Coma
Recognizing Ketoacidosis and Preventing Insulin Coma
Last Updated:
Ketoacidosis is a serious condition that can lead to insulin coma or even death. While it rarely occurs in people with type 2 diabetes, it is a reasonable risk for people with type 1 diabetes. To avoid ketoacidosis, doctors recommend that type 1 patients carefully monitor their lifestyle and blood sugar levels.
Ketoacidosis is a term that refers to high levels of ketones in a person’s blood. Produced when a person doesn't have enough insulin, ketones, in large amounts, act like poison, impairing the brain’s ability to regulate the body.
What Causes Ketoacidosis?
Three common factors known to cause ketoacidosis are—
1. Not enough insulin. Maybe the patient did not inject enough insulin. Or maybe the person required more insulin due to the stress of illness. With insufficient insulin levels, the body breaks down body fat for energy, resulting in the accumulation of ketones in the blood.
2. Not enough food. When people are sick, they often neglect eating. High ketones may occur when someone misses a meal.
3. An insulin reaction (low blood sugar). When blood sugar levels fall too low, the body must use fat to get energy. If testing shows high ketones in the morning, the person may have had an insulin reaction while asleep.
The Symptoms of Ketoacidosis
A diabetic should watch for the following symptoms:
• Thirst
• Dry mouth
• Frequent urination
• High blood sugar levels
• High levels of ketones in the urine
• Persistent tired feeling
• Dry skin
• Flushed appearance
• Nausea, vomiting, or abdominal pain (Though vomiting can indicate a number of illnesses, with ketoacidosis, it signifies the risk of a potentially rapid decline leading to a life-threatening condition.)
• Shortness of breath
• Fruity breath odor
• Inattenton
• Confusion
Confirming High Ketone Levels
A simple urine test can detect ketones. When a person with diabetes experiences the symptoms listed above, he or she can use ketone test strips to check their urine and confirm or dismiss the possibility of ketoacidosis. Doctors routinely recommend that people with type 1 diabetes use ketone test strips to check their urine for ketones when their blood sugar is 240 mg/dl or higher. If the diabetic is ill with a cold or flu, however, doctors advise them to test their ketone levels every 4 to 6 hours.
When Ketone Levels Are High
A diabetic person should call their doctor when—
More than one urine test shows high levels of ketones.
Blood sugar level is 240 mg/dl or higher.
Doctors recommend that diabetic patients carry glucose tablets and/or a tube of glucose gel in case of hypoglycemia. Diabetic patients also should wear a "Medic-Alert" (TM) or other bracelet or jewelry identifying them as diabetic. Otherwise, an insulin coma could be mistaken for drunkenness, especially by the uninformed.
Friends and family of diabetic patients should learn how to give first aid in a insulin emergency, and how to operate the insulin person's blood glucose meter. If possible, they should also learn how and when and why to give insulin injections if necessary. If a diabetes patient has young children living with him/her, it would be wise to teach them the appropriate local emergency telephone number.