How to Help Someone in a Coma

Author's Sidebar: Every once in a while, I'll get a phone call or an email message from a person, who has a relative in the hospital in a diabetic coma. I can usually tell by the tone in their voice that they are desperate, afraid and uncertain what to do.

These types of phone calls are difficult, because there's nothing that I can do to help them. Usually, I suggest that the person make sure that they share as much information that they can about the person's health with the doctors and nurses. The more that you know about the person's health, the better it can help the doctors understand what is happening.

Another thing that I usually suggest is to keep a notebook or journal of what's going on and ask questions, but be respectful to the medical staff.

Use the notebook for taking notes when the doctors tell you things about the patient's condition, etc. Otherwise, you will never remember what was said to relay to other family members. When a large family is involved it gets tiring to keep repeating the same information -- so they can read your notebook.

Also, write down all the pertinent phone numbers and emails of people who would need to be contacted when changes in condition occur. There are usually a lot of people who want this information and having email addresses makes it easier than trying to call everyone.

Keeping notes is also a good way to keep busy. A journal may not only serve as a method for coping with grief, it may also be helpful for the patient when they come out of the coma -- to realize what happened to them. 

If the person has a smartphone or similar device, usually I'll suggest that they google phrases like "diabetic coma" to better understand what is going on.

If the hospital allows it, bring a small CD player or tape player and play some of the patient's music softly in the background. Bring up funny stories about the patient and encourage others to do the same. This will create an environment of happiness.

Another suggestion: If you have a lot of visitors, have a notebook available for everyone to sign-in. You may also want to keep a basket handy for all the cards. This information will be invaluable to the patient during his/her recovery.

Diabetic Coma

A diabetic coma is a medical emergency that is a reversible form of coma found in people with diabetes mellitus. 

There are 3 major types of diabetic coma:

  1. Severe Hypoglycemia with very low blood sugar
  2. Advanced Diabetic Ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion
  3. Nonketoic Hyperglycemic Hyperosmolar (NKHH)* coma in which extreme hyperglycemia and dehydration alone are sufficient to cause unconsciousness.

*Note: This is the type of coma that the author had.

The term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that he has diabetes.

An example might be a physician working in an emergency department who receives an unconscious patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify him as diabetic. 

An estimated 10 percent of diabetics will suffer from at least one episode of diabetic coma in their lifetimes as a result of severe hypoglycemia or hyperglycemia.

Severe Hypoglycemia

People with type 1 diabetes mellitus who must take insulin in full replacement doses are most vulnerable to episodes of hypoglycemia. It is usually mild enough to reverse by eating or drinking carbohydrates, but blood glucose occasionally can fall fast enough and low enough to produce unconsciousness before hypoglycemia can be recognized and reversed.

Hypoglycemia can be severe enough to cause unconsciousness during sleep. Predisposing factors can include eating less than usual, prolonged exercise earlier in the day, Some people with diabetes can lose their ability to recognize the symptoms of early hypoglycemia.

Unconsciousness due to hypoglycemia can occur within 20 minutes to an hour after early symptoms and is not usually preceded by other illness or symptoms. Twitching or convulsions may occur.

A person unconscious from hypoglycemia is usually pale, has a rapid heart beat, and is soaked in sweat: all signs of the adrenaline response to hypoglycemia. The individual is not usually dehydrated and breathing is normal or shallow. A meter or laboratory glucose measurement at the time of discovery is usually low, but not always severely, and in some cases may have already risen from the nadir that triggered the unconsciousness.

Unconsciousness due to hypoglycemia is treated by raising the blood glucose with intravenous glucose or injected glucagon.

Advanced Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA), if it progresses and worsens without treatment, can eventually cause unconsciousness, from a combination of severe hyperglycemia, dehydration and shock, and exhaustion. Coma only occurs at an advanced stage, usually after 36 hours or more of worsening vomiting and hyperventilation.

