Diabetes mellitus belongs to a group of diseases in which the blood sugar level rises. This condition can lead to premature aging of the body and damage to almost all of its organs and systems.
Endocrinologists are convinced that with the observance of preventive measures and carrying out competent therapy, in most cases it is possible to prevent or even stop the occurrence of coma in diabetes. Indeed, in most cases, such a complication occurs when late treatment, lack of self-control and failure to follow the diet.
As a result, a hypoglycemic state develops, which leads to the development of coma in diabetes mellitus. Sometimes the lack of timely relief of this phenomenon may even cause death.
What is diabetic coma and what are its causes and types?
The definition of diabetic coma - describes a condition in which a diabetic loses consciousness when there is a deficit or excess of glucose in the blood. If in such a state emergency care is not provided to the patient, then everything can end in death.
The leading causes of diabetic coma are a rapid increase in the concentration of glucose in the blood, which is caused by insufficient insulin secretion by the pancreas, lack of self-control, illiterate therapy and other things.
Without a sufficient amount of insulin, the body cannot process glucose due to which it does not turn into energy. This deficiency leads to the fact that the liver begins to produce glucose. Against this background, there is an active production of ketone bodies.
So, if glucose accumulates in the blood faster than ketone bodies, then the person loses consciousness and he develops diabetic coma. If the sugar concentration increases along with the content of ketone bodies, then the patient may fall into a ketoacidotic coma. But there are other types of such conditions that should be considered in more detail.
In general, there are such types of diabetic com:
Hypoglycemic coma - may occur when the level of sugar in the blood stream suddenly drops. How long this condition lasts cannot be said, because a lot depends on the severity of hypoglycemia and the health of the patient. Diabetics skipping meals or those who do not comply with insulin dosage are susceptible to this condition. Another hypoglycemia appears after an overstrain or alcohol abuse.
The second type - hyperosmolar coma occurs as a complication of type 2 diabetes, which causes a lack of water and excessive blood sugar. Its onset occurs at a glucose level of more than 600 mg / l.
Often, excessive hyperglycemia is compensated for by the kidneys, which remove excess glucose along with urine. In this case, the reasons for the development of coma is that during dehydration created by the kidneys, the body is forced to save water, which can cause severe hyperglycemia.
Hyperosmolar c. diabeticum (Latin) develops 10 times more often than hyperglycemia. Its appearance is mainly diagnosed in type 2 diabetes in elderly patients.
Ketoacidotic diabetic coma develops in type 1 diabetes. This type of coma can be observed when ketones (harmful acetone acids) accumulate in the body. They are byproducts of fatty acid metabolism, which are formed during acute deficiency of the hormone insulin.
Hyperlactacidemic coma with diabetes is extremely rare. This variety is typical for elderly patients with disorders in the liver, kidneys and heart.
The causes of the development of a diabetic coma of this type are enhanced education and poor utilization of hypoxia and lactate. Thus, the body is poisoned by lactic acid, accumulated in excess (2-4 mmol / l). All this leads to an imbalance of lactate pyruvate and the appearance of metabolic acidosis with a significant anionic difference.
A comatose state that occurs on the background of type 2 or type 1 diabetes is the most frequent and dangerous complication for an adult who is already 30 years old. But especially this phenomenon is dangerous for underage patients.
Diabetic coma in children often develops with an insulin-dependent form of the disease that goes on for many years. Diabetic coma in children often appear at preschool or school age, sometimes in the chest.
Moreover, at the age of 3 years, these conditions occur much more often than in adults.
Types of coma and diabetes are different, so their clinical picture may be different. So, ketoacid coma is characterized by dehydration, accompanied by weight loss of up to 10% and dry skin.
At the same time, the face becomes painfully pale (occasionally reddens), and the skin on the soles and palms turns yellow, itches and flakes. Some diabetics have furunculosis.
Other symptoms of diabetic coma with ketoacidosis include a rotten breath, nausea, vomiting, muscle sluggishness, cold extremities, and low temperature. Because of the intoxication of the body, hyperventilation of the lungs can occur, and breathing becomes noisy, deep and frequent.
