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What is diabetic coma?
What is diabetic coma?
Published: 2017/02/25
Channel: Doc my buddy
Diabetic Coma Survivor
Diabetic Coma Survivor
Published: 2016/03/28
Channel: Charles Carpenter
Waking up from a diabetic coma
Waking up from a diabetic coma
Published: 2016/10/11
Channel: Zoe's World
What can cause a diabetic coma ? | Best Health Channel
What can cause a diabetic coma ? | Best Health Channel
Published: 2017/11/04
Channel: All About Diabetes and Related
Acute complications of diabetes - Hyperosmolar hyperglycemic nonketotic state | Khan Academy
Acute complications of diabetes - Hyperosmolar hyperglycemic nonketotic state | Khan Academy
Published: 2015/05/15
Channel: khanacademymedicine
Causes of Diabetic Coma
Causes of Diabetic Coma
Published: 2013/04/10
Channel: Diabetes.co.uk
Jail police Allows Woman 2 Die in Diabetic Coma after Refusing Requests 2 Test Blood Sugar
Jail police Allows Woman 2 Die in Diabetic Coma after Refusing Requests 2 Test Blood Sugar
Published: 2016/11/08
Channel: charlottecountyflcopwatch2
Learn the signs of diabetic shock
Learn the signs of diabetic shock
Published: 2014/08/10
Channel: LOCAL 12
What causes someone to go into a diabetic coma ? | Best Health Channel
What causes someone to go into a diabetic coma ? | Best Health Channel
Published: 2017/11/08
Channel: All About Diabetes and Related
RABBI JEW BARKER MEDICAL EMERGENCY Key Largo Ambulance Saves my Man In Diabetic Coma 1of3
RABBI JEW BARKER MEDICAL EMERGENCY Key Largo Ambulance Saves my Man In Diabetic Coma 1of3
Published: 2013/10/14
Channel: HoodwinkedbyanAngel Michael Fazio
My Diabetic Coma/How I was diagnosed.
My Diabetic Coma/How I was diagnosed.
Published: 2015/05/29
Channel: Karah Kay
Early Warning Signs of Diabetic Shock
Early Warning Signs of Diabetic Shock
Published: 2014/08/06
Channel: TriHealth Cincinnati
Diabetic Coma
Diabetic Coma
Published: 2015/05/17
Channel: PugsPeeves
I Was Sinking Into a Diabetic Coma | Health
I Was Sinking Into a Diabetic Coma | Health
Published: 2008/08/26
Channel: Health Magazine
Paramedic or EMT What
Paramedic or EMT What's The Difference? Diabetic Coma
Published: 2016/10/11
Channel: Central County Fire & Rescue
Man Slips Into Diabetic Coma; Dog Wakes Wife For Help
Man Slips Into Diabetic Coma; Dog Wakes Wife For Help
Published: 2011/05/06
Channel: WTAE-TV Pittsburgh
new diabetic coma symptoms type 2 2017
new diabetic coma symptoms type 2 2017
Published: 2017/08/21
Channel: Станислав Юдашкин
Diabetic coma and Insulin shock
Diabetic coma and Insulin shock
Published: 2015/12/16
Channel: Home Remedies and medical tips
What Is A Diabetic Coma?
What Is A Diabetic Coma?
Published: 2017/07/14
Channel: ASK bulbul
EMT diabetic coma patient
EMT diabetic coma patient
Published: 2013/03/03
Channel: Zaina Ahmed
Diabetic Coma
Diabetic Coma
Published: 2017/04/07
Channel: Elissa O'Neill
Diabetic Coma (Fake Trailer)
Diabetic Coma (Fake Trailer)
Published: 2015/05/10
Channel: Kristin Deguzman
Can You Recover From A Diabetic Coma?
Can You Recover From A Diabetic Coma?
Published: 2017/09/13
Channel: Question Box
What does a diabetic coma look like ? | Life Care Health Channel
What does a diabetic coma look like ? | Life Care Health Channel
Published: 2017/11/08
Channel: All About Diabetes and Related
Instant diabetic coma
Instant diabetic coma
Published: 2015/10/10
Channel: Lena Workman