In the early to middle stages of ketoacidosis, patients are typically flushed and breathing rapidly and deeply, but visible dehydration, pallor from diminished perfusion, shallower breathing, and rapid heart rate are often present when coma is reached. However these features are variable and not always as described.

If the patient is known to have diabetes, the diagnosis of DKA is usually suspected from the appearance and a history of 1–2 days of vomiting. The diagnosis is confirmed when the usual blood chemistries in the emergency department reveal hyperglycemia and severe metabolic acidosis.

Treatment of DKA consists of isotonic fluids to rapidly stabilize the circulation, continued intravenous saline with potassium and other electrolytes to replace deficits, insulin to reverse the ketoacidosis, and careful monitoring for complications.

Nonketotic Hyperglycemic Hyperosmolar Coma

Nonketotic hyperglycemichyperosmolar coma usually develops more insidiously than DKA because the principal symptom is lethargy progressing to obtundation, rather than vomiting and an obvious illness. Extreme hyperglycemia is accompanied by dehydration due to inadequate fluid intake.

Coma from NKHC occurs most often in patients who develop type 2 or steroid diabetes and have an impaired ability to recognize thirst and drink. It is classically a nursing home condition but can occur in all ages.

The diagnosis is usually discovered when a chemistry screen reveals extreme hyperglycemia (often above 1800 mg/dl (100 mM)) and dehydration. The treatment consists of insulin and gradual rehydration with intravenous fluids.

Other Diabetic Complications

In addition to a coma, a diabetic may develop one or more of the following diabetic complications: retinopathy, nephropathy, neuropathy, stroke, or heart disease.

How You Can Help a Person in a Coma

When a patient is in an intensive care unit (ICU), family members and friends will all want to help. As a concerned family member or friend, here are some additional suggestions of things that you can do to help.

Ask the medical staff. Find a caring nurse to discuss ways that you can be involved in the daily care of the patient in the coma.

Be respectful. This is an emotional time, but don't get overly emotional, i.e. don't holler, argue, scream, etc. in front of the patient. Loving care from family members is important to the recovery process. It is also a positive way to spend time with the patient as well as a learning process for family members.

Keep a journal or notebook. This is VERY IMPORTANT. Have a notebook strictly for taking notes when the doctors tell you things about the patient's condition, etc. Otherwise, you will never remember what was said to relay to other family members. When a large family is involved it gets tiring to keep repeating the same information -- so they can read your notebook.

Also, write down all the pertinent phone numbers of people who would need to be called when changes in condition occur. There are a lot of people who want this information and not everyone can be called.

This is also a good way to keep busy. Also, you may capture something that could be important to the medical staff. A journal may not only serve as a method for coping with grief, it may also be helpful for the patient when they come out of the coma -- to realize what happened to them.

Keep a calendar or photo album. Keep a calendar or photo album next to the patient's bed. Make sure the calendar has pictures the patient might like. On each appropriate date, write significant dates, such as birthdays and anniversaries of people who are special to the patient.

Music and Laughter. If the hospital allows it, bring a small CD player or tape player and play some of the patient's music softly in the background. Bring up funny stories about the patient and encourage others to do the same -- this will create an environment of happiness. Make an audio or video recording of these happy times.

Phone helpers. Designated phone helpers can help to communicate status to others. For example, a friend who works at the patient's place of employment can get the latest news from you, and then send it to his distribution list on e-mail -- this will save you a lot of work!

Another notebook. If you have a lot of visitors, have a notebook available for everyone to sign-in. You may also want to keep a basket handy for all the cards. This information will be invaluable to the patient during his/her recovery.

Gift baskets. This is an excellent to help. Some ideas of gift baskets include donations of telephone cards, containers of quarters, mouthwash, nice soaps, shower bag, fruit, paid parking, a night's stay at a hotel just across from the hospital, bringing meals (hospital food gets really tiring), instant tea, notebooks for taking notes, people acting as a laundry service (i.e. picking up clothes).

