Hyperglycemia is a condition with high blood sugar (more than 126 mg/dL after fasting). Persistently high level of sugar can lead to acute complications such as Hyperosmotic diabetic coma.

What is Hyperosmotic diabetic coma?

If you have diabetes and your blood sugar gets too high (hyperglycemia), you can lose consciousness. This is referred to as a diabetic coma. Diabetic hyperglycemic hyperosmolar coma is a condition of unconsciousness, extreme dehydration (lack of water), and extremely high blood glucose levels. This condition usually happens in type 2 diabetes. There is no ketoacidosis since there is no formation of ketones due to non-occurrence of fat metabolism.

Hyperosmotic diabetic coma has similar symptoms as ketoacidosis (DKA), but a different cause. Abnormally high blood glucose levels (usually above 300 mg/dl) can cause water to be driven out of cells into the blood. The kidneys will be dumping glucose, and the water necessary to carry it from the blood eventually come from within the cells. If this continues, it can cause death. Electrolytes (potassium ion, sodium ion, etc) are also lost, resulting in electrolyte imbalance.

Hyperosmolarity is a condition in which the blood is concentrated with molecules of sodium, glucose, that attract water into the bloodstream. But when the kidneys are conserving water, due to scarcity, blood glucose levels further rise and increase dehydration.

Apart from the symptoms similar to DKA, the vital signs are:

• High temperature
• High pulse rate (above 100 mg/dL)
• High blood pressure (below 100 mg/dL)
• High blood glucose (600-2400 mg/dL)

Diabetic coma is a medical emergency situation. The death rate associated with this condition is as much as 40%. So, medical assistance is a must at the first recognition of the symptoms.

Treatment of diabetic coma
The patient is rehydrated which improves blood pressure and urine output. Electrolyte balance is restored with intravenous dosage and high glucose levels are treated with intravenous insulin.