Pasquel FJ, Umpierrez GE. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care. By Rod Brouhard, EMT-P Rod Brouhard is an emergency medical technician paramedic EMT-P , journalist, educator, and advocate for emergency medical service providers and patients.

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By Rod Brouhard, EMT-P. Medically reviewed by Michael Menna, DO. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles.

The ketones can build up excessively when insulin levels remain too low. Common causes of ketoacidosis include a missed dose of insulin or an acute infection in a person with type 1 diabetes.

Ketoacidosis may be the first sign that a person has developed type 1 diabetes. In order to pick up the earliest signs of ketoacidosis, people with type 1 diabetes whose blood glucose levels are particularly high require more frequent monitoring of blood glucose.

Checking of ketone levels is also recommended. If available, blood ketone testing is preferred. If blood ketone testing is not available, urine testing may be used. A diabetic hyperosmolar coma is caused by severe dehydration and very high blood glucose levels hyperglycaemia. Those at most risk of this type of coma are people with type 2 diabetes, who have an infection or acute illness and have reduced their intake of fluids.

The kidneys respond to high levels of blood glucose by doing their best to remove it, along with a great deal of water. They will become dehydrated and urgently need intravenous fluids.

Without this kind of treatment, they may lapse into hyperosmolar coma. Hyperosmolar coma develops slowly over several days or weeks, so if the high blood glucose levels or dehydration are detected and treated early, coma can be prevented. Hypoglycaemia , or low blood glucose levels below 3.

If the blood glucose falls to very low levels, the person may become unconscious hypoglycaemic coma and seizures may occur. First aid for someone who has lapsed into a diabetic coma includes:. A coma is a medical emergency. The cause of a diabetic coma is diagnosed using a number of tests including:.

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If blood ketone testing is not available, urine testing may be used. A diabetic hyperosmolar coma is caused by severe dehydration and very high blood glucose levels hyperglycaemia. Those at most risk of this type of coma are people with type 2 diabetes, who have an infection or acute illness and have reduced their intake of fluids.

The kidneys respond to high levels of blood glucose by doing their best to remove it, along with a great deal of water. They will become dehydrated and urgently need intravenous fluids. Without this kind of treatment, they may lapse into hyperosmolar coma.

Hyperosmolar coma develops slowly over several days or weeks, so if the high blood glucose levels or dehydration are detected and treated early, coma can be prevented. Hypoglycaemia , or low blood glucose levels below 3.

If the blood glucose falls to very low levels, the person may become unconscious hypoglycaemic coma and seizures may occur. First aid for someone who has lapsed into a diabetic coma includes:. A coma is a medical emergency. The cause of a diabetic coma is diagnosed using a number of tests including:.

This page has been produced in consultation with and approved by:. Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional.

The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances.

The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website. Skip to main content. Home Diabetes. Diabetic coma. Actions for this page Listen Print. Symptoms of hypoglycemia often get worse and can even be fatal if left untreated.

Symptoms of diabetic shock or severe hypoglycemia may include :. If a person suspects they have hypoglycemia, they should get treatment as soon as possible.

Some people may not experience the typical symptoms of hypoglycemia. Doctors call this hypoglycemia unawareness. Hypoglycemia unawareness is more common when a person has had diabetes for a long time or if the person has experienced frequent episodes of hypoglycemia.

Lack of initial warning signs, such as shaking and sweating, may cause the episode to progress fast to seizure and loss of consciousness. A person should call if they suspect their symptoms are due to severe hypoglycemia. People with a person experiencing severe symptoms should call as soon as possible.

Taking insulin is a definitive cause of hypoglycemia. Other oral diabetes medications, especially those in the sulfonylurea and meglitinides classes of drugs, can also lead to low blood sugar. Examples of such drugs include Amaryl, Glyburide, and Glipizide.

If a person living with type 1 diabetes or type 2 diabetes notices symptoms of low blood sugar, they can take steps to help raise their blood glucose levels to an acceptable range.

According to the American Diabetes Association ADA , a person should check blood glucose levels first. This is known as the rule. If the levels are still low, repeat the process and consume another sugary food or drink.

Once the levels have returned to normal, a person can return to their regular meal and snack schedule. Doctors may prescribe a hormone called glucagon to people who are at risk of diabetic shock.

Glucagon comes in a syringe, and a person can use it in an emergency to help their blood glucose levels return to normal. If a person experiencing hypoglycemia becomes unconscious, a person should call Then they should turn the affected person on their side and deliver a glucagon shot.