Volunteers. There are so many things that your friends can do to help. For example, a volunteer can mow your lawn or shovel your driveway if you're spending most of your time in the hospital with your loved one.

After the crisis. You can still help even after the crisis is over. The road ahead is a long one. They will need you even more as others fade away, thinking the crisis is over. Rides to therapy or doctor visits, a day out away from home, visits from friends just because, invitations to dinner. Don't forget them or think you are intruding.

Invaluable! You may think this is a waste of your time, but all together, these activities comprise the chronicle of the patient's recovery, or at least his/her stay in the hospital. It reflects your emotions as a family, including your fears, frustration, anger, and joyful moments.

It shows how you bickered and strained under the stress, but ultimately pulled together and worked to support one another and to assist in the patient's recovery. It shows what the patient's friends and co-workers said and felt. It chronicles the patient's progress from bed-ridden and unconscious, with tubes and monitors, to his final trip home, and onward.

Educate yourself. Use this time to learn about brain injury. Families are encouraged to learn about brain injuries so they will be able to help the brain-injured person recover to the fullest extent possible.

Use your energy wisely. During the first few hours and days, most people are running on adrenaline. This may be the best time for you to deal with some of the issues surrounding the condition of your family member. There is not much you can do for the person in a coma at this point, most decisions are being made by the medical team, and taking action may help you to cope with the stress you are feeling at this difficult time.

Buy a book to add phone numbers. You will need to call employers, insurance carriers, friends, family, an attorney, etc. It is easier if you make this a separate book that you can check each day to remind you of phone calls to make. When you are exhausted with status reports, this book can serve as a guide that someone else may use to take over the task of informing family members and friends of the progress of the patient. It can be very exhausting to keep everyone updated in the first weeks.

Be sure and take notes during your calls. As you continue through the process of waiting, you may forget what you were told, or how you were supposed to follow up on the information you received.

Be positive when visiting the person in a coma. Every brain injury is unique. No one knows how much the person in a coma is aware of his/her surroundings. Some people remember very vividly what was going on around them while they were in a coma. Other people do not. Most people do not remember physical sensations while they were comatose.

Although most medical doctors don't agree with this, it is generally accepted that speaking positively while in the presence of someone who is in a coma is beneficial. Talking to them, telling them about your day as you normally would, reading cards that have been sent...these things help with recovery.

Always begin your visits with your name. "Hi, its me,____."

Occasionally the comatose patient can become agitated by too much stimulation; that's when its a good time to just sit and hold a hand.

When discussing the patient in their presence, always be aware that what you say may be heard. Never speak as if they weren't there.

A person emerging from a coma is disoriented. As soon as the ICU staff allows: Every day write the date in large letters on a large piece of paper. Tape this where the patient can see it. This helps to orient the patient.

Remember the recovery of consciousness is a gradual process and is not just a matter of "waking up" as people often imagine.

Take care of yourself. You will not be helping the patient by becoming ill yourself. Your loved one is in the care of a trained medical team. No one can predict the rate of recovery, so it is important that you try to return to a routine that is as normal as possible.

Accept help from friends and neighbors. Often people in your situation feel uncomfortable about accepting help from others. By accepting help from those who offer, you are allowing them to take some action; to do SOMETHING. If someone asks what they can do to help, don't be afraid to ask for simple things like babysitting one day or bringing a meal. Your life at home may feel slightly overwhelming at this time, so allow friends and neighbors to help.

Remember: You are not alone.

For more information about how to help someone in a diabetic coma and how to avoid a diabetic coma in the first place, refer to the follow web links:

  • Death to Diabetes Blog
  • https://en.wikipedia.org/wiki/Diabetic_coma
  • https://en.wikipedia.org/wiki/Diabetic_coma
  • http://intensivecarehotline.com/clinical-pictures/diabetic-coma/

 

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Copyright © 2016. Death to Diabetes, LLC. All rights reserved.