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How would this change be defined? Would it be defined differently by those who have Asperger’s Syndrome as opposed to the Neurotypicals in their lives? Who is it that wants change? Who is it that expects change? Who is it that is conditioned to think not being able to fully change something means that all change is impossible? And, it is so important for people to realize that not all things deemed as needing some change equal an inability to change. More often than not, this “inability to change” is an illusion because of where the want for change comes from versus what is a different ability. How do you assess the difference between change based on one set of standards versus a different ability that brings with it meaning and a different ability to function and contribute differently.

Why, do you think, is there such focus on Asperger’s Syndrome in terms of those diagnosed with it as not having ability to change? What is the message taken out of this fact, granted, but focusing extensively or even exclusively on this fact?

Does focusing on the reality that people with Asperger’s Syndrome (AS) will always have it leave room for hope? If so, what do you think that hope is for? What could that hope be about?

While it is true that AS is not something that one can recover from, or stop having somehow, that does not mean that people with AS cannot continue to learn and develop new skills, coping skills and/or compensatory skills – they absolutely can.

Now, of course, not everyone with Asperger’s is exactly the same at all. This means that how each person with AS will think about or even be aware about wanting and/or needing to learn new ways of coping and compensating will vary. And, while not a statement set in stone, it does appear, from my experience, as a Life Coach, a person with Asperger’s Syndrome, and a person who communicates with many with AS and has read a lot about it, that among all the variables and differences in the ways that all of us with AS manifest it, gender differences seem to have led many to conclude that the way that Asperger’s effects males isn’t the same way it affects many females. Tony Attwood mentions this in his book, “The Complete Guide to Asperger’s Syndrome.” So this isn’t just me speculating.

For those of us diagnosed in adulthood who didn’t have any way to have early intervention or support like aspie children do today, we have to be creative with how we go about coping and compensating. In most areas of the world there aren’t even services for adults with Asperger’s – as if today’s aspie kids won’t be tomorrow’s aspie adults joining the rest of us in this abyss of sorts.

I have come to realize in my life and my journey with Asperger’s Syndrome that there has been a lot that I have continued to learn. I have pushed my own limits and in many ways still do. I think, initially, after being diagnosed at the age of 40, in 1997, I was trying to get rid of AS – as if eh?

However, for the last many years or so it’s really been much more a journey of gratitude for me. Gratitude for all I have continued to learn and compensate for mixed with an ever-deepening radical acceptance of the paradox of Asperger’s. A paradox that sees AS being both challenging and a blessed-giftedness as well. I continue to experience this rich and profound paradox of what AS seems to take from me, at times, or impose on me at times, and all that AS gives to me, blesses me with most of the time.

Hope lies within this radical acceptance and self acceptance. It lies within the re-framing of society’s penchant for pathologizing difference. Society defines Asperger’s as a disability. I experience it as a different ability. It’s a matter of how we think and what we choose to think about it. In fact, most people I’ve ever talked to and know now or have known who have Asperger’s, like me, wouldn’t want to get rid of it even if they could. Most don’t want to be “changed” to what the masses consider “normal.”

There is no such thing as “perfectly normal.” There is no “everyone else” out there to be like. Who “everyone else” is really just depends on how a group of people think and/or what they value. All-too-often this comes down to sameness. If people are different from what your “normal” is or the ways that you share certain characteristics, ideas, values, and the like in common, you may, even without realizing it, believe that anyone with any differences from your “normal” needs to change to be like you. My question to you is, why?

The focus of neurotypicals (NT’s) and society in general on pathologizing our differences leads to what I would say is an over-focus on what is labelled an inability to change. Who is it that is wanting all of this change? Is it those of us with AS or is it society and neurotypicals who seem to think that just because we are not “like” them – poor-us-kind-of attitude?

It is from this realization that I continue to hope that parents of today’s AS kids, with their interventions, services and so forth, aren’t hoping to change their aspie kids from aspie kids into neurotypical kids. Because that is the one comparison, the one unrealistic expectation that likely is responsible for such focus on how AS is in the hard-wiring and how it cannot be changed. It is a value judgment that serves no one. It is a value judgment that leaves those with AS or other Autistic Spectrum Disorders in what is considered a “less than” place in life. If you are neurotypical how can you really make that judgment when you don’t know what it is like to have Asperger’s? Can you really make a well-informed judgment about that?