Rescue 911: Young Girl vs. Daddy
Rescue 911: Young Girl vs. Daddy's Diabetic Shock
Published: 2014/03/09
Channel: brokkenp
VANILLA CHEX DIABETIC COMA
VANILLA CHEX DIABETIC COMA
Published: 2016/02/26
Channel: Solidrev
How long can you be in a diabetic coma ? |Long Live Facts
How long can you be in a diabetic coma ? |Long Live Facts
Published: 2017/11/03
Channel: All About Diabetes and Related
TOP 5 Magic Kingdom Snacks to Induce a Diabetic Coma
TOP 5 Magic Kingdom Snacks to Induce a Diabetic Coma
Published: 2016/07/24
Channel: DIS Unplugged
What Are The Symptoms Of A Diabetic Coma?
What Are The Symptoms Of A Diabetic Coma?
Published: 2017/09/13
Channel: Question Box
What are the symptoms of a diabetic coma ? | Health for All
What are the symptoms of a diabetic coma ? | Health for All
Published: 2017/11/04
Channel: All About Diabetes and Related
Diabetic coma (vlog 4)
Diabetic coma (vlog 4)
Published: 2017/11/15
Channel: Panda Graves
What Causes Someone To Go Into A Diabetic Coma?
What Causes Someone To Go Into A Diabetic Coma?
Published: 2017/09/13
Channel: Question Box
new diabetic coma symptoms type 1 2017
new diabetic coma symptoms type 1 2017
Published: 2017/07/25
Channel: Nastya Kuteynikova
Man in Diabetic Shock Gets Tasered
Man in Diabetic Shock Gets Tasered
Published: 2008/12/10
Channel: Associated Press
Diabetes: Dog Saves Man from Diabetic Coma
Diabetes: Dog Saves Man from Diabetic Coma
Published: 2007/05/15
Channel: dLife
Diabetic Ketoacidosis (DKA) Explained Clearly by MedCram.com
Diabetic Ketoacidosis (DKA) Explained Clearly by MedCram.com
Published: 2013/01/09
Channel: MedCram - Medical Lectures Explained CLEARLY
Diabetic Coma - Take II
Diabetic Coma - Take II
Published: 2008/06/30
Channel: MistressSovereignty
Symptoms And Treatment For Diabetic Coma And Insulin Shock
Symptoms And Treatment For Diabetic Coma And Insulin Shock
Published: 2016/11/22
Channel: Natural cures diabetes at home
What Can Cause A Diabetic Coma?
What Can Cause A Diabetic Coma?
Published: 2017/09/13
Channel: Question Box
Treatment Of Hypoglycemia Diabetic Coma
Treatment Of Hypoglycemia Diabetic Coma
Published: 2016/11/22
Channel: Diabetic recipes
Diabetic Coma
Diabetic Coma
Published: 2017/05/23
Channel: Wisdo Insights
Sun Rxyzz/Rayzei vs Tudzei 2-1(SLAPPED INTO A DIABETIC COMA)
Sun Rxyzz/Rayzei vs Tudzei 2-1(SLAPPED INTO A DIABETIC COMA)
Published: 2017/09/02
Channel: Sun Rxyzz
Diabetic Coma - How to Eat to Avoid Insulin Spikes
Diabetic Coma - How to Eat to Avoid Insulin Spikes
Published: 2017/04/28
Channel: RukDo
COMA DIABETICO - PERDIDA DE LA CONSCIENCIA EN DIABETICOS
COMA DIABETICO - PERDIDA DE LA CONSCIENCIA EN DIABETICOS
Published: 2016/03/07
Channel: Hernando Coral Rosero
What Is The Definition Of Diabetic coma - Medical Dictionary Free Online
What Is The Definition Of Diabetic coma - Medical Dictionary Free Online
Published: 2014/09/28
Channel: Medical Dictionary Online
Rob Kardashian
Rob Kardashian's Doctors Describe His Close Call With Diabetic Coma
Published: 2016/01/01
Channel: Wochit News
What Can Cause A Diabetic Coma?
What Can Cause A Diabetic Coma?
Published: 2017/07/12
Channel: sparky BUBBLES
Diabetic coma
Diabetic coma
Published: 2011/02/13
Channel: DaveyDorko
Pepto (the diabetic coma)
Pepto (the diabetic coma)
Published: 2014/12/27
Channel: Casey Queen
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WIKIPEDIA ARTICLE

