Diabetic Coma: Who Is At Risk?

Written by Blessing Ifunanya Maduelosi on Tue, 01 August 2023

Key Highlights

  • Diabetic ketoacidosis which can lead to diabetic coma is one of the most lethal complications of diabetes.
  • Diabetic ketoacidosis can lead to diabetic coma, resulting in brain damage and even death.
  • Poor diabetes management, skipping meals, and insulin are some causes.
  • You can prevent diabetic coma by taking appropriate steps such as following a treatment plan, a healthy diet, and exercise.

Coma and diabetes might be your worst nightmare, and "What happens during a diabetic coma?" is a common question that may cross your mind.

A diabetic coma is a serious complication of diabetes that results in indefinite unconsciousness. A diabetic coma can develop if your blood sugar levels are abnormally high (hyperglycemia) or dangerously low (hypoglycemia).

What happens when you go into a diabetic coma? If you get into a diabetic coma, you're still alive but can't wake up or respond to sights, noises, or other stimuli. A diabetic coma can be lethal if left untreated.

Signs and symptoms of diabetic coma

High blood sugar or low blood sugar are typically experienced before a diabetic coma develops.

Signs and symptoms of diabetic coma

When your blood sugar level is too high, you may encounter the following:

  • Fatigue
  • Nausea and vomiting
  • Frequent urination
  • Shortness of breath
  • Increased thirst
  • A parched mouth
  • Stomach pain
  • A rapid heartbeat
  • Fruity breath odor

When your blood sugar level is too low, you may encounter the following:

  • Fatigue
  • Weakness
  • Sweating
  • Hunger
  • Nausea
  • Shakiness or nervousness
  • Anxiety
  • Dizziness or light-headedness
  • Difficulty speaking and confusion

Some people, particularly those who have had diabetes for a long time, can develop a condition called hypoglycemia unawareness, which prevents them from recognizing the warning signals of a blood sugar drop.

Test your blood sugar if you notice any signs of high or low blood sugar, and then adjust your diabetes treatment plan accordingly.

Call for emergency assistance if your symptoms don't improve right away or if they get worse.

When should you see a doctor

  • A diabetic coma is a medical emergency. Make sure you call the emergency helpline number if you experience incredibly high or low blood sugar symptoms and fear you may lose consciousness.
  • Call for emergency assistance if someone you are with and has diabetes has fainted.
  • Be sure to inform the responders that the unconscious person has diabetes.

Causes of diabetic coma

As mentioned earlier, having blood sugar levels either too high or too low for too long may cause serious and life-threatening conditions, increasing the risk of diabetic coma.

Diabetic ketoacidosis (DKA)

Diabetic Ketoacidosis (DKA), a potentially fatal complication of diabetes, develops when the body starts using fat for energy instead of glucose.

In persons without diabetes, insulin facilitates the entry of sugar, which the cells then use as fuel. Diabetes prevents a person from producing enough insulin, which prevents the body from utilizing the sugar for energy.

Lack of sugar causes the liver to convert some body fat into acids known as ketones. The bloodstream accumulates ketones, which then leak into the urine. The blood becomes acidic when these extra ketones enter it, leading to DKA.

Though DKA is most common in people with type 1 diabetes. It may sometimes occur in people with type 2 diabetes and women with gestational diabetes.

Diabetic Hyperosmolar Syndrome

When the blood sugar level exceeds 600 milligrams per deciliter (mg/dL), or 33.3 millimoles per liter (mmol/L), it is called a diabetic hyperosmolar syndrome.

In this condition, the blood becomes thick and syrupy when blood sugar levels are incredibly high. The extra sugar in your blood is excreted in the urine via a filtration process that removes massive amounts of fluid from your body.

If left untreated, this might result in a diabetic coma and life-threatening dehydration. About 25 to 50 percent of those who have diabetic hyperosmolar syndrome go into a coma.


Glucose is necessary for brain function. In extreme circumstances, low blood sugar might make you faint.

Lack of food or excessive insulin levels can also result in hypoglycemia. Alcohol consumption and excessive exercise can both have the same effects.

Risk factors of diabetic coma

Anyone with diabetes is at risk of being in a diabetic coma, but the factors below can increase the risk:

  • Problems with insulin delivery: If you use an insulin pump, you must routinely monitor your blood sugar levels. If the pump breaks down or the tubing (catheter) is twisted or moves out of position, insulin delivery may stop. Diabetic ketoacidosis can result from a shortage of insulin.
  • Skipping meals or insulin: People with diabetes with eating disorders occasionally decide not to take their insulin as prescribed to lose weight. This risky, potentially fatal technique raises the possibility of a diabetic coma.
  • Poor diabetes management: Long-term consequences like a diabetic coma are more likely to occur if you don't correctly monitor your blood sugar levels or take your medications as prescribed.
  • An illness, trauma, or surgery: Blood sugar levels frequently increase, sometimes noticeably, while you're ill or injured. If you have type 1 diabetes and don't adjust your insulin dosage, this could result in DKA. Your chance of developing diabetic hyperosmolar syndrome may also be increased by medical conditions such as congestive heart failure or kidney disease.
  • Alcohol: The impact of alcohol on your blood sugar can be unpredictable. Alcohol's sedative effects may make it more difficult for you to recognize the signs of low blood sugar. This could make you more likely to experience a hypoglycemic diabetic coma.
  • Using illegal drugs: You are more likely to have complications connected to diabetic coma and extremely high blood sugar levels if you use illegal drugs like cocaine and ecstasy.

