The Diabetic coma is one the most dangerous and again emergent case experienced during dental care delivery. Actually it mistreated and aggravated-diabetic cases resulting coma, that is categorized into Hypoglycemic coma, Diabetic ketoacidosis and Hyperosmolar coma.

2. Definition
Types of diabetic coma
Causes of diabetic coma
Signs and symptoms
Management

3.  This a aggravated diabetic-resulting
pathological condition leading to loss of
conscious.
 It is mainly due to impaired control of blood
sugar levels.
 It may progress to different organs like eyes,
kidney, blood vessels and nerve tissues
 diabetic coma is linked with severe and
inadequately treated diabetic mellitus

4. Three types are linked to diabetic coma:
 diabetic ketoacidosis coma
 Hyperosomolar coma
 Hypoglycaemic coma

5.  This is also normally known as insulin
dependent diabetic mellitus-IDDM
 It yield in the accumulation of ketone build-
ups due to insulin deficiency which then raise
the acidity of the blood
 It is linked to both types of diabetics i.e. type
I & type II

6. 1. Absolute lack of insulin- linked to type 1
diabetic
2. Relative Lack of Insulin
i. Acute illness
• Infection or other inflammatory process
• Myocardial infarction
• Stroke
• Trauma

7. ii. Endocrinopathies: Anti-Insulin Hormone
Excess
iii. Drugs
 Steroids
 Calcium channel blockers
 Pentamidine
 Beta-blocking agents
 Dilantin
 Alcohol

8. SIGNS
 Polyuria
 Polydipsia
 Weakness
 Lethargy
 Myalgia
 Headache
 Anorexia
 Nausea
 Vomiting
 Abdominal pain
 Breathlessness
SYMPTOMS
 Hyperpnoea
 Hypothermia
 Acetone breath
 Acidotic breathing
 Dyspnea
 Acute abdomen
 Dehydration
 Hyporeflexia
 Hypotonia
 Coma

9. This is due to the dehydration and the
exaggerated increase in blood glucose level
The increase in blood glucose level may be
due to:
 forgotten diabetic medications or insulin
Sugary food and fluids intake
Some diseases like flu and pneumonia

10.  This coma is due to low blood glucose level
usually less than 3.5 mmol/l
 It occurs in the diabetic patients who are on
insulin and certain other diabetics medication
like sulphonylureas:
 Takes extra dose
Exercise strenuously without taking extra food
Misses a meal (starvation)
Drinks too much alcohol

11.  Dull headache
 Fatigue
 Inordinate thirst
 Epigastric pain
 Nausea
 Vomiting
 Parched lips
•Flushed face, and
sunken eyes.
•The temperature
usually rises and then
falls.
•The systolic blood
pressure drops, and
circulatory collapse
may occur.

12.  Sweats
 Weakness
 Heart palpitation
 Intense hunger
 Confusion, drowsiness, altered behavior
especially when the blood glucose drops
down.

13.  Medical history
 Physical examination – the person may be
wearing an emergency bracelet identifying
their medical condition
 Blood tests – including tests for glucose and
ketone levels

14.  DKA is treated by
 Intravenous fluid
 Insulin and potassium administration
 Hyperosmolar diabetics can be corrected by
 Intravenous fluids
 Insulin, potassium and sodium infused as soon as
possible.
 Hypoglycemic diabetic: glucagon to reverse
the action of insulin or glucose administration is
urgent

15.  The preventive measures are to often :
¥ Take care of your meal
¥ Check your ketones when your blood sugar is high
¥ Keep an eye on your blood sugar level
¥ Take your medication as directed with your
physician
¥ Drink alcohol with caution
¥ Physical exercises

16.  http://medical-
dictionary.thefreedictionary.com/diabetic+coma
 www.betterhealth.vic.gov.au, Copyright © 1999/2015 State
ofVictoria.
 Fishbein HA, Palumbo PJ: Acute metabolic complications in
diabetics. In diabetics in America. National diabetics Data
Group, National Institutes of Health, 1995;p.283-291 (NIH
publ. No.95-1468).
 Kitabchi AE et al. Management of hyperglycemic crises
in patients with diabetics. diabetics Care 2001;24: 241-
269.