Untreated diabetes often leads to diabetes coma but this should not arise in cases under proper medical surveillance. However, stresses such as intercurrent infections frequently upset diabetes control and may create a medical emergency without coma supervening.
The occurrence of glycosuria (sugar in urine) of 2 percent or more, with ketonuria (the presence of ketones in the urine, a warning sign of severe and uncontrolled diabetes) in a drowsy patient who appears ill should be regarded as diabetes crisis. It must be appreciated that all degrees of crisis exist in diabetes; the severity is proportional to the ketosis (overproduction of ketones), not to the level of the blood sugar. In the presence of kidney or other diseases, urinary ketones are not an adequate index of ketosis.
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While starting diabetes treatment, a careful examination must be made to try to discover the initiating cause of the crisis; infection, infarction, trauma or neglect being the commonest. But treatment is a matter of urgency and should not be unduly delayed by prolonged search for causes.
Two other words of warning: The diabetic patient should be disturbed as little as possible. Routine nursing procedures may be omitted until the patient is fully conscious. Better a dirty diabetic patient than a clean corpse
While there is ketosis, there will be resistance to the action of insulin. As soon as ketosis begins to subside, sensitivity to the action of insulin increases sharply. It is possible to precipitate hypoglycemia (the medical condition of having an unusually low level of sugar in the blood) by too vigorous therapy.
The regime detailed below is suitable for a diabetic patient in coma. The stages of treatment are below:
1) Treat precipitating causes of diabetes, including infection
2) Correct dehydration (a dangerous lack of water in the body resulting from inadequate intake of fluids or excessive loss through sweating, vomiting, or diarrhea)
3) Replace lost electrolytes (Electrolytes help to control fluid levels in the body, maintain normal pH levels, and ensure the correct electric potential between nerve cells that enables the transmission of nerve signals)
4) Re-establish the metabolism of carbohydrate.
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