Included were only those cases in which were present 1 an elevated level of blood sugar, 2 a low carbon dioxide-combining power and 3 clinical symptoms of diabetic coma, with definite signs of mental depression.

This series totaled cases of coma in diabetic patients. Coma occurred twice in 16 patients, three times in 5 patients, four times in 1 patient and seven times in 2 patients. COLLEN MF. MORTALITY IN DIABETIC COMA. Arch Intern Med Chic.

Artificial Intelligence Resource Center. X Facebook LinkedIn. This Issue. Share X Facebook Email LinkedIn. September MORRIS F. COLLEN, M. Author Affiliations BERKELEY, CALIF. visual abstract icon Visual Abstract.

Access through your institution. Add or change institution. Timely and improved protocols pertaining to the care of DKA patients as well as admitting less severe DKA cases due to a lower threshold in admission criteria could be one of the causes of shorter stays observed in 3.

Unfortunately, a slightly higher mortality rate was calculated in , as it rose from 0. The higher incidence and mortality rate among males and among Blacks can be linked with lifestyle and sex hormones as well as racial and genetic differences in responses to treatment and management of diabetes, respectively 4 , 5.

Since the number of comorbid conditions tends to increase with aging, the higher risks for complications in older age groups can predispose the elderly with DKA to a higher mortality rate.

While our study showed that there was an associated higher mortality rate among DKA patients covered by Medicare, it is unclear whether it is due to any differences in compliance with treatment among patients with different insurance forms.

We can, therefore, confirm that DKA is a growing concern with an equally heavy financial burden on the health care system. The authors are grateful to the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality Rockville, MD www.

jsp for allowing the authors access to their database more details about the database are available from www. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions.

researched and analyzed the data and wrote the initial manuscript. contributed to discussion of the analysis and edited the manuscript. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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e-Letters: Observations October 13 An Update on the Incidence and Burden of Diabetic Ketoacidosis in the U. Kamleshun Ramphul Kamleshun Ramphul. Corresponding author: Kamleshun Ramphul, adramphul hotmail. This Site. Google Scholar. Jyotsnav Joynauth Jyotsnav Joynauth. Diabetes Care ;43 12 :e—e Article history Received:.

Connected Content. A correction has been published: Erratum. Diabetes Care ;e—e Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Table 1 Incidence and mortality of DKA in the U.

in DKA patients in DKA cases per 10, admissions. Deaths among DKA patients. Deaths per 10, DKA patients admitted. All cases , View Large. Health care utilization and burden of diabetic ketoacidosis in the U.

Treatment for DKA usually takes place in the hospital. But you can help prevent it by learning the warning signs and checking your urine and blood regularly. DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms include the following:.

DKA is dangerous and serious. You can detect ketones with a simple urine test using a test strip, similar to a blood testing strip. Ask your health care provider when and how you should test for ketones.

When you are ill when you have a cold or the flu, for example , check for ketones every four to six hours. If your health care provider has not told you what levels of ketones are dangerous, then call when you find moderate amounts after more than one test.

Often, your health care provider can tell you what to do over the phone. Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control. Check with your health care provider about how to handle this situation.

Diabetes Complications. This can be administered immediately after the potassium level is known to be higher than 3. In general, insulin is given at 0. Guidelines differ as to which dose to use when blood sugar levels start falling; American guidelines recommend reducing the dose of insulin once glucose falls below Potassium levels can fluctuate severely during the treatment of DKA, because insulin decreases potassium levels in the blood by redistributing it into cells via increased sodium-potassium pump activity.

A large part of the shifted extracellular potassium would have been lost in urine because of osmotic diuresis. Hypokalemia low blood potassium concentration often follows treatment.

This increases the risk of dangerous irregularities in the heart rate. Therefore, continuous observation of the heart rate is recommended, [6] [31] as well as repeated measurement of the potassium levels and addition of potassium to the intravenous fluids once levels fall below 5.

If potassium levels fall below 3. The administration of sodium bicarbonate solution to rapidly improve the acid levels in the blood is controversial. There is little evidence that it improves outcomes beyond standard therapy, and indeed some evidence that while it may improve the acidity of the blood, it may actually worsen acidity inside the body's cells and increase the risk of certain complications.

Cerebral edema, if associated with coma, often necessitates admission to intensive care, artificial ventilation , and close observation. The administration of fluids is slowed. Once this has been achieved, insulin may be switched to the usual subcutaneously administered regimen, one hour after which the intravenous administration can be discontinued.

In people with suspected ketosis-prone type 2 diabetes, determination of antibodies against glutamic acid decarboxylase and islet cells may aid in the decision whether to continue insulin administration long-term if antibodies are detected , or whether to withdraw insulin and attempt treatment with oral medication as in type 2 diabetes.

