1. Primary Cause
Diabetic coma is a life-threatening condition triggered by diabetic ketoacidosis (DKA). Its core pathogenesis lies in insufficient insulin to decompose glucose for energy supply, which disrupts fat metabolism and leads to massive accumulation of ketone bodies. Normally, blood ketone concentration stays below 2 mg/dL. When ketones build up to nearly 50 mg/dL or higher in the bloodstream, diabetic ketoacidosis develops.
2. Predisposing Factors
Acute infections unrelated to diabetes mellitus
Excessive intake of sugar and fatty foods, insufficient insulin dosage or abrupt insulin discontinuation
Severe vomiting, severe diarrhea and starvation
Myocardial infarction
Extreme fatigue, emotional stress and pregnancy
3. Identification
Existing diabetic symptoms will worsen, including anorexia, polydipsia, polyuria, fatigue, nausea and vomiting, generalized body pain, headache and dizziness. Typical signs also include fruity (rotten apple) odor on exhaled breath, hypotension, tachycardia, dyspnea and loss of consciousness.
In the progressive stage, patients suffer severe dehydration, oliguria, dry skin, sunken eyeballs, hoarseness, hypotension and cold extremities. In the late stage, all reflexes diminish or disappear, followed by coma.
4. First Aid Measures
Keep the patient resting absolutely in bed. Maintain clean oral cavity and skin to avoid secondary infection.
Fluid resuscitation: Intravenous drip of 1,000–2,000 mL normal saline to expand blood volume, improve blood circulation and renal function, and prevent hypoglycemia. The infusion rate shall be adjusted according to blood pressure, heart rate and urine output under professional medical guidance.
For mild cases with ketones detected in morning urine, increase the dosage of long-acting insulin before dinner.
Oral glucose supplementation if ketosis is induced by starvation.
Temporary intramuscular injection of 20 units of insulin for patients under severe emotional stress.
Targeted infection control if the condition is triggered by infection.
Arrange immediate hospital transfer for standardized diagnosis and treatment without delay.