Diabetic Coma in Type 2 Diabetes

Diabetic coma -- also known as hyperglycemic hyperosmolar nonketotic syndrome -- is a serious complication that can happen to a person with type 2 diabetes who is ill or stressed. Diabetic coma occurs when the blood sugar gets too high and the body becomes severely dehydrated. Unlike ketoacidosis, which typically occurs in people with type 1 diabetes and produces similar symptoms, no ketones are formed in diabetic coma. So rarely is there an acid build up in the blood. Ketoacidosis rarely occurs in people with type 2 diabetes.

The CDC reports that diabetic coma occurs most often among people who are older than 60. This may be because older people often have an altered sense of being thirsty and are more likely to become dehydrated. Most sufferers have a history of diabetes, but for some, the disease is undiagnosed or untreated.

In most cases, there is a history of excess thirst and urination for weeks prior to diagnosis. Excess urination and extreme elevations of blood sugar levels lead to dehydration throughout the body, including cells becoming dehydrated. The severe loss of body water can lead to shock, coma, and death. Death rates can be as high as 50%.

People who are especially at risk include those who are chronically ill or disabled.

What Causes Diabetic Coma?

Causes of diabetic coma can include:

• Infection
• Heart attack
• Kidney failure
• Medicines (diuretics, heart medication, or steroids)
• Illness
• Bleeding ulcer
• Blood clot
• Uncontrolled blood sugar

What Are the Early Symptoms of Diabetic Coma?

Early symptoms that may lead to diabetic coma if not treated include:

• Increased thirst
• Increased urination
• Weakness
• Drowsiness
• Altered mental state
• Headache
• Restlessness
• Inability to speak
• Paralysis

If you have any of these symptoms, test your blood sugar and call your doctor if your blood sugar is high. Diabetic coma typically occurs when blood sugar reaches 600 mg/dL (milligrams per deciliter) or more.

How Is Diabetic Coma Treated?

Once early symptoms of a diabetic coma are noticed, treatment typically requires intravenous fluids as ordered by your doctor and may require insulin. It can lead to death if left untreated.

How Can Diabetic Coma Be Prevented?

Diabetic coma can be prevented by the following:

• Check your blood sugar regularly, as recommended by your health care provider.
• Check your blood sugar every four hours when you are sick.
• Take special care of yourself when you are sick.

Diabetes and Alcohol

Diabetes and Alcohol

Alcohol is processed in the body very similarly to the way fat is processed, and alcohol provides almost as many calories. Therefore, drinking alcohol in people with diabetes can cause your blood sugar to rise. If you choose to drink alcohol, only drink it occasionally and when your diabetes and blood sugar level are well-controlled. If you are following a calorie-controlled meal plan, one drink of alcohol should be counted as two fat exchanges.
It is a good idea to check with your doctor if you are overweight or have high blood pressure or high triglyceride levels before drinking alcohol. If you are in doubt about whether drinking alcohol is safe for you, check with your doctor.

Effects of Alcohol on Diabetes

Here are some other ways that alcohol can affect diabetes:

• While moderate amounts of alcohol can cause blood sugar to rise, excess alcohol can actually decrease your blood sugar level -- sometimes causing it to drop into dangerous levels.
• Beer and sweet wine contain carbohydrates and may raise blood sugar.
• Alcohol stimulates your appetite, which can cause you to overeat and may affect your blood sugar control.
• Alcohol can interfere with the positive effects of oral diabetes medicines or insulin.
• Alcohol may increase triglyceride levels.
• Alcohol may increase blood pressure.
• Alcohol can cause flushing, nausea, increased heart rate, and slurred speech.

Diabetes and Alcohol Consumption Dos and Don'ts

People with diabetes should follow these alcohol consumption guidelines:

• Do not drink more than two drinks of alcohol in a one-day period. (Example: one alcoholic drink = 5-ounce glass of wine, 1 1/2-ounce "shot" of liquor or 12-ounce beer).
• Drink alcohol only with food.
• Drink slowly.
• Avoid "sugary" mixed drinks, sweet wines, or cordials.
• Mix liquor with water or diet soft drinks.

Monitoring Blood Sugar and Avoiding Diabetes Complications

Monitoring Blood Sugar and Avoiding Diabetes Complications

Maintaining control of blood glucose (blood sugar) is a fact of life for people with diabetes. Uncontrolled blood glucose levels can cause serious health complications that affect nearly every system and organ in your body. Regular blood sugar tests throughout the day can help you maintain safe blood glucose levels and lower the risks for a host of diabetes complications:

Cardiovascular Disease and Stroke. Cardiovascular disease is one of the most common complications of diabetes, leading to heart attack, stroke, angina, and coronary artery disease. About 65% of people with diabetes die from cardiovascular disease and stroke. Adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than people without diabetes.

