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An Introduction To Diabetic Coma

Dr. Rehan Uppal

2 min read

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Diabetes poses a host of complications, one of them being Diabetic Coma. Induced as a result of extremely high (hyperglycemia) or extremely low (hypoglycemia) blood glucose levels, diabetics may fall into a state of unresponsiveness which, if not treated within two hours, might cause permanent brain damage, or even death.


1- Diabetic Ketoacidosis

The breakdown of fat stores by the muscle cells to meet their energy requirements in the absence of insulin stimulates the release of substances called Ketones, an unchecked accumulation of which can induce a diabetic coma. While more common in type 1 diabetes, it can also occur in people with type 2 or gestational diabetes.

2- Hypoglycemia

Brought about by either medication overdose, strenuous exercise, inadequate food consumption, or a combination of these factors, blood sugar levels that are chronically lower than 70 mg/dL can affect brain function and induce a comatose state, in some cases. However, patients with long-term diabetes may only display or recognize the symptoms of hypoglycemia in its later stages, also known as ‘Hypoglycemia Unawareness’.

3- Diabetic Hyperosmolar Syndrome

Blood glucose levels higher than 600 mg/dL can change blood consistency from semi-watery to thick and syrupy, which, when passed into the urine can result in excess fluid drainage from the body in order to excrete the sugar-rich urine, and, consequentially, a coma. Usually affecting older and middle-aged adults with type 2 diabetes, the condition may also cause blood clots, a heart attack, or stroke.


Signs of a diabetic coma are identical to the symptoms of high, and low blood sugar, which are:

1- Hyperglycemia (High Blood Sugar)

  • Fatigue
  • Dry mouth
  • Fruity breath
  • Stomach pain
  • Increased thirst
  • Rapid heartbeat
  • Trouble breathing
  • Frequent urination
  • Nausea and vomiting

2- Hypoglycemia (Low Blood Sugar)

  • Nausea
  • Paralysis
  • Confusion
  • Hallucinations
  • Extreme hunger
  • Visual problems
  • Profuse sweating
  • Heart palpitations
  • Difficulty speaking
  • Fatigue or weakness
  • Shakiness or anxiety
  • Dizziness or light-headedness

Risk Factors

A diabetic coma is more likely in case of:

  • Insulin Pump Malfunctions: Insulin delivery through tubed or tubeless pumps, particularly in type 1 diabetes, may sometimes be obstructed due to malfunctions in the pump or delivery tube without the patient’s awareness, resulting in ketoacidosis and coma.
  • Higher dosage of Insulin: For Type 2 diabetes patients who inject insulin multiple times a day, Hypoglycemia may result if a patient injects too much insulin or injects the regular dosage but does not eat regular quantity of food. In such cases, Hypoglycemia may set in within a couple of hours resulting in Diabetic Coma a few hours later.
  • An Illness or Trauma: Failure to adjust insulin doses in accordance with other co-occurring medical conditions or injuries with type 1 diabetes, or congestive heart failure, kidney disease, and other medical conditions alongside type 2 diabetes greatly elevates the risk of a diabetic coma.
  • Skipping Insulin: Those suffering from eating disorders, particularly anorexia nervosa or bulimia, may often skip their daily insulin doses in order to lose weight gained due to diabetes.


A diabetic coma can be resolved very quickly if immediate steps are taken. However, this depends on what kind of coma it is.

A hyperglycemic coma can be resolved by the doctor administering insulin and water. A hypoglycemic diabetic coma can be resolved by glucagon injection and giving glucose.

The patient will hopefully recover after these initial measures are taken. A full recovery is usually the case. But, if the patient does not get the desired treatment in a timely manner, this coma can cause permanent issues like brain damage. The coma can lead to death as well, as stated earlier. 


  • Follow your prescribed meal plan and take your medication as directed. Talk to the best stomach specialist in Multan for assistance.
  • Check your blood glucose levels frequently, particularly after exercising as it can reduce blood sugar levels.
  • If you have type 1 diabetes, always carry glucagon injections (a hormone that stimulates the liver to release stored glucose in case of low blood sugar) and fast-acting sugar sources like orange juice within reach.
  • Educate your close friends and family on the signs and emergency protocols for hyper and hypoglycemia.

Emergency Care For Non-Medical Professionals

  • Check the unconscious person’s blood sugar.
  • If lower than 70 mg/dL, administer a glucagon injection, or rub glucose gel, honey or non-sugar-free syrup on the inside of the cheek, while avoiding sugary drinks and insulin injections.
  • If above 70 mg/dL, seek immediate medical assistance, and inform the medical staff of the steps you’ve taken upon arrival.

Patients usually recover as soon as blood sugar levels are stabilized, without retaining any brain damage if treated promptly. Therefore, if you or a loved one is diabetic, be on the lookout for extreme hyper or hypoglycemic symptoms and seek immediate medical condition in case of coma.

You can also book an appointment with a top Diabetes Specialist in Karachi, Peshawar and Islamabad to get advise on Diabetes through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your diabetes-related concerns. 

Disclaimer: The contents of this article are intended to raise awareness about common health issues and should not be viewed as sound medical advice for your specific condition. You should always consult with a licensed medical practitioner prior to following any suggestions outlined in this article or adopting any treatment protocol based on the contents of this article.

Dr. Rehan Uppal - Author Dr. Rehan Uppal is a Internal Medicine Specialist practicing in Islamabad. Dr. Rehan Uppal has the following degrees: MBBS, M.C.P.S, M.R.C.G.P, MAAFP (USA) and has 19 years of experience. He loves writing about medical issues and health concerns so that the general awareness and understanding regarding health can be increased.

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