The concept of diabetic coma means a condition associated with diabetes mellitus and metabolic disorders. It manifests itself with a sharp increase or decrease in plasma sugar levels. Such a diagnosis is a clear threat to the health and life of the patient, and therefore requires immediate first aid.
Types of coma
The condition is divided into several varieties. Moreover, each individual type needs its own approach to treatment. This is explained by the difference in reasons provoking coma. In general, there are four types:
- Ketoacidotic is provoked by the release of an impressive volume of ketones that have arisen in the process of assimilation of fatty acids in type 1 pathology;
- Hyperosmolar is provoked by dehydration and an excess of glucose over 30 mmol / l or more in the absence of ketones in type 2;
- Hypoglycemic is provoked by an incorrect calculation of the insulin dose, as well as food disorders, in which sugar levels decrease to 2.5 mmol / l, and sometimes even lower;
- Lactic acidosis is a rather rare form that manifests itself in the process of progression of anaerobic glycolysis and lactate-pyruvate balance.
Depending on the type of coma, a certain type of therapy is selected and its own list of medicines suitable for the case is selected.
Regardless of the specific type of coma in diabetes, the reason for this condition is the same – the level of sugar in the blood. Depending on whether it is low or high, the condition manifests itself. But it can be provoked by a decrease in the concentration of mineral components of the blood, which leads to its oxidation, also called acidosis. In diabetic coma, ketosis is the mechanism that triggers organ dysfunction. Nervous tissues are most affected in such a case. The coma is manifested by the accumulation of fats that react to oxidation. They also provoke deviations in metabolic processes. Until the metabolism is restored, the patient in a coma will not be able to get out of this state.
In fact, it is the developing acidosis and insulin deficiency that significantly inhibit the body’s processes, disrupting the functions of the brain. This leads to a sharp deterioration in the condition and the onset of coma.
The clinical picture as a whole is characterized by a high rate and stage-by-stage development. The first manifestations of the hyperglycemic variety can be noted a day or two before the onset of the attack. In particular, there is:
- Several times increase in sugar with hyperglycemia;
- Vomiting and nausea;
- Frequent urge to use the toilet;
- Pain in the abdominal area;
But one of the main typical signs is a pronounced smell of acetone from the mouth. There is a complaint of thirst, increased frequency of seizures, loss of sensitivity. With hypoglycemic coma and its approximation, certain manifestations of the precomatous state can be considered, while the symptoms are somewhat different:
- The sugar level is reduced to less than 2.5 mmol / l;
- Anxiety, fear a couple of hours before coma;
- Hyperhidrosis, i.e. sweating;
- Loss of consciousness;
- Weakness, drowsiness.
Before losing consciousness, other signs are also detected, including headache, lack or decrease in appetite, diarrhea, dizziness, constipation, and malaise. With a diabetic coma, it is important to keep track of the body temperature, which most often drops. And therefore, ideally, it should be maintained normal or even slightly raised. In this case, the covers should remain not only warm, but also dry. With the progression of the state, a person enters a state of prostration, as if leaving the real world, losing awareness of his own personality and location. An untrained person is able to identify a diabetic coma by the following criteria:
- A sharp drop in blood pressure;
- Weak pulse;
- Soft eyeballs.
To stop the process, you need to call the fast ambulance number, since removing a person from a diabetic coma requires the correct effect of a physiological and medication type, with which the patient’s relatives and relatives clearly cannot cope.
Naturally, when the patient falls into a coma, the corresponding signs appear. These include:
- The smell of acetone in the patient’s room;
- The smell of apple from the mouth;
- Rare and noisy breathing;
- Loose, dry, cold, pale skin;
- Brown coating on the tongue;
- Decrease in body temperature and blood pressure;
- Vomiting and blood impurities in the masses;
- Confusion of consciousness;
- Convulsions up to the inability to bend the leg or open the mouth;
- Loss of consciousness.
If we talk about first aid, then here you should follow the generally accepted path. It is necessary to begin to render it immediately after the manifestation of signs. If we talk about the phased implementation of activities, then you should:
- Lay the diabetic on his side or stomach;
- Eliminate tight clothing, including belts and ties;
- Free the respiratory tract from foreign objects, such as dentures;
- Call an ambulance;
- Give the patient a little bit of sweet tea to drink.