From Wikipedia, the free encyclopedia
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Diabetic coma
Classification and external resources
Specialty endocrinology
ICD-10 E10.0, E11.0, E12.0, E13.0, E14.0
ICD-9-CM 250.2, 250.3
MeSH D003926

Diabetic coma is a reversible form of coma found in people with diabetes mellitus. It is a medical emergency.[1]

Three different types of diabetic coma are identified:

  1. Severe low blood sugar in a diabetic person
  2. Diabetic ketoacidosis (usually type 1) advanced enough to result in unconsciousness from a combination of a severely increased blood sugar level, dehydration and shock, and exhaustion
  3. Hyperosmolar nonketotic coma (usually type 2) in which an extremely high blood sugar level and dehydration alone are sufficient to cause unconsciousness.

In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that they have diabetes. An example might be a physician working in an emergency department who receives an unconscious patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify them as diabetic. Brief descriptions of the three major conditions are followed by a discussion of the diagnostic process used to distinguish among them, as well as a few other conditions which must be considered.

An estimated 2 to 15 percent of diabetics will suffer from at least one episode of diabetic coma in their lifetimes as a result of severe hypoglycemia.

Types[edit]

Severe hypoglycemia[edit]

People with type 1 diabetes mellitus who must take insulin in full replacement doses are most vulnerable to episodes of hypoglycemia. It is usually mild enough to reverse by eating or drinking carbohydrates, but blood glucose occasionally can fall fast enough and low enough to produce unconsciousness before hypoglycemia can be recognized and reversed. Hypoglycemia can be severe enough to cause unconsciousness during sleep. Predisposing factors can include eating less than usual or prolonged exercise earlier in the day. Some people with diabetes can lose their ability to recognize the symptoms of early hypoglycemia.

Unconsciousness due to hypoglycemia can occur within 20 minutes to an hour after early symptoms and is not usually preceded by other illness or symptoms. Twitching or convulsions may occur. A person unconscious from hypoglycemia is usually pale, has a rapid heart beat, and is soaked in sweat: all signs of the adrenaline response to hypoglycemia. The individual is not usually dehydrated and breathing is normal or shallow. Their blood sugar level, measured by a glucose meter or laboratory measurement at the time of discovery, is usually low but not always severely, and in some cases may have already risen from the nadir that triggered the unconsciousness.

Unconsciousness due to hypoglycemia is treated by raising the blood glucose with intravenous glucose or injected glucagon.

Advanced diabetic ketoacidosis[edit]

Diabetic ketoacidosis (DKA), if it progresses and worsens without treatment, can eventually cause unconsciousness, from a combination of a very high blood sugar level, dehydration and shock, and exhaustion. Coma only occurs at an advanced stage, usually after 36 hours or more of worsening vomiting and hyperventilation.

In the early to middle stages of ketoacidosis, patients are typically flushed and breathing rapidly and deeply, but visible dehydration, pale appearance from diminished perfusion, shallower breathing, and a fast heart rate are often present when coma is reached. However these features are variable and not always as described.

If the patient is known to have diabetes, the diagnosis of DKA is usually suspected from the appearance and a history of 1–2 days of vomiting. The diagnosis is confirmed when the usual blood chemistries in the emergency department reveal a high blood sugar level and severe metabolic acidosis.

Treatment of DKA consists of isotonic fluids to rapidly stabilize the circulation, continued intravenous saline with potassium and other electrolytes to replace deficits, insulin to reverse the ketoacidosis, and careful monitoring for complications.

Nonketotic hyperosmolar coma[edit]

Nonketotic hyperosmolar coma usually develops more insidiously than DKA because the principal symptom is lethargy progressing to obtundation, rather than vomiting and an obvious illness. Extremely high blood sugar levels are accompanied by dehydration due to inadequate fluid intake. Coma from NKHC occurs most often in patients who develop type 2 or steroid diabetes and have an impaired ability to recognize thirst and drink. It is classically a nursing home condition but can occur in all ages.

The diagnosis is usually discovered when a chemistry screen performed because of obtundation reveals an extremely high blood sugar level (often above 1800 mg/dl (100 mM)) and dehydration. The treatment consists of insulin and gradual rehydration with intravenous fluids.

Identifying the cause[edit]

Diabetic coma was a more significant diagnostic problem before the late 1970s, when glucose meters and rapid blood chemistry analyzers were not universally available in hospitals. In modern medical practice, it rarely takes more than a few questions, a quick look, and a glucose meter to determine the cause of unconsciousness in a patient with diabetes. Laboratory confirmation can usually be obtained in half an hour or less. Other conditions that can cause unconsciousness in a person with diabetes are stroke, uremic encephalopathy, alcohol, drug overdose, head injury, or seizure.

Fortunately, most episodes of diabetic hypoglycemia, DKA, and extreme hyperosmolarity do not reach unconsciousness before a family member or caretaker seeks medical help.

Treatment[edit]

Treatment depends upon the underlying cause:

  • Hypoglycaemic diabetic coma: administration of the hormone glucagon to reverse the effects of insulin, or glucose given intravenously.
  • Ketoacidotic diabetic coma: intravenous fluids, insulin and administration of potassium and sodium.
  • Hyperosmolar diabetic coma: plenty of intravenous fluids, insulin, potassium and sodium given as soon as possible.

References[edit]

  1. ^ Richard S. Irwin; James M. Rippe (2008). Irwin and Rippe's intensive care medicine. Lippincott Williams & Wilkins. pp. 1256–. ISBN 978-0-7817-9153-3. Retrieved 20 November 2010. 

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