Diabetic coma

The Diabetic coma is a loss of consciousness, which can be triggered by absolute or relative insulin deficiency. A coma is a life-threatening situation and requires immediate inpatient hospital treatment. In about 25% of cases it is a newly discovered diabetes mellitus.

Triggering mechanisms of diabetic coma

• Lack of insulin delivery: in addition to the onset of diabetes mellitus to day omitted for several hours insulin injection may be the cause. But even an oral diabetes drug therapy may not be sufficient in the course and lead to a diabetic coma.

• Insufficient insulin delivery: This can occur both in a poorly controlled diabetes mellitus or continued faults in the operation of syringes, pens or insulin pumps.

• Increased insulin requirement: For long -lasting stress situations (eg, infections, serious illnesses, operations ) is no longer sufficient, the previous insulin dose.

Forms of diabetic coma

In diabetic coma two forms are distinguished: ketoacidotic coma and hyperosmolar coma.

Ketoacidotic coma

The ketoacidotic coma is typical for the type - 1 diabetes, that occurs at absolute insulin deficiency. Since no more insulin is produced by the pancreas and the cells therefore can not accept any sugar from the blood, the body by breaking down fats and proteins tries to gain energy. This creates " acidic " metabolic products, such as ketone bodies. The blood sugar is 16.65 to 38.85 mmol / l ( 300-700 mg / dl). The increased blood sugar levels due to an increased excretion of urine (polyuria ), since the glucose in the tubules of the kidney can not be completely reabsorbed, leading to osmotic diuresis. In addition it comes to acidosis (acidosis ) due to the derailed metabolism. The body tries to compensate for this by increased exhalation of carbon dioxide. Typical is a frequent, regular, deep breathing ( Kussmaul breathing) with acetone odor. About the polyuria it comes to dehydration, thus it can lead to a prerenal kidney failure, blood salts (electrolytes ) increase, especially potassium is greatly increased. Typical are often massive abdominal pain ( woody hard belly: Pseudoperitonitis ), it can also lead to cardiac arrhythmias.

Hyperosmolar coma

The hyperosmolar coma is typical for type 2 diabetes, that occurs in the relative insulin deficiency. It is still produced the body's own insulin, which is sufficient to inhibit the excessive fat and protein degradation. Here are the massively elevated blood glucose ( BG > 33.3 mmol / l [ 600-1,000 mg / dl ] ) the problem. Due to the high blood sugar, the osmolarity of the blood increased. Again, it comes over the polyuria to dehydration, thus it can lead to a prerenal kidney failure, blood salts (electrolytes ) increase, especially potassium is greatly increased. In particular, the dehydration it comes to increasing apathy to coma.

Symptoms

Smell of acetone in breath ( smell of rotten apple, earlier in nail polish or nail polish remover contain ) at the ketoacidotic metabolic imbalance, thirst, and greatly increased drinking ( polydipsia ), frequent urination (polyuria ), fatigue, nausea, vomiting, abdominal pain, hypotension, muscle reflexes may be preceded by warning signs as the development of a diabetic coma.

Therapy

In addition to an emergency call and applying the stable side position for the first responders remain no possibility of intervention after the onset of coma. The most important primary measure is intravenous supply of liquid (electrolyte solution) already by the emergency service. Insulin administration is the residential treatment reserved, since insulin in addition to its hypoglycemic effect also promotes the uptake of potassium into cells. Since the plasma potassium preclinical can not be controlled, there is a risk of hypokalemia, so the threshold for the excitability of cells is increased. Especially at the heart of this can be felt by malignant arrhythmias. Under close laboratory monitoring of kidney function, electrolytes, the pH of blood sugar and the slow normalization of metabolic values ​​are.

After reaching a normal metabolism, the readjustment of diabetes mellitus depending on the type of diabetes ( type 1, type 2 ) and the cause of the metabolic imbalance occurs.