It is necessary to monitor the patient’s breathing. If breathing has stopped or cardiac arrest has occurred, then appropriate measures are taken – chest compressions and artificial respiration. Since different types of diabetic coma require modified treatment, the patient will not be able to do it on the spot without an appropriate list of medicines and equipment. Therefore, these are all measures that can be taken as first aid.
Putting the patient on their back is strictly prohibited. Given that vomiting is a common symptom of this condition, there is a high risk that the patient will suffocate due to vomit.
The consequences of this state are many. Some of them simply impair health, and some can lead to death:
- Dehydration of the body;
- Decreased blood volume;
- Lowering blood pressure;
- Violation of blood circulation in the internal organs;
That is, literally the entire body suffers. And the longer the patient is not helped, the higher the risks associated with death.
Even the normalization of all processes is not a guarantee that the patient will regain consciousness. The longest stay in a diabetic coma is more than 40 years.
It is simply impossible to diagnose diabetic patients “by eye”. Therefore, the patient is assigned a list of tests to confirm the diagnosis. In particular, a general blood test is taken. With all types of this condition, with the exception of hypoglycemic coma, the sugar index exceeds 30 mmol / l. But with the latter, the sugar indicator decreases to a threshold of 2.5 mmol / l, and sometimes even lower. It is impossible to diagnose diabetic coma exclusively “by eye”. That is why the patient is assigned a list of studies that is essentially small. Of these, in practical experience, the most important remains a complete blood count. This is how the glucose level is reflected. Also, a blood test for biochemistry and urinalysis are performed. In hyperglycemic coma, the diabetic generally does not experience any distinctive or specific symptoms. Ketoacidotic coma manifests itself in urine tests with ketone bodies. Hyperosmolar is characterized by an increase in plasma osmolarity, and lactacidemic – lactic acid.
The first and foremost treatment is correct first aid. If the patient is not injected with the necessary drugs for a long time, then the risk of complications increases many times. In this case, edema of the brain, lungs, and stroke, and thrombosis, and much more can occur. Therefore, after the diagnosis is made, therapy begins immediately.
With a ketone coma, specialists direct all their forces primarily to restore indicators from important organs. These values include blood pressure, heart rate (pulse), respiration. They try to bring the patient back to consciousness. The paroxysmal state is stopped with the help of saline and glucose in order to bring the balance of the water-salt type back to normal. With the lactacidemic form, the activities are similar, but the bias goes to the acid-base balance. When the patient is already taken to the hospital, he is given injections of glucose and insulin. After bringing the indicators to the generally accepted level, a symptomatic effect on the body is carried out. With its help, the main signs of the condition are eliminated.
With the manifestation of signs of hypoglycemic coma, you can eliminate the signs of an impending crisis on your own. To do this, it is enough to drink sweet tea, eat a lump of sugar or a spoonful of jam. After that, the most comfortable position for a diabetic is taken. If there is no relief, an ambulance is called. When the dose of insulin is exceeded, the person is given slow carbohydrates. This is ideal for corn porridge. If the lesion is severe, then only a physician can inject a glucose solution or glucagon.
A diabetic coma can be fatal if left untreated. According to statistics, this is how about 10% of cases end.
A coma in diabetes is a significant deviation in the work of the body, which in one way or another, but leaves traces of impact on the functioning of internal organs. Depending on the degree of damage and other factors, doctors can make rough forecasts, but they will not be 100% correct. A person can be saved only by the fastest possible administration of correctly selected medicines.
Prevention of this condition is the fulfillment of the doctor’s prescriptions and adherence to a certain lifestyle. These include:
- Regular diagnostics;
- Compliance with the doctor’s rules regarding healthy lifestyle;
- Sugar control;
- Active lifestyle;
- Quitting negative habits;
- Increasing stress resistance and avoiding overstrain.
The presented measures will help eliminate all the typical prerequisites for a diabetic coma. In parallel, a diet is being conducted, and on an ongoing basis. The use of certain drugs is agreed with the endocrinologist.