What Is Behind Diabetic Coma?

Another fine article from Dr. Stephen Ponder, a T1 Endofrinologist.


Great artical, Thank You for posting!

Great article but I doubt if the number of lifetime lows of an insulin dependent diabetic is only around 5000, Over a mere 20 years that would be only 25 lows per year. I know I have more than one low every two weeks :slight_smile:


I really don’t like the term “diabetic coma.” It ranks right up there with “brittle diabetic.” Diabetic coma can either mean that you had a bad hypo or DKA or HHS. Before the discovery of insulin, when people died from diabetes, the most common death was “diabetic coma” and that is what was listed on the death certificate. People didn’t die from hypos. Today, things are totally different, mostly people with diabetes lose conciousness because of a hypo. And it is treated the total opposite. For the life of me, I don’t understand why do people still talk about diabetic coma.

I’m not familiar with HHS - can you spell it out?



Definition of a hypo seems quite fluid.

Witness the tuanalyze poll that found hypo rates that were astronomically high.

Perhaps the most stable was the DCCT’s definition of an “extreme hypo” as one that requires the assistance of another person.

A little more on hypo statistics from Tuanalyze. Note the extreme range of numbers - some report more than 100 “severe lows” per year and others report just 1. Strangely (maybe a flaw in the data collection?) there are no entries for “zero”.

That is the Hyperosmolar Hyperglycemic State, sometimes also called hyperosmolar nonketotic state (HNS), hyperosmolar hyperglycemic nonketotic coma (HHNKC) or hyperosmotic non-ketotic coma (HONKC). Essentially it is a diabetic coma driven by electrolyte imbalances and usually occurs in T2, where you have very high blood sugar levels, but where there is insulin present (which suppresses ketosis).

I’ll blame it on a low :slight_smile: but I just shouldn’t try to do even simple division at bedtime.


How was “severe low” defined for this poll? I agree with Tim that it should be “one you need assistance with” or would add in “one you are unconscious from” . The only low I’ve had that I would describe as “severe” was when I “came to” finding myself drenched in sweat and measured 38, but realized I’d been unconscious and lower. I had this experience when I first started using insulin (and didn’t know what I was doing) and as that was in februrary 2009, my answer to this poll would, in fact, be “zero”.

Yes, 5000 seems a bit low…

Just two months ago I was experiencing wicked lows, over and over. I adjusted basals, I:C ratios, etc…but it took a while to get things stable again.

At one point my meter told me that in the past 90 day period I’d had 101 hypo events (below 70). And that wasn’t even counting the ones at work where I didn’t test and was just drinking juice to bring me up, or the ones in the middle of the night where I didn’t test but was gobbling glucose tablets like a sleep-crazed maniac…

I also know that women with diabetes who are pregnant…can experience VERY MANY wicked lows…daily, or multiple times a day, for a trimester or more.

Dr. Ponder is a Facebook friend, and I asked him questions about the article. He must be a very busy man. He gives short little answers and answers the first question, but I don’t think he reads the whole message. He is a Pediatrician/Endocrinologist, and may not have much time for Facebook.