Diabetic ketoacidosis occurs in 4. There has been a documented increasing trend in hospital admissions. Contents move to sidebar hide. Article Talk. Read Edit View history. Tools Tools. What links here Related changes Upload file Special pages Permanent link Page information Cite this page Get shortened URL Download QR code Wikidata item.

Download as PDF Printable version. In other projects. Wikimedia Commons. For other uses, see DKA disambiguation. Medical condition. doi : PMID S2CID World Journal of Diabetes.

PMC Diabetes Care. Ferri's Differential Diagnosis: A Practical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders. Elsevier Health Sciences. ISBN Archived from the original on Endocrinology and Metabolism Clinics of North America.

Association of British Clinical Diabetologists. Archived from the original on 9 December Retrieved 10 August The American Journal of the Medical Sciences. British Medical Journal. The Journal of Clinical Endocrinology and Metabolism.

Emergency Medicine Journal. American Journal of the Medical Sciences. June In Marcdante KJ, Kliegman R, Nelson WD eds. Nelson Essentials of Pediatrics 7th ed.

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds. Harrison's Principles of Internal Medicine 16th ed.

New York, NY: McGraw-Hill. Textbook of Clinical Pediatrics. Pediatric Endocrinology Reviews. Annals of Internal Medicine. Clinical Therapeutics. Nature Communications. Bibcode : NatCo.. On this page. When to see a doctor. Risk factors. A Book: Guide to the Comatose Patient.

A Book: The Essential Diabetes Book. Symptoms of high blood sugar or low blood sugar usually develop before a diabetic coma. High blood sugar hyperglycemia If your blood sugar level is too high, you may have: Increased thirst Frequent urination Blurred vision Tiredness or weakness Headache Nausea and vomiting Shortness of breath Stomach pain Fruity breath odor A very dry mouth.

Low blood sugar hypoglycemia If your blood sugar is too low, you may have: Shakiness Anxiety Tiredness or drowsiness Weakness Sweating Hunger A feeling of tingling on your skin Dizziness or lightheadedness Headache Difficulty speaking Blurry vision Confusion Loss of consciousness Some people, especially those who've had diabetes for a long time, develop a condition known as hypoglycemia unawareness.

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In severe cases, low blood sugar hypoglycemia may cause you to pass out. Low blood sugar can be caused by too much insulin or not enough food. Exercising too vigorously or drinking too much alcohol can have the same effect. Anyone who has diabetes is at risk of a diabetic coma, but the following factors can increase the risk: Insulin delivery problems.

If you're using an insulin pump, you have to check your blood sugar frequently. Insulin delivery can stop if the pump fails or if the tubing catheter becomes twisted or falls out of place. A lack of insulin can lead to diabetic ketoacidosis.

An illness, trauma or surgery. When you're sick or injured, blood sugar levels can change, sometimes significantly, increasing your risk of diabetic ketoacidosis and diabetic hyperosmolar syndrome.

Poorly managed diabetes. If you don't monitor your blood sugar properly or take your medications as directed by your health care provider, you have a higher risk of developing long-term health problems and a higher risk of diabetic coma.

Deliberately skipping meals or insulin. Sometimes, people with diabetes who also have an eating disorder choose not to use their insulin as they should, in the hope of losing weight. This is a dangerous, life-threatening thing to do, and it raises the risk of a diabetic coma.

Drinking alcohol. Alcohol can have unpredictable effects on your blood sugar. Alcohol's effects may make it harder for you to know when you're having low blood sugar symptoms. This can increase your risk of a diabetic coma caused by hypoglycemia.

Illegal drug use. Illegal drugs, such as cocaine, can increase your risk of severe high blood sugar and conditions linked to diabetic coma. If it is not treated, a diabetic coma can lead to permanent brain damage and death. Keep these tips in mind: Follow your meal plan.

Consistent snacks and meals can help you control your blood sugar level. Keep an eye on your blood sugar level. Frequent blood sugar tests can tell you whether you're keeping your blood sugar level in your target range.

It also can alert you to dangerous highs or lows. Check more frequently if you've exercised. Exercise can cause blood sugar levels to drop, even hours later, especially if you don't exercise regularly.

Take your medication as directed. If you have frequent episodes of high or low blood sugar, tell your health care provider. You may need to have the dose or the timing of your medication adjusted. Have a sick-day plan. Illness can cause an unexpected change in blood sugar. If you are sick and unable to eat, your blood sugar may drop.