However, paradoxically, even that which cannot be changed cannot fully limit some change, development, and continued learning. We must be careful not to judge that change or to quantify it based upon neurotypical expectations, value judgments or comparisons.

The paradox of an inability to change in an of itself, from the inside out, for this adult with Asperger’s, is realized as an on-going active and engaging invitation to not invest in or attach to expectations that others want to put upon me. It continues to be a challenge for me to nurture my own nature, regardless.

Change, on-going development, and continued learning that takes place within a positive framework from an awareness and practice of radical acceptance for what is grants a freedom for, and comfort with, difference that does not fight against itself. Once we give up that fighting against self because we are often reminded that we are not like the masses, so to speak, we can arrive at a positive and healthy self-acceptance.

Sad to say that many young adults neglect to have their blood work done at least once a year. Probably until they have this burdensome feeling, then that’s the time they see a physician. Without them knowing, their cholesterol level had actually skyrocket. This can be a turning point when they set out to be more conscious of their diet. However, for some people, it may be too late to lower cholesterol normally. As an alternative, their doctor may have to order a medicine to help reduce their cholesterol levels.

As a general rule, anything that’s consumed in excess is most often dangerous to us. Same thing applies to the cholesterol quantity in your body. If you’re not particularly interested in the nutrients of the meals that you eat, you may lose tabs on the quantity of cholesterol you’re taking in your body. Obviously, it’s absurd that you calculate the cholesterol in the food you eat. By far the most practical and precise method to have your cholesterol administered is actually getting a fat profile test every now and then.

The cholesterol levels are different from person to person. Age, lifestyle or diet plan cannot be the sole basis of a person’s health. There are people who seem to be in top shape and are leading a healthy lifestyle but on the contrary they nurse some cholesterol problems. On the other hand, it is also possible for a couch potato to be in the pink of health despite his lousy lifestyle. Thus, you cannot really judge a person’s health condition based on his physical attributes alone. Generally, factors that may affect a person’s heart condition are his genes, his lifestyle habits, or his eating habits. When you are investigating the root cause of a health problem, you can eliminate the causes one by one.

As you check your cholesterol level, it’s also extra helpful if you know and comprehend the cholesterol level chart. It doesn’t mean that you will not have your physician interpret the results but with some knowledge you get to understand your health status as well. Based on the total cholesterol level chart, if your cholesterol range is somewhere below 200, then that simply indicates that you are spared from the risk of acquiring coronary diseases. However, if your cholesterol range is between 200 to 239, then that is considered as borderline high. Meaning, there is a possibility that you will develop heart disease. Lastly, if your cholesterol level fall between 240 and above, then you will just double the risk of acquiring heart disease.

The chart does not mean to scare you. It only serves as your guide in keeping a healthy heart.

If your cholesterol numbers are high, they got there for a reason. In this article, I’d like to discuss the purpose and function of cholesterol in your body, and the reason why cholesterol levels get high. When you understand this, you will better understand what foods you need to avoid.

First, what is cholesterol?

Cholesterol is a white sterol (alcohol) found in most of our cells. It is an anti-oxidant, protecting your body from dangerous free radicals. It helps in our digestion, plays a role in dealing with stress, and is used by the body to repair damaged arterial walls. It is found in the foods we eat (mother’s milk is very rich in cholesterol!), and is also produced in our bodies by the liver.

When the body is weakened by damaged arteries or damaged intestinal walls, cholesterol is the material the body uses to fix them. It’s a repair substance that acts like putty to mend a hole in the wall, or to strengthen a weak spot. When it accumulates in one or more spots, it can easily restrict the flow of blood. The result is higher blood pressure and risk of blockage.

But what causes blood vessels to become weak and in need of repair?

According to Dr. Beiler, “fats do their greatest harm to the body when they are used as shortening or cooking oil, that is, when they are heated with other foods, especially the starches. Fried bread or potatoes, doughnuts, hot cakes, pie crust, cakes and pastries – all offer altered cholesterol. And when you eat these highly regarded confections, the result is imperfect artery lining, erosion of the arteries, atherosclerosis. The greatest offenders are doughnuts and potato chips…”

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• Polyunsaturated fats ( most vegetable oils) are particularly susceptible to heat because of their unsaturated bonds, and are likely to form free radicals in the presence of high heat. Their outer rings have empty spaces (thus the term ‘unsaturated’), and react readily with other compounds.
• Hydrogenated or trans fats are created by taking polyunsaturated oils (usually), subjecting them to even more intense heat and pressure, mixing them with tiny metal particles, gassing them, emulsifying them with soap-like substances, and finally steam-cleaning them. This produces a product that is even more toxic to the body – one that the body does not recognize.