According to the ADA, the person should come around within 15 minutes. They will need immediate medical attention if they do not. For this reason, calling for emergency help is the first step.

To administer a glucagon injection, a person should:. However, if a person can keep a glucagon nasal spray on hand, this may be easier for a friend or family member to administer.

A person should take the warning signs and symptoms of hypoglycemia extremely seriously. When blood glucose levels are too low, it can affect brain functioning and lead to complications, including :. When treating hypoglycemia, it is vital that a person does not take more glucose than they need, as this can cause blood sugar levels to rebound too high.

A person can make general lifestyle changes to help avoid diabetic shock and hypoglycemia, including :. Also, people can adjust their blood sugar targets according to their individual needs. For example, people with hypoglycemia unawareness might benefit from targeting a higher blood sugar.

People can prevent complications by carrying a medical alert bracelet or another form of identification to inform emergency personnel that they have diabetes. A continuous glucose monitoring system with alerts may be a good solution for some.

To use, a person needs to insert a sensor into the skin, typically on the abdomen. A person can get a continuous glucose monitoring system online or from pharmacies that carry medical equipment.

If you don't start to feel better quickly, or you start to feel worse, get medical care right away. A diabetic coma is a medical emergency. If you have symptoms of high or low blood sugar and you think you might pass out, call or your local emergency number.

If you're with someone with diabetes who has passed out, call for emergency help. Tell the emergency personnel that the unconscious person has diabetes. Blood sugar that's either too high or too low for too long may cause the following serious health problems, all of which can lead to a diabetic coma.

Diabetic ketoacidosis. If your muscle cells become starved for energy, your body may start breaking down fat for energy. This process forms toxic acids known as ketones. If you have ketones measured in blood or urine and high blood sugar, the condition is called diabetic ketoacidosis.

If it's not treated, it can lead to a diabetic coma. Diabetic ketoacidosis is most common in people who have type 1 diabetes. But it can also occur in people who have type 2 diabetes or gestational diabetes. Diabetic hyperosmolar syndrome.

When blood sugar is very high, the extra sugar passes from the blood into the urine. That triggers a process that draws a large amount of fluid from the body. If it isn't treated, this can lead to life-threatening dehydration and a diabetic coma.

Anyone who has diabetes is at risk of a diabetic coma, but the following factors can increase the risk:. Good day-to-day control of your diabetes can help you prevent a diabetic coma. Keep these tips in mind:.

Consider a continuous glucose monitor, especially if you have trouble maintaining stable blood sugar levels or you don't feel symptoms of low blood sugar hypoglycemia unawareness. Continuous glucose monitors are devices that use a small sensor inserted underneath the skin to track trends in blood sugar levels and send the information to a wireless device, such as a smart phone.

These monitors can alert you when your blood sugar is dangerously low or if it is dropping too fast. But you still need to test your blood sugar levels using a blood glucose meter even if you're using one of these monitors.

Continuous glucose monitors are more expensive than other glucose monitoring methods, but they may help you control your glucose better. A continuous glucose monitor, on the left, is a device that measures blood sugar every few minutes using a sensor inserted under the skin.

An insulin pump, attached to the pocket, is a device that's worn outside of the body with a tube that connects the reservoir of insulin to a catheter inserted under the skin of the abdomen.

Insulin pumps are programmed to deliver specific amounts of insulin continuously and with food. On this page. When to see a doctor. Risk factors. A Book: Guide to the Comatose Patient. A Book: The Essential Diabetes Book.

Symptoms of high blood sugar or low blood sugar usually develop before a diabetic coma. High blood sugar hyperglycemia If your blood sugar level is too high, you may have: Increased thirst Frequent urination Blurred vision Tiredness or weakness Headache Nausea and vomiting Shortness of breath Stomach pain Fruity breath odor A very dry mouth.

Low blood sugar hypoglycemia If your blood sugar is too low, you may have: Shakiness Anxiety Tiredness or drowsiness Weakness Sweating Hunger A feeling of tingling on your skin Dizziness or lightheadedness Headache Difficulty speaking Blurry vision Confusion Loss of consciousness Some people, especially those who've had diabetes for a long time, develop a condition known as hypoglycemia unawareness.

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You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. Your brain needs sugar glucose to function. In severe cases, low blood sugar hypoglycemia may cause you to pass out.