While you are healthy, talk with your doctor about how to best manage your blood sugar levels if you get sick. Consider storing at least a week's worth of diabetes supplies and an extra glucagon kit in case of emergencies.

Check for ketones when your blood sugar is high.

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Sign in to access free PDF. Save your search. Customize your interests. Create a personal account or sign in to:. Privacy Policy. Make a comment. Most people make a full recovery. However, if they do not receive treatment soon after entering the coma, there may be long-term effects, for example, a risk of irreversible brain damage.

Even if a diabetic coma does not occur, the long-term impact of having blood sugar levels that are often too low or too high can be damaging. There are three main causes of diabetic coma. Two causes are most often associated with type 1 diabetes, and one is most often associated with type 2 diabetes.

According to the American Diabetes Association , a person with type 1 diabetes will experience symptoms of hypoglycemia twice a week on average. People with type 2 diabetes who use insulin are less likely to experience hypoglycemia, but it can still happen.

Hypoglycemia usually only occurs in people who are receiving treatment with insulin, but it can occur with oral medications that increase insulin levels in the body. Eating or drinking a source of glucose will bring blood glucose levels back into the healthy range, and the person will feel better almost immediately.

If the person does not notice or act on the symptoms and the glucose levels continue to decrease, they will become unconscious. Diabetic ketoacidosis is a serious complication of type 1 diabetes that arises when levels of ketones in the blood become too high and the acid level of the blood increases.

It can also result in a diabetic coma. The levels of ketones in the blood can become too high if an individual uses fat rather than sugar as an energy source. This occurs in people with type 1 diabetes for various reasons, including not receiving enough insulin or illness.

People with diabetic ketoacidosis will also have high glucose levels in their blood since the sugar cannot go from the blood and into the cells.

The body tries to reduce the high glucose levels by allowing glucose to leave the body in the urine. However, this also causes the body to lose more water.

A person with diabetic ketoacidosis will :. A person with hyperosmolar syndrome will have normal blood ketone levels and a normal acid balance. Initial treatment is with an injection of saline solution into the veins.

This will rehydrate the person and help to lower blood glucose levels. uk recommend the following to reduce the risk of a diabetic coma:. Blood sugar monitoring kits are available for purchase online. Recognizing the early signs of low or high blood sugar levels and regular monitoring can help people with diabetes keep their blood sugar levels within the healthy range.

Informing those you work or live with about your condition and wearing a medical ID bracelet or pendant can help others bring you appropriate help if a coma does occur. My doctor has just told me I have type 2 diabetes. How worried should I be about a diabetic coma?

A diabetic coma is unlikely as long as you take your medications as prescribed and monitor your blood glucose levels routinely.

Daniel Murrell, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice. Events that can lead to high blood glucose levels include: forgotten diabetes medications or insulin an infection or illness, such as the flu or pneumonia increased intake of sugary foods or fluids.

Diabetic hypoglycaemic coma Hypoglycaemia , or low blood glucose levels below 3. Symptoms of hypoglycaemia Symptoms of hypoglycaemia include: tremor racing pulse or heart palpitations sweating weakness intense hunger confusion, altered behaviour, drowsiness or coma — these may occur if the blood glucose level becomes very low.

Prolonged or frequent coma should be avoided and hypoglycaemia needs to be treated quickly. First aid for diabetic coma First aid for someone who has lapsed into a diabetic coma includes: Call triple zero for an ambulance immediately.

Turn them onto their side to prevent obstruction to breathing. Follow any instructions given to you by the operator until the ambulance officers arrive.

If available, administer 1 mg of glucagon for rapid reversal of hypoglycaemia. Diagnosis of diabetic coma A coma is a medical emergency. The cause of a diabetic coma is diagnosed using a number of tests including: medical history physical examination — the person may be wearing an emergency bracelet identifying their medical condition blood tests — including tests for glucose and ketone levels.

Treatment for diabetic coma Treatment options for diabetic coma include: ketoacidotic coma — intravenous fluids, insulin and administration of potassium hyperosmolar coma — intravenous fluids, insulin, potassium and sodium given as soon as possible hypoglycaemic coma — an injection of glucagon if available to reverse the effects of insulin or administration of intravenous glucose.

Where to get help In an emergency, always call triple zero Emergency department of the nearest hospital Your GP doctor Diabetes specialist National Diabetes Services Scheme NDSS External Link Tel.

Hypoglycemia low blood glucose levels External Link , Baker Heart and Diabetes Institute. Hypoglycemia External Link , MSD manual: Professional version. Diabetic ketoacidosis DKA External Link , MSD manual: Professional version. Hyperosmolar hyperglycemic state HHS External Link , MSD manual: Professional version.

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