Both polyunsaturated and hydrogenated oils tend to become rancid when exposed to heat, and the free radicals that result can injure the arterial walls as well as precipitate the buildup of plaque. This creates an environment in the arteries that calls upon cholesterol to fix and maintain the arterial walls.

If you have high cholesterol, first realize that cholesterol rich foods are not necessarily the cause of high cholesterol in your blood. Cakes, cookies, French fries, potato chips, margarine, and other foods made with polyunsaturated or hydrogenated oils are much more likely to create havoc with your arteries than butter or animal fats. Remember, cholesterol in your blood is there to protect it; if it’s too high, it’s because chemically altered processed foods have rendered your arteries unfit, and cholesterol has responded to prevent a blowout.

There are many different kinds of autism symptoms. Some are more severe than others. Some are less understood than others. Some of the more unique autism symptoms have to do with intellectual quirks, such as hyperlexia and special interests.

Child

Many kids with autism tend to be quite smart. Autistic children with high IQs may be classified as having Asperger’s syndrome (a form of high functioning autism). As we know, autism is a spectrum disorder, so there will be kids who have autism and have extremely different abilities and backgrounds and each can exhibit different autism symptoms.

Hyperlexia – a Unique Symptom of Autism

Not everyone will have the autism symptoms described in this article. But many will. Many kids with autism have something called hyperlexia. It means that they can recognize letters and words, and read, by a very early age, often by 2.

Kids who have hyperlexia don’t understand what they are reading, but they love reading. They read everything they can get their hands on. They are the type of kids that will read every sign, every label, and every package because of their love of language.

Comprehension is Often a Problem with Hyperlexia

The problem with hyperlexia is that while it looks pretty neat on the outside to have a 2 or 3 year old reading books, it becomes a problem later on when they struggle with the comprehension of what they are reading. This unique ability to read above age level but not comprehend what is being read is a classic autism symptom.

A young child with autism may “read” a book, but they can’t break it down into smaller parts or understand the parts of language or rules of grammar that make up it. They can echo lines from the books they read, often long complicated sentences (also called “echolia”), but forming their own original sentences is often much harder.

The autism symptom, Hyperlexia, in many ways is like skipping the basic rules of language to go to the more advanced ones – but without ever mastering the basic ones that you will need for all future lessons.

Special Interests are a Common Autism Symptom

Most kids with autism also have special interests. There are certain subjects that they are fascinated with and will remember every obscure detail about. It might be dinosaurs, fire trucks of World War II – and your child’s mind will be a like a sponge for every piece of information out there about this topic.

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The autistic child often has a great memory for details. Remembering numbers and dates come easily to them. This amazing ability to remember obscure details is a common symptom of autism. Because of this, some will refer to those who exhibit this autism symptom as “walking encyclopedias.”

Kids with autism will often get very absorbed in what they are doing, especially when it pertains to their special interests. They are hard to interrupt and may even seem to lose track of the world around them.

These Autism Symptoms May Help with Future Employment

While these autism symptoms have the unfortunate effect of isolating them from their peers when they are younger, when they are older these traits can be helpful. In the work world, the knowledge, dedication and loyalty people with autism show can be a boon in certain fields and under certain conditions. Special interests, hyperlexia and other intellectual quirks are just some of the many autism symptoms that you may find in your child.

The bronchial asthma refers to the reversible airway obstruction which is caused by an inflammation of the airways. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night and early morning.

Acute bronchial asthma in adults
The application of the guidelines on the treatment of acute bronchial asthma assumes you have been diagnosed with asthma after excluding other differential diagnosis in pathological situations such as:

1. COPD exacerbation;
2. congestive heart failure;
3. pulmonary embolism;
4. mechanical obstruction of the airways;
5. laryngeal dysfunction.

