DIABETIC COMA

Types of Diabetic Coma

Often, the term "diabetic coma" is used generically to indicate different types of complications typical of diabetic disease, characterized by a prolonged loss of consciousness of the patient.
More specifically, it is often stated that diabetic coma is a complication of diabetes that can be caused by hypoglycemia, non-ketotic hyperglycemic-hyperosmolar syndrome, or diabetic ketoacidosis.
However, this generic use of the term "diabetic coma" is not entirely accurate. In fact, it would be more correct to speak, respectively, of:

Hypoglycemic coma, due precisely to a situation of hypoglycemia and also called "insulin shock" or "reaction to" insulin ".

Non-ketotic hyperglycemic-hyperosmolar coma, identifiable as hyperglycemic-hyperosmolar syndrome, a complication of type II diabetes that usually occurs following a period of symptomatic hyperglycemia.

Ketoacidosic coma or diabetic coma which can occur in the case of diabetic ketoacidosis that has not been adequately treated and / or diagnosed.

Therefore, this article will only deal with diabetic coma as a consequence of diabetic ketoacidosis.

Causes

In light of what has just been said, diabetic coma occurs in the case of diabetic ketoacidosis, of which it represents the "evolution. Not surprisingly, some authors use the term" diabetic coma "just as a synonym for" diabetic ketoacidosis ".
Diabetic ketoacidosis is itself a complication of diabetes (especially type I diabetes mellitus, although in some cases it can also occur in patients with type II diabetes) caused by an absolute deficiency of insulin.
Due to the lack of insulin, glucose - although present in the body and in the bloodstream - cannot enter the cells; therefore, it cannot be used.
The cells, therefore, try to make up for this lack by exploiting fatty acids, from whose metabolism they derive the energy they need.
However, the metabolism of fatty acids in the absence of adequate amounts of glucose in the cell leads to the synthesis of so-called ketone bodies.
Moreover, at the same time - given the lack of intracellular sugar - the body paradoxically produces hormones that stimulate the secretion of glucose into the circulation; this only worsens the hyperglycemia already present in the patient, since, given the lack of insulin, however, the newly synthesized glucose cannot reach the intracellular level.
The combination of these phenomena therefore leads to the onset of ketoacidosis, therefore of diabetic coma.

Symptoms

Diabetic coma does not appear suddenly, but its onset is preceded by a particular symptomatology and its onset is slow and progressive.
The symptoms preceding the onset of this complication essentially consist of:

Nausea and vomit;

Abdominal pain;

Intense thirst;

Polyuria and pollakiuria;

Blurred vision;

Disorientation;

Mental confusion;

Tiredness, drowsiness and lethargy which can then progress to a coma.

In association with these symptoms, the patient will present with hyperglycemia, glucosuria, ketonemia, ketonuria, cardiac arrhythmias, and deep, wheezing breathing.
Briefly summarizing, it can be stated that the loss of consciousness in diabetic coma is associated with a strong global dehydration of the patient (in particular, the eyes appear sunken and the mucous membranes dry), ketosic breath (due to the increase in the production of ketone bodies from part of the body), elevated blood sugar, electrolyte changes and decreased blood pH.

Treatment

As mentioned, diabetic coma is a complication of diabetes that can even be fatal. For this reason, as soon as the characteristic symptoms of diabetic ketoacidosis appear, it is essential to contact your doctor and go to the hospital.
It is therefore clear that prevention and timeliness of diagnosis constitute the best available treatment for this serious complication.
In any case, the treatment of diabetic coma must absolutely take place in a hospital setting and under the strict supervision of the doctor:

First, it is essential to rehydrate the patient through intravenous administration of fluids.
If the dehydration is very severe, usually, we proceed with a rapid intravenous infusion of physiological solution. If, however, the dehydration is less severe, the amount of fluids to be administered will be determined by the doctor on a case-by-case basis.
Of course, your doctor will also treat any electrolyte imbalances.

Later, or simultaneously with the rehydration process (depending on what the doctor decides), the patient must also be given an "appropriate dose of insulin (always established by the doctor on a case-by-case basis), in order to restore normal levels. of glycaemia and in order to stop the synthesis of ketone bodies by the organism.

Naturally, the blood glucose levels will have to be regularly monitored, so as to evaluate the patient's response to the therapy in order to be able, consequently, to adjust the dosage of insulin to be administered to the patient, until the desired effect is obtained.