Hypertension (High Blood Pressure). People with diabetes are also at greater risk of developing hypertension (high blood pressure), which increases the risk of heart attack, stroke, kidney disease, and eye problems.

High Cholesterol Levels. People with diabetes, especially those with poorly controlled blood sugars, tend to have elevated levels of triglycerides and lower levels of healthy HDL cholesterol. People with type 2 diabetes tend to have similar LDL or "bad" cholesterol levels compared to those without diabetes, but their LDL particles seem to be smaller and more prone to cause damage. These abnormalities also increase the risk of heart disease for people with type 2 diabetes.

Vision Loss or Blindness. Diabetes is the leading cause of blindness for American adults High blood sugar leads to blurred vision, glaucoma, cataracts, and can cause loss of vision or blindness (diabetic retinopathy). Keeping your blood sugars under control will greatly reduce your risks of diabetes-related eye complications.

Diabetic Neuropathy (Nerve Damage). Diabetic neuropathy can lead to problems throughout your body, including the nerves that control your senses of vision, hearing, and taste. Nerve damage can also cause you to lose the ability to feel heat, pain, or cold. Small cuts or other wounds, like blisters, might not get noticed, or heal slowly, increasing the risk for skin infections and ulcerations.
Diabetic neuropathy can affect the nerves that control your digestive system. Diabetic gastroparesis is a disorder in which the movement of food through the digestive tract is slowed or stopped. This type of nerve damage can cause wide fluctuations in blood sugar and make glucose control difficult. In men with diabetes, diabetes can damage nerves and blood flow in the penis, leading to erectile dysfunction.

Kidney Disease. The kidneys filter waste products out of your blood.  But kidney disease affects more than just your blood. Diabetes is the leading cause of kidney failure. Kidney disease doubles your risk of heart attack, stroke, and early death. High blood sugars progressively damage your kidneys over time, and signs of kidney damage also represent a risk factor for heart disease.

Skin Conditions. A host of skin problems are associated with diabetes. Fungal infections, yeast infections, itching, blisters, and boils are common skin issues for people with diabetes. Even though anyone can develop these skin conditions, diabetic people can be more susceptible to infections and slow healing. About one-third of people with diabetes will develop a diabetes-related skin disorder during their life.

Controlling Diabetes: When Pills Aren't Enough

Diabetes and weight loss: It is the yin and yang of optimal health. There's no question about it. If you're overweight and have type 2 diabetes, dropping pounds lowers your blood sugar, improves your health, and helps you feel better.
But before you start a weight loss plan, it's important to work closely with your doctor or diabetes educator -- because while you're losing weight, your blood sugar, insulin, and medications need special attention.
Make no mistake -- you're on the right path. "No matter how heavy you are, you will significantly lower your blood sugar if you lose some weight," says Cathy Nonas, MS, RD, a spokeswoman for the American Dietetic Association and a professor at Mount Sinai School of Medicine in New York City.
A National Institutes of Health study found that a combination of diet and exercise cuts the risk of developing diabetes by 58%. The study involved people who were overweight (average body mass index of 34) and who had high -- but not yet diabetic -- blood sugar levels.
"We know it's true -- that if someone with diabetes loses 5% to 10% of their weight, they will significantly reduce their blood sugar," Nonas tells WebMD.
"We see it all the time. People can get off their insulin and their medication," she says. "It's wonderful. It shows you how interwoven obesity and diabetes are."
Even losing 10 or 15 pounds has health benefits, says the American Diabetes Association. It can:

• Lower blood sugar
• Reduce blood pressure
• Improve cholesterol levels
• Lighten the stress on hips, knees, ankles, and feet

Plus, you'll probably have more energy, get around easier, and breathe easier.

Diabetes, Weight Loss, and Changes in Blood Sugar

Cutting back on just one meal can affect the delicate balance of blood sugar, insulin, and medication in a body with diabetes. So it's important to work with an expert when you diet to lose weight.
Check with your doctor before starting a weight loss plan, then consult with a diabetes educator or nutritionist, advises Larry C. Deeb, MD, a diabetes specialist in Tallahassee, Fl.
"Don't try to lose weight on your own," says Deeb. "With a doctor and a good nutritionist, it's very safe to do. This is very important if you're taking insulin or medications."

The Right Balance for Diabetes and Weight Loss

Christine Gerbstadt, MD, a spokeswoman for the American Dietetic Association, warns that if you have diabetes, "you don't want to run the risk of high or low blood sugar while you're dieting. You want tight glucose control while you lose weight."
Gerbstadt suggests cutting 500 calories a day, "which is safe for someone with diabetes," she says. "Cut calories across the board -- from protein, carbohydrates, and fat -- that's the best way." She recommends that people with diabetes maintain a healthy ratio of carbs, fat, and protein. The ideal:

• 50% to 55% carbs
• 30% fat
• 10% to 15% protein