The asthma exacerbations (acute asthma) are a marked, often progressive worsening of asthma symptoms and bronchial obstruction, which appear in the space of hours or even days and can last up to weeks. The goals of treatment of asthma attack are:

1. The answer to the bronchial asthma as soon as possible.
2. Plan for preventing future recurrences.

The severe asthma attack is a potentially fatal situation. Therefore, once diagnosed, treatment should be started as soon as possible. The therapy differs depending on the severity of the crisis and therefore it is necessary to advance a rapid assessment of severity, which is essential for detecting a range of symptoms and signs, and some objective parameters of respiratory function and oxygenation status of the patient. The assessment of respiratory function by measuring the PEF (peak expiratory flow) is easy to perform and can be made by the patient at home. The management of asthma attack should include:

1. Early intervention: It is important that the patient be educated to recognize the severity of asthma in early action at home and seek medical attention when necessary.

2. Appropriate drug treatment: The cornerstone of treatment of asthma attack are as follows:-

• Repeated administration of rapid acting beta2-agonists
• Early introduction of systemic corticosteroids
• Correction of hypoxemia

3. Monitoring the patient’s condition and response to treatment. Monitoring must be done through assessment of symptoms and objective parameters (repeated measurement of lung function).

Home treatment of asthma attack
The home treatment is possible for the less severe asthma attacks, defined by level of symptoms and possibly as a reduction of PEF below 20%, presence of nocturnal awakenings, and increased use of beta2-agonist bronchodilators in the short duration of action.

Action Plan
Each patient must have a written action plan based on symptoms and possibly also on the measurement of PEF, which determines how to recognize signs of deterioration and to assess the severity of the crisis, when to modify or improve the treatment and require specialist care when appropriate. This allows you to initiate appropriate treatment for early signs of deterioration with a greater chance of success.

Pharmacotherapy
The first use of drugs are fast acting beta2-agonists: salbutamol spray 2-4 puffs (200-400 mcg) every 20 minutes for the first time with a spacer (or salbutamol 100/150 micrograms / kg max 5 mg in 2 – 3 ml of saline via nebulizer). At constant dose, the use of a pressurized aerosol with spacer (if the patient is able to use it) is able to achieve the same improvement as with the nebulizer.

After the first hour, the dose of rapid-acting beta2-agonist depends on the severity of the crisis: 2-4 puffs every 3-4 hours for one or two days in severe asthma and in the most serious crises it can take 6-10 puffs every 1-2 hours.

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If the patient improves rapidly and if the PEF values increased to above 80% predicted or personal best and improvement persists for at least 3-4 hours, no other therapy is needed. Otherwise, you may want to add oral corticosteroids for 4 to 5 days to expedite the resolution of the crisis. It is a careful patient monitoring and prompt delivery to the hospital in case of no response.

Directions for immediate hospitalization
The patient should be hospitalized if:

1. Patient is at high risk for fatal asthma.
2. The exacerbation is severe (the patient has significant symptoms, does not improve after the first dose of medication, PEF is below 60% predicted or personal best after treatment with beta2-agonists).
3. The response to beta2-agonists is not quick or sustained for at least 3 hours.
4. There is no improvement after 6 hours of treatment with systemic corticosteroids.
5. There is further deterioration.

Hypertension is a word that is used to describe a medical condition of high blood pressure, which is a measurement of the force of blood against the walls of your arteries when blood is pumped throughout the body. The readings are measured in millimeters of mercury (mmHg). This reading is given in two numbers – for example, 120 over 75 (120/75 mmHg).

− The first number is your systolic pressure and it can be dangerous if this number is above 140.

− The second number is the diastolic pressure, which is considered high if it is over 90.

You can have hypertension if the diastolic pressure is between 120 and 139 and the systolic pressure is between 80 and 89. The likelihood of hypertension increases if you have a history of heart or kidney problems. In such cases, your blood pressure needs to be maintained even lower than people who do not have these conditions. The risk of high blood pressure increases if you are obese, or you have diabetes or you are a smoker. Recent research shows that being an African American also increases your risk of developing hypertension. A proper cause is not identified in most of the cases and this is known as essential hypertension.

This condition can be caused by other medical conditions or by intake of certain medications and this is known as secondary hypertension. This type of hypertension could be because of alcohol use, atherosclerosis, chronic kidney disease, cocaine use, and diabetes. Some medications that cause secondary hypertension are corticosteroids, birth control pills, appetite suppressants, and migraine medications. Some of the common symptoms of this condition are confusion, fatigue, nosebleed, ear noise, vision changes in and ear buzzing. If you are suffering from severe headache or any other symptoms mentioned above, you should call a doctor immediately.

