Diagnosis and treatment of diabetic coma

The article was professionally consulted with Master, Doctor Vu Thi Duyen - Doctor of Nephrology - Endocrinology - Department of Examination & Internal Medicine, Vinmec Hai Phong International General Hospital.

Coma is an acute complication that can occur in diabetics when blood glucose levels are too high or too low. When a diabetic patient is in a coma, the patient needs urgent medical help.

Timely diagnosis of diabetic coma is very important for the patient. Doctors need to quickly examine, evaluate, ask relatives about medical history to promptly perform tests to accurately diagnose the disease.
Clinical: Patient is comatose, calls unresponsive, has bad breath, signs of severe dehydration, rapid shallow breathing etc...

To diagnose diabetic coma, the following tests are indicated:
Determination of blood sugar (capillary or intravenous glucose is the fastest). Determination of blood ketone levels, urinary ketones Blood osmotic pressure. Blood gas test. Urine test. Electrolyte tests, liver and kidney function.

Diabetic coma is an emergency requiring urgent treatment. Treatment depends on whether your blood sugar is too high or too low or the cause.

If blood sugar is too high (coma due to ketoacidosis or due to increased osmotic pressure) requires intensive treatment:
Active intravenous fluids to restore fluid to organ tissues, even pumping fluids through gastric tube. Insulin infusions or intravenous insulin injections help body tissues absorb glucose in the blood. Add potassium, sodium or phosphate to help cells function properly. Respiratory support if there is respiratory failure. Treat with antibiotics if there is an infection. Symptomatic treatment of comorbidities.

If blood sugar is too low below 3.9 mmol/l you may be given an injection of glucagon or hypertonic glucose 10%, 20%, 30% to bring blood sugar back to normal.

A diabetic coma is a medical emergency. If you notice symptoms of blood sugar that is too high or too low, call 911 right away to ensure help is available before you pass out.

If you are not trained in caring for patients with diabetes, wait for the emergency care team to arrive.
If you are familiar with caring for a diabetic patient then check the unconscious person's blood sugar and follow these steps (capillary glucose test).
If blood sugar is less than 70 mg/dL (3.9 mmol/L) give glucagon injection to the patient. Do not try to give water to the sick person because there is a risk of aspiration and respiratory failure, and do not give insulin to people with low blood sugar. If your blood sugar is above 70 mg/dL (3.9 mmol/L) wait for an ambulance. Do not infuse hypertonic glucose when blood sugar is not low. If you have called for medical help, wait for the urgent care team to learn about your diabetes and what steps you have taken, if any. Diabetic coma requires urgent diagnosis and treatment if delay can be life-threatening or even fatal. Therefore, when there are signs of illness, family members need to immediately take the patient to the hospital and strictly follow the treatment regimen of a specialist to avoid serious complications.
Vinmec International General Hospital is the address for examination, treatment and prevention of diseases. When performing the examination process at Vinmec, customers will be welcomed and used modern facilities and equipment along with perfect medical services under the guidance and advice of experts. Good doctors, well-trained both at home and abroad.
Customers can directly go to Vinmec Health system nationwide to visit or contact the hotline for support

Reference source: mayoclinic.org