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Worried about Diabetic Coma - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Diabetes
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User :   My husband is 67 and has Type II diabetes 15+ years and coronary artery disease 25+ years. His diabetes has been uncontrolled for at least 2 years (A1C of 9.8 last year and 9.9 this year). He refuses to monitor except in the morning. We have recently switched insurance plans and are getting better education. He has been told to take his readings at least 4 times a day as well as to write down what he eats and what time he takes his meds. He uses Lantus (50 IU in the morning), Metformin (200 mg. I think, 2 tabs 2xday), and most recently, Afidra (10 IU with lunch). His readings have been all over the place -- 300 in the afternoon, and then he wakes up with lows -- 60 and under. He just came to bed and told me his reading just before coming to bed was 317. He fell asleep immediately. How do I tell if he goes into a diabetic coma while sleeping? I'm afraid to go to sleep for fear I will miss a sign that this is occurring. He refuses to go to ER.
Doctor :   Hi
Doctor :   I am Dr. xxx
Doctor :   Let me read the query
User :   Hello, Dr. ccc
Doctor :   Give me a couple of minute
User :   Okay
Doctor :   317 level would not generally lead to a Diabetic coma
Doctor :   yes ofcourse he needs to take care more to control his regular blood sugar levels
User :   Isn't this a dangerous level -- possibly leading to kidney damage and other damage? Also how would I recognize diabetic coma while sleeping, should his sugar go higher than 300?
Doctor :   The Diabetic coma is an acute emergency where the blood sugar levels shoots up acutely
User :   To what level would you consider acute?
User :   I was told to take him to the ER if it is higher than 300 but he refuses to go.
Doctor :   More than 400 to 450
User :   Okay, that has happened on occasion, so again, if he is asleep when this happens, how would I recognize coma?
Doctor :   Cold limbs
User :   Yes ...
Doctor :   Fast heart rate
Doctor :   Faster breathing
User :   Okay
User :   He breaths faster most of the time now, far more than usual, even when awake.
Doctor :   But yes your husband needs thorough education personally
User :   When he is sleeping he twitches and makes really strange sounds.
Doctor :   He needs to control his blood sugar to less than 140 values to be able to prevent complications in future
Doctor :   Ok
Doctor :   Is this a usual or recent finding?
User :   I realize that, but I'm just worried about how to recognize the signs of coma
User :   What, the twitching, etc? No, it has been going on for at least a year, and not every night.
Doctor :   Ok
User :   Also, we were told his blood sugar should be under 180, not 140 -- 2 hours after eating.
Doctor :   Ofcourse your doctor is right
Doctor :   But it is better to be less than 140 on most times
User :   Is this all?
Doctor :   yes as I told you keep observing these symptoms, non responsive behaviour
Doctor :   disorientation all these are signs
Doctor :   or early signs
User :   If he is asleep, he is going to be unresponsive unless I wake him up
Doctor :   yes
User :   These don't make sense for when a person is asleep.
Doctor :   But the faster breathing and faster heart rate makes sense
Doctor :   Moreover the blood sugar cannot peak after 4 horus
User :   Yes, but he is ASLEEP!!!! He will be nonresponsive unless I wake him!!!
User :   After 4 hours from what?
Doctor :   take it my word, if his average blood sugars are around 300
Doctor :   he cannot go into coma
Doctor :   Coma results only when there is a acutely rise in Blood sugar
User :   I know ... but it sometimes goes higher. HOW DO I TELL HE IS GOING INTO A COMA IF HE IS ASLEEP, WITHOUT WAKING HIM?
Doctor :   The goal or objective for you is not to think about the coma but to regulate the average blood sugar levels
Doctor :   You test his blood sugar
Doctor :   while asleep
Doctor :   if more than 400 and non repsonsive
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