When diabetic coma occurs in type 2 diabetes, its symptoms also consist in a reduced tone of the eyeballs and constriction of the pupils. Occasionally, the omission of the upper eyelid and squint.
Also developing ketoacidosis is accompanied by frequent spontaneous urination, in which the discharge has a fruity odor. At the same time the stomach hurts, intestinal peristalsis is weakened, and the level of blood pressure is reduced.
Ketoacidotic coma in diabetics can have varying degrees of severity - from drowsiness to lethargy. Brain intoxication contributes to epileptic seizures, hallucinations, delusions and confusion
Hyperosmolar diabetic coma signs:
- speech impairment;
- neurological symptoms;
- involuntary and rapid movements of the eyeball;
- rare and weak urination.
The signs of diabetic coma in hypoglycemia are slightly different from other types of comatose conditions. This condition can be characterized by severe weakness, hunger, unreasonable anxiety and fear, chills, tremors and sweating of the body. The consequences of diabetic coma in hypoglycemia - loss of consciousness and the appearance of seizures.
Hyperlactacidemic diabetic coma is characterized by dryness of the tongue and skin, Kussmaul-type breathing, collapse, hypotension, and reduced turgor. Also, the comatose period, which lasts from a couple of hours to several days, is accompanied by tachycardia, oliguria, turning into anuria, the softness of the eyeballs.
Hypoglycemic coma and other types of similar conditions in children develop gradually. The diabetic precoma is accompanied by abdominal discomfort, anxiety, thirst, drowsiness, headache, poor appetite and nausea. As it develops, the patient's breathing becomes noisy, deep, the pulse is quickened, and arterial hypotension appears.
In diabetes in infants when the child begins to fall into a coma, he develops polyuria, constipation, polyphagia and increased thirst. His diapers become hard with urine.
Glycemic coma in children is manifested by the same symptoms as in adults.
What to do with diabetic coma?
If first aid for complications of hyperglycemia is untimely, then a patient with diabetic coma, the consequences of which are extremely dangerous, can result in pulmonary and brain edema, thrombosis leading to heart attacks and strokes, oliguria, renal or respiratory failure and so on. Therefore, after the diagnosis has been carried out, the patient should immediately be given help with diabetic coma.
So, if the patient's condition is close to unconscious, then an emergency call should be made. While it is going to go, it is necessary to put the patient on his stomach or on his side, insert the air duct and prevent the tongue from dropping. If necessary, it is necessary to normalize the pressure.
And what to do with diabetic coma caused by an excess of ketones? In this situation, the algorithm of action is to normalize the vital functions of the diabetic, such as pressure, heartbeat, consciousness and breathing.
If a lacticidecidemic coma develops in diabetes mellitus, then the same measures should be taken as in ketoacidosis. But in addition, water-electrolyte and acid-base balance should be restored. Also, assistance with diabetic coma of this type consists in administering a glucose solution with insulin to the patient and performing symptomatic therapy.
If in type 2 diabetes, a slight hypoglycemic coma has occurred, then self-help is possible. This period will not last long, so the patient must have time to take fast carbohydrates (a few pieces of sugar, a spoon of jam, a glass of fruit juice) and take a comfortable position so as not to injure yourself when you lose consciousness.
If hypoglycemia in diabetes mellitus is triggered by insulin, which lasts a long time, then the diet for diabetic coma involves taking slow carbohydrates in the amount of 1-2 XE before going to bed.
The severe form requires a jet injection of glucose solution (40%) or glucagon (1 mg) for an adult. But when arresting a condition in children, the dose is halved. If the patient does not regain consciousness, then he is taken to the hospital in an emergency room, where the treatment of diabetic coma is based on the drip of the glucose solution (10%).
Knowing what a diabetic coma is, it is easier to determine its symptoms and promptly prevent the development of severe consequences. After all, if you understand in what condition the diabetic urgently needs help, then you can provide invaluable help to it, since the time taken glucose solution will help save a person’s life, and the normalized blood glucose level will help to avoid the development of a number of adverse effects.
An expert in the video in this article will tell you about the symptoms and treatment of diabetic coma.