Work up consists of a detailed history (from the family/attendants if the patient is unconscious), physical examination and laboratory tests.
On the basis of test results, a diagnosis can be made and treatment is immediately begun.
Treatment depends upon the underlying cause. Symptomatic treatment, however, is immediately begun. Dehydration should be treated with normal saline and/or dextrose. Serum electrolytes should be corrected by intravenous infusions.
Mortality attributed to HNC is variable, with rates from 10-50%, most likely depending upon the underlying illness or comorbidity .
The prognosis of advanced DKA leading to diabetic coma depends upon the treatment of the cause, i.e of the DKA itself. So if DKA is treated, the blood sugar level will go down and prognosis will be excellent.
Severe hypoglycemic diabetic coma also has a good prognosis, providing the patient is immediately brought to the ICU and his glucose levels along with serum electrolytes are corrected.
A serious post-treatment complication is cerebral edema, which may be related to therapy . Other complications include hyperglycemia or hypoglycemic shock, lactic acidosis, speech or motor impairment, etc.
Diabetic coma develops when blood sugar levels exceed or not satisfy the tolerance capacity of the body. An exact cut off value is not decided upon, however, it is safe to say that a diabetic coma may arise if blood sugar levels become more than 5 times the normal random blood sugar limit (200 mg/dl).
The incidence of diabetic ketoacidosis in developing countries is not known, but it may be higher than in industrialised nations .
The exact incidence of other types of diabetic coma is also not known.
It should be noted that it has no known correlation or predilection to any particular race, ethnicity or region.
Age is not a factor in disease manifestation, unless it is coupled with pre-existing illness. It may occur in young children suffering from type 1 diabetes mellitus or it may occur in old age patients in their 6th or 7th decade of life suffering from type 2 diabetes mellitus.
Diabetic coma may develop due to one of the following conditions:
Hyperosmolar nonketotic coma (HNC)
Typically, in clinical practise, HNC is seen in patients with type 2 diabetes mellitus and residual insulin secretion . This type develops much more insidiously than other types because it usually does not present with vomiting or other clear signs. Upon blood sugar level evaluation, severe hyperglycemia is revealed, often with glucose as high as 1800mg/dL.
Diabetic ketoacidosis (DKA)
Causes of DKA in type I diabetes mellitus include the following :
Causes of DKA in type II diabetes mellitus include the following :
So, if DKA is present and advances to a worse state characterised by increasing lethargy, dehydration and accompanied with vomiting and severe hyperglycemia, it may lead to shock and ultimately a diabetic coma.
Severe hypoglycemic coma
This type is much more common in patients suffering from type 1 diabetes mellitus. Although, it can be easily reversed by eating carbohydrate rich food, often the drop in blood sugar level is sudden and sharp, leading to unconsciousness. If left untreated, the patient may rapidly progress to a diabetic coma.
Diabetic coma is a severe complication of long standing diabetes mellitus. It occurs when blood sugar levels go very high or low and the patient loses consciousness. This may occur in diabetics who do not keep their blood glucose levels in control, regardless of which type of diabetes they have.
It should be noted, however, that this is a reversible coma. With appropriate treatment and management, the patient may fully recover.
Diabetic coma occurs as a result of too little insulin, too much food, infectious causes, GI upset, etc .
It may present with the following symptoms :
Diagnosis is clinical. It is made by a careful appraisal of the patient's health and by the evaluation of laboratory test results.
Treatment of the disease depends upon the underlying cause. Once the cause is identified and appropriately treated, the complication should abate.