What is diabetic coma?

Diabetic coma is loss of consciousness occurring as a result of very high blood sugar. Its causes are similar in  both  type  1  and  type  2  diabetes, but  with  the important difference that  other abnormalities of the blood chemistry may contribute to the coma in type 1 diabetes. These other abnormalities occur as  a result of the almost total lack of insulin that is present in type 1 diabetes. For this reason, while blood sugar is almost  always very high in people with type 2 dia- betes who are in  diabetic coma, being several hun- dreds  (of  mg/dl)  to  2000  or  more,  it  can  be  less elevated in people with type 1 diabetes, sometimes as low as only 200 or 300. In the case of type 1 diabetes, diabetic coma can occur solely as a result of  having insufficient insulin in the body (e.g., running out of or not taking one’s insulin), while in the case of type

2 diabetes, there is almost always another stress to the body that  precipitates the  coma, such as infection, dehydration, etc. If the serious abnormalities of blood chemistry that led to diabetic coma are not corrected rapidly, death can occur. Although the derangements

in blood chemistry are more complex and severe in type 1  diabetes than  in  type 2  diabetes, there  is a higher mortality in type 2 diabetic coma because peo- ple suffering from it tend  to be older, in less robust health, and with more cardiac risk factors. Also, addi- tional symptoms of nausea, vomiting, and  abdominal pain  occur in  the  derangements  of type 1  diabetes leading to coma and the diagnosis may be made earlier as a result. In the early stages of coma in type 2 dia- betes, abnormalities of brain function and conscious- ness are more prominent due to the extreme degree of dehydration. Moreover, the illness that precipitated the coma may carry its own serious health risks. Although only a minority of patients with diabetes will succumb to coma, it remains an important medical  emergency that requires immediate intervention.