A diabetic coma, also called a diabetes-related coma, is what happens when a person with diabetes has a blood sugar level that becomes dangerously high or low. The person then becomes unconscious and needs emergency medical treatment. This is a serious disorder, and it’s possible to die from a diabetic coma if medical attention is not rapidly administered.

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Diabetic Coma Causes

A diabetes-related coma has two causes: hypoglycemia, or low blood sugar; and hyperglycemia, or high blood sugar. With hypoglycemia, blood sugar levels get below 54 mg/dL (which is considered severely low), and there’s not enough blood sugar for the brain’s most basic needs.

“Systems begin to shut down,” says Robert Alesiani, chief pharmacotherapy officer and a clinical pharmacist for Tabula Rasa HealthCare in Moorestown, New Jersey.

With hyperglycemia, the body – particularly the kidneys – can’t manage the overload of sugar, says Francisco Prieto, MD, a family physician in Sacramento, California, and chair of the American Diabetes Association National Advocacy Committee. An excessively high blood sugar is 300 mg/dL or higher.

If you don’t catch hypo- or hyperglycemia early, it can progress to dangerous levels, creating potential for a diabetic comma to occur.

There are a few things that may lead to a diabetic coma:

• Taking too much or too little insulin if you use insulin.
• Having a faulty insulin pump. For instance, the pump stops working as it should, and you don’t recognize the problem quickly enough to fix it.
• Drinking alcohol, which can lower your blood sugar.
• Increasing exercise, as this can lower your blood sugar. Exercise is great for the body and mind, but when you have diabetes, you need to consider your blood sugar levels.
• Not eating enough or skipping meals.
• Using too much of medications that change your blood sugar, such as steroids.
• Sickness, which can alter your insulin levels.

Although anyone with diabetes is vulnerable to a diabetes-related coma, those with Type 1 diabetes are at higher risk because of their reliance on insulin. For instance, they may not take the insulin they’re prescribed due to access problems or cost, the insulin may get hot and not work or there may be a problem with the insulin pump, says Dr. Tamara K. Oser, an associate professor of family medicine at the University of Colorado School of Medicine in Aurora, Colorado, and a spokesperson for the Association for Diabetes Care & Education Specialists.Those are just a few examples of how a reliance on insulin can tie in with the risk for a diabetes-related coma, often due to factors outside of your control.

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Symptoms of a Diabetic Coma

The symptoms of a diabetic coma will vary depending on the cause. Here are some of the symptoms if it’s associated with severe hypoglycemia:

• Confusion.
• Lightheadedness.
• A fast heart rate.
• Feeling sweaty.
• Feeling tired.
• Headache.
• Hunger.

Diabetes-related coma symptoms associated with hyperglycemia include:

• Abdominal pain.
• Having a dry mouth.
• Feeling very thirsty.
• Feeling tired.
• Having to urinate more.
• Having fruity-smelling breath.
• Nausea and vomiting.
• Shortness of breath.

With severe hyperglycemia, it’s possible for the body to go into diabetic ketoacidosis, which can occur with or without a diabetic coma. This is when the body produces ketones, or excess blood acids as the liver starts to break down fat for fuel and produces ketones because the body doesn’t have enough insulin. Ketones can be monitored with a urine or blood test. They can reach dangerous, life-threatening levels. The symptoms above also are associated with high ketone levels. The fruity breath smell is because of the ketones produced, which have a fruity odor.

Diabetic ketoacidosis is more common among those with Type 1 diabetes but also can occur with Type 2 diabetes.

Untreated severe hypo- or hyperglycemia can lead to a seizure or a diabetic coma, and that’s when the person becomes unconscious.

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What to Do for a Diabetic Coma

If you’re with someone who has diabetes and passes out due to very low or high blood sugar, call 911 for further guidance and get them to emergency care. Don’t try to give them anything by mouth as they could choke on it. Prompt treatment can help avoid brain damage and death.

If you’re with someone who appears to have high or low blood sugar and they still are awake, try to use a blood glucose monitor, also called a glucometer, to find out if they are hypo- or hyperglycemic, Alesiani advises. If they wear a continuous glucose monitor, you can check the results for confirmation of hyperglycemia or hypoglycemia. The device should warn in advance if blood sugar is rapidly dropping or climbing, Prieto says. You can also help that person check their ketones with a blood or urine test.

If their blood sugar is low (70 mg/dL or below), then feed them 15 grams of carbohydrates as soon as possible. This could include:

• Half a can of regular soda, not diet.
• Half a glass of orange juice.
• About 3 teaspoons of granulated sugar or honey.
• Glucose tablets.

After administering the carbohydrates, wait 15 minutes and check their blood sugar level again. Continue to repeat this until their glucose is in a more normal range or until the person you’re treating no longer has any symptoms.
There are also easy-to-use injectors and nasal sprays for glucagon, an emergency medicine used to bring blood sugar back up rapidly in people with diabetes. It can be used when a person is not awake and can’t take something by mouth. A person with diabetes or the parent of a child with diabetes may already have this. Follow instructions on the package for how to use it.

If you’re with someone who has symptoms of hyperglycemia, and their blood sugar isn’t getting lower, you should seek emergency help.

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Diagnosing and Treating a Diabetic Coma

Health care professionals will perform blood tests to measure things such as blood glucose, ketone levels and acidity of the blood, Oser says.

To help treat hypoglycemia, health care professionals will give electrolytes, like sodium and potassium, as well as hypertonic dextrose. These can help control blood sugar and maintain normal levels.

For hyperglycemia, health care professionals will replace any fluids lost to dehydration as well as electrolytes, insulin or any other supplemental medications.

A person who’s had a diabetes-related coma may require hospitalization for a few days to fully recover. With quick treatment, a full recovery from a diabetic coma is possible.

Preventing a Diabetic Coma

The best way to prevent a diabetic coma is to keep your blood sugars as balanced as possible.

Here are some ways to keep your blood sugar level in the right range if you have diabetes:

• Let your health care provider know if you can’t afford insulin or other diabetes-related medications. They may have other options available to help you pay for your medicines. This is better than not using your medications at all.
• Check your blood sugar as often as your health care provider recommends.
• Listen to your body and respond to signs of potential hypo- or hyperglycemia as early as possible to avoid them from becoming worse.
• Follow your diabetes treatment plan for food, exercise and using medications.
• Talk with your diabetes health care team about having the medication glucagon or ketone tests on hand in case you have a diabetes-related emergency. This is especially important if you’re on insulin.
• Maintain appointments with your diabetes care team to keep your diabetes under control.

Even if you don’t have diabetes, make sure to maintain regular appointments with your health care provider. It’s possible to have a diabetes emergency, such as diabetic ketoacidosis, without even knowing that you have diabetes, Oser says. That’s why it’s important to spread awareness of high and low blood sugars so you can seek help for them quickly if needed, she explains. Regular health checks can help monitor for any chronic conditions such as diabetes.

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