1. History

If patient has missed his meals, or undergone severe exertion, if her had sweating & hunger, and if he has become unconscious suddenly then he is hypoglycemic coma.

On the contrary, if he had not taken his regular Tablets or insulin, if he had fever or any illness and if he has lost consciousness gradually, then he is Hyperglycemic Coma.

2. Clinical Picture

If patient is breathing quietly, pulse is lslow & bounding, then he is in Hypoglycemic Coma.

If patient is febrile, looks toxic Pulse is feeble & fast and Breathing is rapid, deep with sweet odour, then he is in Hyperglycemic Coma.

3. Blood Sugar Strips:

If available, will make the diagnosis clear.

In case of doubt (hypo or hyper?)

1. Inj. 25% glucose 25ml x 4 amps I.V. stat

A. if patient stats waking up

2. Give 25% glucose till he is alert. (upto 10 amps)

3. Then I.V. 10% dextrose drip + Oral sweets.

4. Observe the patient for 6 hrs, till the effects of hypoglycemic drugs is over.

B. if patient does not wake up,

Refer to a physician.

Diabetic coma must be managed in a Hospital.

Principles of management of Diabetic Coma:

1. Insulin Drip:

I. 20 Units PL. insulin +500 ml Saline at 15-20 drops/minute till B1-sugar comes to below 300 mg%

II. Then 5% dedxtrose 500 ml + 10 u Plain insulin to maintain the level.

III. A loading subcutaneous does of insulin may be given Inj. P1. insulin 40u S.C.Stat.

2. I.V. N.Salline 540 ml x 3-4 pints x fast x via a separate I.V. line to corrects dehydration.

3. inj. Sodabicarb 100ml slow I.V. stat, then as required.

4. Inj. Decadron I.V. 6-8 hrly (Antibiotic +7A-9)

5. Monitor Blood sugar, Urine ketone bodies & S.Electrolytes

6. Other measueres –as required:

i. Oxygen, bronchodilators.

ii. Ryles’s Tube aspiration.

iii. Inj. Decadron if cerebral edema.

iv. General care of unconscious patient

Hypoglycemia, when prolonged, causes permanent Brain Damage. So when in doubt, give 4 amps of 25% glucose.