blood sugar, he or she should receive medical care.
People with diabetes who take sulfonylurea oral hypoglycemic medications, like glipizide , glyburide , or glimepiride , should contact their health care practitioner or seek urgent medical care if they experience an insulin reaction. These medications can remain active in the body for a prolonged period of time, and observation in a hospital setting may be necessary.
Insulin reactions, especially those that occur at night or early morning should be reported to your health care practitioner. People with diabetes should keep a record of their blood sugar readings as it is an important tool to help keep blood sugars under a good control and decrease the risk of long-term complications of diabetes.
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Why Am I Having Lows
If you are experiencing low blood glucose and youre not sure why, bring a record of blood glucose, insulin, exercise, and food data to a health care provider. Together, you can review all your data to figure out the cause of the lows.
The more information you can give your health care provider, the better they can work with you to understand what’s causing the lows. Your provider may be able to help prevent low blood glucose by adjusting the timing of insulin dosing, exercise, and meals or snacks. Changing insulin doses or the types of food you eat may also do the trick.
S For Treating A Person With Symptoms Keeping Them From Being Able To Treat Themselves
Dont hesitate to call 911. If someone is unconscious and glucagon is not available or someone does not know how to use it, call 911 immediately.
Do NOT:
- Provide food or fluids
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How To Prevent Hypoglycemia
Make sure you eat after taking a premeal diabetes medication .
Newer CGMs have predictive models and can inform you if your blood glucose is dropping too fast. Activate the hypoglycemia alarms in your CGM if you use one.
Using hybrid closed-loop insulin pumps also decreases risk of hypoglycemia as the pump constantly receives blood sugar data from the CGM and in turn decreases or even suspends insulin delivery if needed.
There are also bi-hormonal pumps under development that use both insulin and glucagon. These pumps are expected to significantly reduce hypoglycemia events in patients on insulin pumps.
You Develop Sores That Tend To Heal More Slowly Than Usual
Cuts, scrapes, bruises, and other wounds heal more slowly in the presence of uncontrolled blood sugar, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes causes nerve damage and affects circulation, especially in the lower legs and feet, which can delay healing because there isnt enough blood flow to the area. Even minor wounds are more prone to infections, which can become very serious and even result in amputations of the foot. You may notice drainage seeping onto your socks or an unpleasant smell if you develop a foot ulcer, notes the American Podiatric Medical Association.
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How To Administer Glucagon
To administer a glucagon injection, a person should:
- Unseal the vial of powder
- Take off the needle cover from the syringe
- Insert the needle into the vial and push the plunger to release all the saline into the powder
- Swirl the vial gently to make sure the powder dissolves in the liquid and the liquid is clear
- Pull the plunger back to draw the liquid into the syringe.
- Inject into the outer mid-thigh or arm muscle of the person.
- Turn the person on his or her side in case of vomiting, which commonly occurs after an injection.
However, if a person can keep a glucagon nasal spray on hand, this may be easier for a friend or family member to administer.
A person should take the warning signs and symptoms of hypoglycemia extremely seriously. When blood glucose levels are too low, it can affect brain functioning and lead to complications, including:
- loss of consciousness
When treating hypoglycemia, it is vital that a person does not take more glucose than they need, as this can cause blood sugar levels to rebound too high.
A person can make general lifestyle changes to help avoid diabetic shock and hypoglycemia, including:
Also, people can adjust their blood sugar targets according to their individual needs. For example, people with hypoglycemia unawareness might benefit from targeting a higher blood sugar.
People can prevent complications by carrying a medical alert bracelet or another form of identification to inform emergency personnel that they have diabetes.
When To Contact A Medical Professional
- Shortness of breath
- Red, painful skin that is spreading quickly
These symptoms can quickly get worse and become emergency conditions .
Also contact your provider if you have:
- Numbness, tingling, or pain in your feet or legs
- Problems with your eyesight
- Sores or infections on your feet
- Symptoms of high blood sugar
- Symptoms of low blood sugar
- Frequent feelings of depression or anxiety
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What Are The Symptoms Of A Diabetic Reaction
If untreated, symptoms may progress to confusion, nonsensical behavior, coma, and death.
High Blood Sugar Symptoms
- Symptoms occur gradually over several days.
- A person with high blood sugar develops increasing thirst and urination due to large amounts of unused glucose being lost in the urine.
- Skin feels warm and dry respirations may be shallow the pulse is rapid and weak, and breath may have a sweet odor .
- A person with high blood sugar may become confused or comatose, and death may result.
