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Diabetic Coma: Causes, Symptoms, Treatment

Diabetic Coma is a complication of diabetes which is life threatening.

This is mostly a complication of type 2 diabetes but people with other types of diabetes too, can get affected with diabetic coma. This type of coma is a reversible form of coma. Diabetic coma causes unconsciousness which you cannot awaken from until medically treated.

If untreated, Diabetic Coma can be fatal. If the blood sugar is very high or is dangerously low then it can lead to diabetic coma. Improved diagnosis and early treatment of the causative factors of Diabetic Coma can reduce the risk of death.



1. Severe low blood Sugar (hypoglycemia) in a diabetic person.

2. Advanced Diabetic Ketoacidosis – This can lead to unconsciousness due to a combination of factors such as high blood glucose levels, shock, dehydration and exhaustion.

3. Nonketotic Hyperosmolar Coma – This type of coma occurs when the blood sugar levels is extremely high along with dehydration.


Risk Factors

Anyone suffering with diabetes has a risk of diabetic coma. Persons suffering from type 1 diabetes are at a risk due to lowered levels of blood sugar and diabetic ketoacidosis; while people with type 2 diabetes are at risk due to diabetic hyperosmolar syndrome.

Irrespective of the type of diabetes, the following factors pose a risk of diabetic coma:

  • Failure in insulin delivery.
  • Trauma, illness or surgery.
  • Poorly managed diabetes.
  • Purposeful skipping of insulin doses.
  • Consumption of alcohol – Alcohol can reduce blood sugar levels leading to diabetic coma caused by hypoglycemia.
  • Illegal use of drugs – Drugs can accelerate the risk of extremely increased blood sugar levels and diabetic coma.



1:: Extreme Hypoglycaemia – Patient may become unconscious and may lead to diabetic coma, when the blood sugar levels in the brain falls to a level below 3.5 mmol/l. Coma can occur if the individual has consumed – an overdose of insulin or other anti-diabetic medication; excess of alcohol or has performed excessive exercise.

2 :: Diabetic Ketoacidiosis (DKA) – When there is insulin deficiency in the body, the body is not capable of using glucose in the blood for energy, instead fats are broken down to provide energy. This leads to the formation of compound known as ketones. Accumulation of ketones in the body leads to ketoacidosis. Common causes of DKA are inadequate production of insulin, severe dehydration, severe infection or other illness, missed insulin dose or intake of medications such as corticosteroids and few diuretics.

3 :: Diabetic Hyperosmolar syndrome – This condition occurs when the blood sugar levels exceed 600 mg/dl. Common causes of this condition are skipped dose of insulin, injury, acute infection, increased sugar intake or consumption of heavy food.



Symptoms may vary depending on the type of diabetes suffered by the patient. Diabetic coma is generally represented as a combination of numerous signs and symptoms. There are differences in symptoms of diabetic coma due to high & low blood sugar levels.

Symptoms of Diabetic Coma due to high blood sugar (hyperglycaemia)
  • Increased thirst.
  • Increased frequency of urination.
  • Dryness of mouth.
  • Abdominal pain.
  • Increased heart rate.
  • Nausea.
  • Drowsiness.
  • Fatigue.
  • Fruity breath odor.
Symptoms of Diabetic Coma due to low blood sugar (hypoglycaemia)
  • Anxiety.
  • Weakness.
  • Fatigue.
  • Dizziness.
  • Nausea.
  • Confusion.
  • Sudden hunger.
  • Difficulty speaking.
  • Increased sweating.


  • Physical examination.
  • Enquiry into the Medical history.
  • Blood sugar examination.
  • Ketone test.
  • Serum urea & serum creatinine.
  • Blood Electrolyte levels.



Hypoglycaemia Diabetic Coma is treated by

  • Hormone glucagon to reverse the effects of insulin.
  • Glucose intravenously.
  • Intravenous fluids to restore water to tissues.
  • Insulin, to aid tissues absorb the glucose.
  • Sodium, potassium or phosphate supplements, to replace lost electrolytes.

Ketoacidosis diabetic Coma is treated by

  • Insulin intravenously, to decrease blood glucose and reverse Ketoacidosis.
  • Intravenous fluids, to correct dehydration.
  • Sodium, magnesium, potassium or phosphate supplements, to replace lost electrolytes.

Hyperosmolar diabetic coma is treated by

  • Intravenous fluids, to rectify dehydration. Fluids to be given minimum 30 to 60 minutes before administration of insulin.
  • Insulin, to bring down levels of blood sugar.
  • Potassium and sodium as required.
  • Antibiotics to treat infections.


  • Control blood sugar levels.
  • Regular assessment and monitoring of blood sugar levels.
  • Regular consumption of medicines as prescribed.
  • When your blood sugar is high, check for ketones.
  • To treat, low blood glucose levels keep fast acting sources of glucose readily available.
  • Be cautious when drinking alcohol, as alcohol has an unpredictable effect on blood sugar.


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