Various medications and therapies are available on the market for the treatment of this condition but only a few of these drugs and therapies are effective.

• One of the medications that is not only effective but also safer than others is Ramipril. This prescription medication is used for the treatment of congestive heart failure and high blood pressure. It belongs to a class of medications known as ACE inhibitors. Just like other drugs, Ramipril also has some mild side effects but it is not necessary that you will suffer from side effects if you use it. Always use this drug as prescribed.

• Amlodipine is also an effective medication that helps in the treatment of this condition. Amlodipine is a medication that works by relaxing blood vessels and improving the flow of blood in the body. Other than hypertension, this drug is also used for the treatment of coronary artery disease. Do not use this drug if you have a liver problem or congestive heart failure. Intake of alcohol can increase the side effects of this drug and it is best to avoid consumption of alcohol when you use this drug. Always consult a doctor before using any drug for the treatment of high blood pressure.

You are in the grocery store making a purchase and suddenly your child who has autism, displays the loudest tantrum you ever heard. There you stand in shock and with embarrassment from this outburst. Your child needs a meltdown. But how?

Has this ever happened to you? You know you must deal with this tantrum and give your child a meltdown.

Having a child who has the disorder of autism is extremely challenging, when an outburst of a tantrum occurs.

If you have other children or are aware of other children, who are not autistic, a high percentage of those children who are under five years of age, usually have tantrums and outbursts. But, these tantrums usually can be stopped or corrected.

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When a child with the disorder of autism, displays tantrums, you want to calm him or her down with a meltdown.

It can be difficult and challenging to calm your autistic child down and control his or her behavior.

Before you decide to take your child out in public places, prepare yourself that tantrums might happen and you must give your child a meltdown to stop the aggression and frustration.

In addition, you need to understand why the tantrums are happening.

If a tantrum happens when you are in public, I found the best thing to do is to solve it. Try and communicate with your child by making firm eye contact and say the word “NO.” Be very firm with that word.

If your child does not understand what “NO” means, try to use visual cards with pictures on them or create visual meaning, use expressions of signs and symbols, signals for your child to relate to. Such as the word calm down, quiet, not so noisy, do not push or shove, do not throw objects, no screaming, etc.

I have discovered if you know your child will have an outburst, try to distract your child from that problem.

There may be times when you will want to carry pictures, certain toys, music, books, stuffed animals to offer a diversion from the tantrums and outbursts.

I knew a mother who had a cart full of groceries and her child had a tantrum. She had no choice but remove her child and herself from the premises. She had to discipline and give her child a meltdown.

To solve tantrums and outbursts, you may have to stop what you are doing and let your child know, enough is enough, you as parent(s), caregiver(s), are in charge. His or her behavior must come to a halt. It must stop. A meltdown should be given.

In the future, if you find your child is having the tantrums and meltdowns when you are planning the same routine, evaluate what is causing his or her tantrums?

A usual human disorder that strikes a lot of persons as they get older is drop in eyesight clarity or better still vision loss. Nearly all persons who are more than the age of 40 encounter some kind of eyesight problem. Strain on eye muscles that are delicate or an inappropriate flow of blood to the retina can make your vision to worsen. The use of herbal supplements may enhance retinal worsening and can aid to hinder various kinds of eye problems.

The herbs you will need to improve your eyesight are namely passionflower, mahonia grape extract, bilberry, goldrenseal, aspalathus and ginkgo biloba.

When you consume a supplement rich in bilberry extract, its antioxidant compounds will aid to shield your retina from eye problems. Bilberry is a berry which is black and blue in colour and it has anthocyanosides. It also aids to enhance improper vision at night if the disorder is occurring as a result of lack of peculiar coloring pigments which the eyes need to function effectively. It is essential to bear in mind that bilberry functions as a preventive solution instead of a remedial solution.

You need to utilize ginkgo biloba to enhance your retinal impairment together with the rest of other body problems like tinnitus, amnesia (loss of memory) and inadequate circulation. It deals with present problems associated with retinal impairment and functions as a preventive herb by enhancing the movement of blood and nutrients to the retina.