What Causes Insulin Reaction
Insulin reactions occur when there is an imbalance of food intake and the amount of insulin in the body. Oral hypoglycemic medications can remain active in the body for more than 24 hours. The effects of Injectable insulin can be short or very long depending upon the type. Even in individuals whose diabetes is well controlled and regulated with medication, a variety of factors can cause the insulin/glucose levels to fluctuate from the normal range. Also, alcohol plays a role in causing hypoglycemia?
People who have had diabetes for 10-20 years and/or have been on long term or large doses of insulin are more prone to “insulin unawareness”. They can suddenly become hypoglycemic without any warning and should check sugar before driving. They should consider Continuous Glucose Monitoring or a handheld reader with a 14-day patch that lets them read blood sugar at any time.
Perhaps the most common cause of an insulin reaction or hypoglycemia is a missed meal. Once insulin is injected or a diabetes medication is taken, its effect needs to be balanced by caloric intake from food . If the number of calories eaten decreases, blood glucose levels drop and the insulin acts unopposed, which causes the characteristic symptoms of an insulin reaction. An insulin reaction can also occur with exercise. When a person exercises the muscle cells need extra energy , and if food intake is decreased, the blood sugar levels will drop.
- night sweats, and
- increased appetite and weight gain.
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What Is Hypoglycemia
Hypoglycemia is a low level of blood sugar. The cells in your body use sugar from carbohydrates for energy. Insulin, which normally is made in the pancreas, is necessary for sugar to enter the cells. It helps keep the levels of sugar in the blood from getting too high.
It’s important to maintain the proper level of sugar in your blood. Levels that are too high can cause severe dehydration, which can be life-threatening. Over time, excess sugar in the body does serious damage to organs such as your heart, eyes, and nervous system.
Ordinarily, the production of insulin is regulated inside your body so that you naturally have the amount of insulin you need to help control the level of sugar. But if your body doesn’t make its own insulin or if it can’t effectively use the insulin it does produce, you need to inject insulin as a medicine or take another medication that will increase the amount of insulin your body does make. So if you need to medicate with insulin, it becomes your responsibility to see that you have the amount of insulin you need when you need it.
Why Do Hypos Happen
Understanding why you get hypos can help you prevent them from happening as often.
We dont always know why hypos happen, but some things make them more likely. These include:
- missing or delaying a meal or snack
- not having enough carbohydrate at your last meal
- doing a lot of exercise without having extra carbohydrate or without reducing your insulin dose
- taking more insulin than you needed
- drinking alcohol on an empty stomach.
Insulin and some other diabetes medications can make you more likely to have a hypo. Check with your diabetes healthcare team if youre not sure whether the treatment youre on is likely to cause hypos.
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Treatment For Diabetic Coma
Treatment options for diabetic coma include:
- ketoacidotic coma intravenous fluids, insulin and administration of potassium
- hyperosmolar coma intravenous fluids, insulin, potassium and sodium given as soon as possible
- hypoglycaemic coma an injection of glucagon to reverse the effects of insulin or administration of intravenous glucose.
Financial Support And Benefits
Some people with diabetes may be eligible to receive disability benefits and incapacity benefits, depending on the impact the condition has on their life.
The main groups likely to qualify for welfare benefits are children, elderly people, people with learning disabilities or mental health problems, and those with complications of diabetes.
People over 65 who are severely disabled, may qualify for a type of disability benefit called Attendance Allowance.
Carers may also be entitled to some benefit too, depending on their involvement in caring for the person with diabetes.
Staff at your local Citizens Advice Bureau can check whether you’re getting all of the benefits you’re entitled to. Both they and your diabetes specialist nurse should also be able to give you advice about filling in the forms.
GOV.uk has more information about benefits, and the Diabetes UK website has further advice about the Disability Living Allowance .
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How Is Hypoglycemia Treated
If your hypoglycemia is mild or moderate, the best way to raise your blood sugar level quickly is to eat or drink something that contains 15 to 20 grams of glucose or other sugar. You might take 3 to 4 glucose tablets or 1/3 to 1/2 tube of glucose in gel form, which you can buy at the drugstore. Or you may want to drink a half cup of fruit juice .
Other snacks you can use to raise your sugar level include:
- One-half cup of regular soda — not diet
- 1 tablespoon of honey, molasses, or corn syrup
- One-quarter cup raisins
- 2 large or 6 small sugar cubes dissolved in water
You can also ask your doctor or dietitian for recommendations for other snack items that can help raise your blood sugar level when you need to.
After you’ve taken a snack, wait 15 minutes and check your blood sugar level again. If it is still low, eat another snack, then wait 15 minutes and check it again. Repeat the process until your blood sugar level is in its normal target range. Following that, eat another small snack if your regular meal is more than an hour away, such as half a sandwich, 1 ounce of cheese with 4 to 6 crackers, or 1 tablespoon peanut butter with 4 to 6 crackers.
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