Low blood sugar can be caused by too much insulin or not enough food. Exercising too vigorously or drinking too much alcohol can have the same effect. Anyone who has diabetes is at risk of a diabetic coma, but the following factors can increase the risk: Insulin delivery problems.

If you're using an insulin pump, you have to check your blood sugar frequently. Insulin delivery can stop if the pump fails or if the tubing catheter becomes twisted or falls out of place.

A lack of insulin can lead to diabetic ketoacidosis. An illness, trauma or surgery. When you're sick or injured, blood sugar levels can change, sometimes significantly, increasing your risk of diabetic ketoacidosis and diabetic hyperosmolar syndrome.

Poorly managed diabetes. If you don't monitor your blood sugar properly or take your medications as directed by your health care provider, you have a higher risk of developing long-term health problems and a higher risk of diabetic coma.

Deliberately skipping meals or insulin. Sometimes, people with diabetes who also have an eating disorder choose not to use their insulin as they should, in the hope of losing weight. This is a dangerous, life-threatening thing to do, and it raises the risk of a diabetic coma.

Drinking alcohol. Alcohol can have unpredictable effects on your blood sugar. Alcohol's effects may make it harder for you to know when you're having low blood sugar symptoms. This can increase your risk of a diabetic coma caused by hypoglycemia.

Illegal drug use. Illegal drugs, such as cocaine, can increase your risk of severe high blood sugar and conditions linked to diabetic coma. If it is not treated, a diabetic coma can lead to permanent brain damage and death.

Keep these tips in mind: Follow your meal plan. Consistent snacks and meals can help you control your blood sugar level. Keep an eye on your blood sugar level.

Frequent blood sugar tests can tell you whether you're keeping your blood sugar level in your target range. It also can alert you to dangerous highs or lows. Check more frequently if you've exercised. Exercise can cause blood sugar levels to drop, even hours later, especially if you don't exercise regularly.

Take your medication as directed. If you have frequent episodes of high or low blood sugar, tell your health care provider. You may need to have the dose or the timing of your medication adjusted. Have a sick-day plan. Illness can cause an unexpected change in blood sugar. If you are sick and unable to eat, your blood sugar may drop.

While you are healthy, talk with your doctor about how to best manage your blood sugar levels if you get sick.

Consider storing at least a week's worth of diabetes supplies and an extra glucagon kit in case of emergencies. If your blood sugar level is too low, you may be given a shot of glucagon. This will cause your blood sugar level to quickly rise.

Intravenous dextrose also may be given to raise blood glucose levels. A diabetic coma is a medical emergency that you won't have time to prepare for. If you feel symptoms of extremely high or low blood sugar, call or your local emergency number to make sure help is on the way before you pass out.

If you're with someone with diabetes who has passed out or is acting strange, possibly as if they have had too much alcohol, call for immediate medical help. If you are familiar with diabetes care, test the unconscious person's blood sugar and follow these steps:. On this page. Preparing for your appointment.

Lab tests At the hospital, you may need lab tests to measure: Your blood sugar level Your ketone level The amount of nitrogen, creatinine, potassium and sodium in your blood. More Information. Blood urea nitrogen BUN test.

Creatinine test. High blood sugar If your blood sugar level is too high, you may need: Intravenous fluids to restore water to your body Potassium, sodium or phosphate supplements to help your cells work correctly Insulin to help your body absorb the glucose in your blood Treatment for any infections.

Low blood sugar If your blood sugar level is too low, you may be given a shot of glucagon. Request an appointment. What you can do in the meantime If you have no training in diabetes care, wait for the emergency care team to arrive.

Do not try to give fluids to drink. Do not give insulin to someone with low blood sugar. Don't give sugar to someone whose blood sugar isn't low. If you called for medical help, tell the emergency care team about the diabetes and what steps you've taken, if any. By Mayo Clinic Staff. Aug 11, Show References.

American Diabetes Association. Glycemic targets: Standards of Medical Care in Diabetes — Diabetes Care. Cryer PE. Hypoglycemia in adults with diabetes mellitus. Accessed July 11, Tips for emergency preparedness. Low blood glucose hypoglycemia. National Institute of Diabetes and Digestive and Kidney Diseases.

Insulin pumps: Relief and choice. Continuous glucose monitoring. Managing diabetes. Hirsch IB. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis.

Inzucchi SE, et al. Clinical presentation, diagnosis and initial evaluation of diabetes mellitus in adults. Castro MR expert opinion.