Management and treatment of diabetic coma

After learning about the signs, symptoms, and causes behind the devastating diabetic coma, let's dive into its management and treatment.


An early diagnosis is crucial if you encounter a diabetic coma. The emergency medical team will do a physical examination and might ask those who are with you about your medical history. You might choose to wear a medical ID necklace or bracelet if you have diabetes.

Lab tests

Once at the hospital, you may need to get tested for various measurements:

  • Blood sugar and ketone levels
  • Amount of nitrogen or creatinine in your blood
  • Amount of potassium, sodium, and phosphate in your blood

Preventive Strategies

Preventive Strategies for diabetic

  • It's essential to monitor your blood glucose levels and food daily if you have diabetes. Proper blood glucose control is critical to avoiding a diabetic coma. In other words, do as your doctor advises, take your insulin, and test your blood sugar and ketones.
  • You should monitor your carbohydrate intake closely. This is true for type 1 or type 2 diabetics. A dietician who is also a certified diabetes educator can be a wise decision. They could assist you in making a meal plan for diabetes.
  • If you forget to take your insulin or other diabetes medicine, you should know what to do. Consult your doctor about it and learn what to do if you experience hyper or hypoglycemia symptoms.

Your health can be impacted by diabetes in multiple ways. Your cardiovascular health, in particular, can be harmed by uncontrolled diabetes. The chemistry of your body changes as you age. Be prepared to modify your diet or medicine dosages along the way.

Although diabetic coma is rare, you should be aware of the possibility of getting it. Make sure your diabetes is well managed, and ask your doctor any questions you may have about avoiding a diabetic coma.


Immediate treatment is needed if you go into a diabetic coma. Brain damage or death could occur if there is any delay in responding.

treatment for diabetes

You'll receive the following if your blood sugar is too high:

  • Intravenous fluids
  • Phosphate, sodium, and potassium supplements
  • Insulin

You'll receive the following if your blood sugar is too low:

  • Glucagon (a hormone to increase blood sugar) injections
  • Intravenous fluids
  • 50% dextrose solution

Recovery from diabetic coma

When your blood glucose levels return to normal, you should begin to feel better immediately. If unconscious, you should regain consciousness shortly after therapy starts.

You might sustain some brain damage if the symptoms persisted for a while before treatment or if you fell into a diabetic coma and remained there for many hours or longer. A diabetic coma left untreated could be fatal.

People who receive immediate medical attention for a diabetic coma typically make a complete recovery. Your doctor could advise you to wear a medical identity bracelet detailing your diabetes and other health issues. This could ensure that you receive prompt treatment for any potential problems in the future.

Your doctor will work with you to create a diabetes treatment plan if you go into a diabetic coma before realizing you have the disease. This will involve medication as well as diet and exercise recommendations.


It is essential to know the dangers or by-products of diabetes, such as diabetic ketoacidosis or diabetic coma, which can lead to brain damage and death.

But with proper care and management of diabetes, you can prevent diabetic coma. Ensure that you get yourself tested, follow your healthy diet, exercise often, and take your medications on time.


Blessing Ifunanya Maduelosi

Blessing Ifunanya Maduelosi is a pharmacist by profession; her health credentials include a BPharm (Bachelor of Pharmacy). Blessing is a resident of Port Harcourt, Rivers State, Nigeria.

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  1. Ghimire, P., & Dhamoon, A. S. (2021). Ketoacidosis. In StatPearls [Internet]. StatPearls Publishing.
  2. Nyenwe, E. A., & Kitabchi, A. E. (2016). The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism, 65(4), 507-521.
  3. George, J. T., Mishra, A. K., & Iyadurai, R. (2018). Correlation between the outcomes and severity of diabetic ketoacidosis: A retrospective pilot study. Journal of family medicine and primary care, 7(4), 787.
  4. Smith, C. B., Choudhary, P., Pernet, A., Hopkins, D., & Amiel, S. A. (2009). Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Diabetes care, 32(7), 1196-1198.
  5. Gosmanov, A. R., Gosmanova, E. O., & Kitabchi, A. E. (2021). Hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endotext [Internet].
  6. Eledrisi, M. S., & Elzouki, A. N. (2020). Management of diabetic ketoacidosis in adults: A narrative review. Saudi Journal of Medicine & Medical Sciences, 8(3), 165.
  7. Alberti, K. G. M. (2020). History of the Treatment of Diabetic Ketoacidosis. In Unveiling Diabetes-Historical Milestones in Diabetology (Vol. 29, pp. 202-206). Karger Publishers.
  8. Balaji, R., Duraisamy, R., & Kumar, M. P. (2019). Complications of diabetes mellitus: A review. Drug Invention Today, 12(1).
  9. Seddik, A. A., Bashier, A., Alhadari, A. K., AlAlawi, F., Alnour, H. H., Hussain, A. A. B., ... & Railey, M. J. (2019). Challenges in management of diabetic ketoacidosis in hemodialysis patients, case presentation and review of literature. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13(4), 2481-2487.