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Why Ketoacidosis Cause Coma

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A state of profound unconsciousness from which a person cannot be aroused. It may be the result of trauma, a brain tumor, loss of blood supply to the brain (as from cerebrovascular disease), a toxic metabolic condition, or encephalitis (brain inflammation) from an infectious disease. In people with diabetes, two conditions associated with very high blood glucose may cause coma; these are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Severe hypoglycemia, or very low blood glucose, may also lead to coma. It’s important for all people with diabetes to learn to recognize these conditions and respond accordingly. Diabetic ketoacidosis is a serious imbalance in blood chemistry causing about 100,000 hospitalizations each year, with a mortality rate of under 5%. It typically occurs when a person has high blood sugar and insufficient insulin to handle it. Without adequate insulin, the body breaks down fat cells for energy, flooding the bloodstream with metabolic by-products called ketoacids. Meanwhile, the kidneys begin filtering large amounts of glucose from the blood and producing large amounts of urine. As the person urinates more frequently, the body becomes Continue reading >>

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  1. Steve Rapaport

    Correlation isn't causation, so the question's presupposition of high blood sugar 'resulting' in diabetic coma is wrong. They both result from common causes.
    Diabetic coma (advanced diabetic ketoacidosis or DKA) is not the result of high blood sugar, but of low insulin and water levels. Low insulin levels lead to high blood sugar AND to ketoacidosis. Hence there's no minimum blood sugar level to watch for (though there may be for a given individual).
    The best way to avoid DKA is to keep insulin levels steady in the bloodstream, keep well hydrated, and keep small amounts of food in the system at all times.
    DKA is a result of the body demanding sugar for fuel, and being denied it through lack of insulin. The body burns fat instead, which produces ketone bodies as a byproduct. The ketones build up in blood, making it acid and highly concentrated. Concentrated blood sucks water out of cells by osmosis. Dehydration makes this worse. The ketones signal the liver that glucose is desperately needed, so it dumps stored glucose to help out, but in the absence of insulin this just makes things worse -- now the blood is full of ketones AND glucose, and even more highly concentrated. Both of these conditions will get worse until fast-acting insulin and missing electrolytes are added in carefully controlled doses, including a drip-feed for hydration and frequent recheck and adjustment of all those values.

  2. Suhail Malhotra

    First we must know that there are 2 types of diabetes.
    IDDM(insulin dependent diabetes mellitus) aka Type 1
    NIDDM( non insulin dependent diabetes mellitus) aka Type 2.
    Type 1 is due to loss of insulin secretion by pancreas as in destruction of pancreas.
    Type 2 is due to insulin resistance that is insulin secretion is ok but body cells don't respond to it.
    Now the comas in these two types are different to the extent that they are named differently.
    The coma of type 1 is called the DKA(diabetic ketoacidosis) and that of type 2 is HONK( hyperosmotic non ketotic coma) now known as HHS(hyperglycemic hyperosmolar state).
    DKA occurs in type 1 diabetes or situations simulating type 1 mechanism like when a patient forgets to take his dose of insulin or in states when patient is regular with insulin but the body needs more than normal as in cases of surgery or illness or pregnancy.
    Blood glucose ranges in DKA from 250 to 600 mg/dl( 13 to 33 mmol/l) with increased ketones in blood which being acidic drive the blood ph to acidic levels ( <7.3). Symptoms include vomiting,increased urination, increased thirst, abdominal pain,increased rate of respiration(Kussumaul breathing) and in the end coma.
    HONK or HHS is caused by type 2 diabetes or situations similar to it like relative insulin deficiency combined with inadequate fluid intake and often precipitated in patients with type2 DM and a concurrent illness.
    Blood glucose ranges from 600 to 1200 mg/dl (33 to 66 mmol/l). The blood ph is normal (>=7.3) as ketones are absent. Patient is lethargic with increased thirst and increased urination leading to coma.
    Symptoms absent in HONK are nausea, vomiting, abdominal pain and increased rate of respiration which were very much a part of DKA.

  3. Jae Won Joh

    If you are asking what blood sugar levels are commonly seen in diabetic coma[1], there is a very wide range. Patients naive to the condition typically present with blood glucoses around the 300s, while those with chronic poorly-managed diabetes can present with blood glucoses over 1000.
    [1] As Steve Rapaport already pointed out in his answer, the high glucose level is not, in and of itself, the problem.

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