Prevention of a Diabetic Coma
Prevention of serious complications of diabetes, including diabetic coma, requires keeping the diabetes in strict glycemic control by vigilant and aggressive blood glucose management. Even then some things can induce a hyperglycemic state that is unavoidable.
Beginning a regimen of steroids due to a flare of an arthritic condition can raise blood sugars as a side effect of this medication. Infections affect the body’s metabolism in ways that promote hyperglycemia. When an well-controlled diabetic patient begins to develop hyperglycemia without explanation, hidden causes should be sought and identified, including infection, drugs, or drug-drug interactions.
Recognizing Warning Signals
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), life-threatening complications of diabetes, give warning signals. Since either hyperglycemic state–ketotic (DKA) or non-ketotic (HHS)–can create neurological changes that lead to coma and death, recognizing warning signals is the best way to avoid untoward outcomes. Patient self-testing plays an important part of recognizing warnings of hyperglycemia.
Since DKA progresses more rapidly, it may be more difficult to identify its warning signals in a timely way compared with the slower onset of changes in HHS. In either, the warning signals of a worsening hyperglycemic state include the following:
- Frequent urination–much more than usual
- Unusual thirst and drinking much more than usual
- Weight loss
- Concentrated urine that appears very dark or brown
- Any of the above occurring with infections or the use of medications that can augment a hyperglycemia tendency
While it is true that the above are seen in diabetes itself, without HHS or DKA, the distinguishing feature is “more than usual.” A patient is his or her own best expert as to when extraordinary changes occur, and a prompt response is the best prevention strategy.