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. Is Your Type 2 Diabetes Under Control? 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. Tips Kesehatan: Mengenal Gejala & Penyebab Koma Diabetikum Koma diabetikum merupakan komplikasi diabetes yang menyebabkan ketidaksadaran dan dapat mengancam jiwa. Penderita diabetes yang memiliki kadar gula darah sangat tinggi (hiperglikemia) atau gula darah sangat rendah (hipoglikemia) bisa mengalami koma diabetikum. Penderita yang mengalami koma diabetikum masih tetap hidup tetapi tidak mampu menanggapi rangsangan seperti suara, warna, atau cahaya. Koma diabetikum yang tidak segera ditangani bisa berakibat fatal. Gejala Koma Diabetikum Sebelum mengalami koma diabetikum, biasanya penderita akan mengalami tandatanda dan gejala gula darah tinggi atau gula darah rendah. Gula darah tinggi (hyperglycemia) Jika kadar gula terlalu tinggi, penderita mungkin mengalami gejala sebagai berikut: Peningkatan rasa haus Sering buang air kecil Kelelahan Mual dan muntah Sesak napas Perut sakit Napas berbau buah Jantung berdetak cepat Gula darah rendah (hypoglycemia)

Jika kadar gula terlalu rendah, penderita mungkin merasakan gejala: Gemetar atau gugup Lelah Berkeringat Lapar Mual Mudah marah Denyut jantung tidak teratur atau berdetak cepat Perilaku agresif Bingung Beberapa orang mengembangkan suatu kondisi yang dikenal sebagai ketidaksadaran hipoglikemia (hypoglycemia unawareness) dan tidak mengalami gejala penurunan kadar gula darah seperti di atas. Penyebab Koma Diabetikum Kadar gula darah ekstrim yang berkepanjangan gula darah yang terlalu tinggi atau terlalu rendah dalam jangka lama dapat menyebabkan koma diabetikum. Berikut adalah beberapa penyebab koma diabetikum: 1. Ketoasidosis diabetikum (diabetic ketoacidosis) Saat sel-sel otot membutuhkan energi, tubuh akan merespon dengan memecah timbunan lemak. Proses ini membentuk asam beracun yang dikenal sebagai keton. Jika tidak diobati, ketoasidosis bisa menyebabkan koma diabetikum. Ketoasidosis diabetikum paling umum terjadi pada orang yang memiliki diabetes tipe-1, tetapi juga dapat memengaruhi orang-orang yang memiliki diabetes tipe-2 atau gestational diabetes. 2. Sindrom hiperosmolar diabetikum (diabetic hyperosmolar syndrome) Saat kadar gula darah puncak terukur sebesar 600 mg/dL atau 33 mmol/L, kondisi ini dikenal sebagai sindrom hiperosmolar diabetikum. Ketika gula darah mencapai level ini, darah menjadi kental dan manis. Kelebihan gula lantas dibuang ke dalam air seni yang memicu pembuangan jumlah besar cairan dari tubuh. Jika tidak ditangani, sindrom hiperosmolar diabetes dapat menyebabkan dehidrasi dan menyebabkan koma. Sindrom hiperosmolar diabetikum umum terjadi pada penderita paruh baya yang memiliki diabetes tipe-2. 3. Hipoglikemia

Otak perlu glukosa untuk berfungsi normal. Level gula darah yang rendah dapat menyebabkan pingsan. Hipoglikemia dapat disebabkan karena kadar insulin terlalu tinggi atau terlalu sedikit makan. Berolahraga terlalu keras atau minum alkohol terlalu banyak dapat pula menjadi penyebab Sumber: http://oketips.com/4197/tipskesehatan-mengenal-gejala-penyebabkoma-diabetikum/#ixzz1MkmTp4sz Diabetic hyperglycemic hyperosmolar syndrome Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes that involves extremely high blood sugar (glucose) levels without the presence of ketones. Ketones are byproducts of fat breakdown. Causes Diabetic hyperglycemic hyperosmolar syndrome is a condition of: Extremely high blood sugar (glucose) levels Extreme lack of water (dehydration) Decreased consciousness The buildup of ketones in the body (ketoacidosis) may also occur. This condition is usually seen in people with type 2 diabetes. It may occur in those who have not been diagnosed with diabetes, or in people who have not been able to control their diabetes. The condition may be brought on by: Infection Other illness Medications that lower glucose tolerance or increase fluid loss (in people who are losing or not getting enough fluid) Normally, the kidneys try to make up for high glucose levels in the blood by allowing the extra glucose to leave the body in the urine. If you do not drink enough fluids, or you drink fluids that contain sugar, the kidneys can no longer get rid of the extra glucose. Glucose levels in the blood can become very high as a result. The blood then becomes much more concentrated than normal (hyperosmolarity). Hyperosmolarity is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances

that normally cause water to move into the bloodstream. This draws the water out of the body's other organs, including the brain. Hyperosmolarity creates a cycle of increasing blood glucose levels and dehydration. Risk factors include: A stressful event such as infection, heart attack, stroke, or recent surgery Congestive heart failure Impaired thirst Limited access to water (especially in patients with dementia or who are bedbound) Older age Poor kidney function Poor management of diabetes -- not following the treatment plan as directed Stopping insulin or other medications that lower glucose levels Symptoms Coma Confusion Convulsions Increased thirst Increased urination (at the beginning of the syndrome) Lethargy Nausea Weakness Weight loss Symptoms may get worse over a period of days or weeks. Other symptoms that may occur with this disease: Dysfunctional movement Loss of feeling or function of muscles Speech impairment Exams and Tests Signs may include: Extreme dehydration High temperature -- higher than 38 degrees Centigrade (100.4 degrees Fahrenheit) Increased heart rate Low systolic blood pressure Test results include: High serum osmolarity (concentration)

Higher than normal BUN and creatinine Higher than normal serum sodium Mild ketone buildup (ketosis) Very high blood glucose Evaluation for possible causes may include: Blood cultures Chest x-ray Electrocardiogram (ECG) Urinalysis Treatment The goal of treatment is to correct the dehydration. This will improve the blood pressure, urine output, and circulation. Fluids and potassium will be given through a vein (intravenously). High glucose levels are treated with intravenous insulin. Outlook (Prognosis) Patients who develop this syndrome are often already ill. The death rate with this condition is as high as 40%. Possible Complications Acute circulatory collapse (shock) Blood clot formation Brain swelling (cerebral edema) Increased blood acid levels (lactic acidosis) When to Contact a Medical Professional This condition is a medical emergency. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of diabetic hyperglycemic hyperosmolar syndrome. Prevention Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition. Alternative Names Hyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK) References Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29:27392748. Cydulka RK, Maloney Jr. GE. Diabetes mellitus and disorders of glucose homeostasis. In: Marx J, Hockberger R, Walls R, eds. Rosen's Emergency Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier;2009.

Update Date: 5/10/2010