Consume passionflower which is in supplement form if you encounter steady asthenopia (strain of the eyes). It is a chilling herb that aids to make the little blood vessels of the eyes to relax. Some persons also use these herbs as a remedy to restiveness and sleeplessness.

You have to begin to take goldenseal. It can help to solve eye problems known as pinkeye and hordeolum. It is a very powerful herb that assists in lowering rubor.

Another herb to take for eyesight improvement is aspalathus. It is a strong herb gotten from the republic of South Africa. It has antioxidant which is a bit related to bilberry. This herb can enhance your current eye condition for good together with the improvement to your immune function.

UV radiation and the sun harm our eyes heavily. You can make use of extract from mahonia grape to restore the negative effect UV radiation and sun rays has had on your eye. It can also aid to tone up the capillary vessels in the retina. It can lower the natural worn-out of the eyes and assist in preserving your eye health.

Diabetes management is a way by which every individual controls diabetes to avoid its further complications. Nevertheless, for it to be effective, one needs to be up and doing. The first thing that must be established is the fact that one is really living with the disease as well as the extent of damage this ailment has done to the body. This will enable such a person to know where to start from. Therefore, one needs to consult his doctor for medical check up where various tests will be conducted. It is the outcome of the tests being conducted that will determine diabetes management required.

Diabetes management is not as easy as you might think particularly if you are the type that cannot keep your eyes off junk and processed foods. Therefore, for effective diabetes management, you must embrace healthy diet. Identified below are some other diabetes management tips you can use to prevent yourself from diabetes.

1. The first tip is that you must steer clear of unhealthy eating and lifestyle. People cannot discipline themselves any longer as far as eating habit is concerned. Unhealthy and junk foods must be avoided as much as possible. Some processed and fast foods are unhealthy and must be avoided.

2. Try as much as possible to do exercise regularly. Have and maintain a regular exercising routine that will clean the cells and assists in the circulation of blood.

3. Eat more raw vegetables, beans and fruit. This will help a lot as they contain vitamins, fiber and protective antioxidants which help to reduce the risk of heart disease and ensure healthier blood circulation.

4. Drink plenty of water and other healthy liquids often. However, sugary drinks must be avoided because they can make blood glucose to rise very quickly and be difficult to control.

5. In your diabetes management, avoid too many salt and salty foods.

6. Always supplement with balanced diet and herbal remedies.

7. Avoid eating too much meal at a sitting. Take small quantity at regular intervals.

8. Take high fiber diet high fiber diet is good for children with juvenile diabetes otherwise called type 1 diabetes. Taking 60 grains of fiber daily will ensure stable blood sugar among children.

9. Cut back on saturated fat. Too much of this can raise cholesterol levels and the risk of heart disease and stroke.

Diabetes management is necessary to avoid further damage and after effect of diabetes. However, this will be effective if you can maintain healthy eating habits. Also, for it to work, you must be self disciplined to take your mind and eyes off junk and processed foods. Nevertheless, follow the above tips strict for efficient and successful management.

What is a diabetic coma?

It is a medical emergency and an acute life-threatening event that occurs in people with Diabetes Mellitus.

What causes a diabetic coma to occur?

1. diabetes that is undiagnosed
2. failure to take insulin as prescribed
3. treatment that is not adequate
4. infection
5. surgery
6. trauma
7. stress

What happens with a diabetic coma?

There is not adequate insulin to metabolize glucose so fats are used for energy. When these fats are broken down it causes ketone waste to build up causing metabolic acidosis. The body attempts to react to counteract the state of acidosis. What happens is that the alkali reserve is depleted causing water, potassium and sodium chloride to be lost. The respiratory rate increases, in a process called kussmaul breathing, as the body attempts to blow off excess carbon dioxide that will eventually cause hypoxia. Urinary excretion is also increased leading to dehydration.

What are the warning signs and symptoms of a diabetic coma?

1. headache that is dull
2. fatigue
3. thirst
4. nausea/vomiting
5. epigastric pain
6. facial flushing
7. lips are parched
8. eyes sunken
9. increased body temp to begin with then decreased
10. drop in systolic blood pressure
11. circulatory collapse

The treatment for a diabetic coma includes the immediate administration of short-acting insulin and replacing electrolytes and fluids to counteract the acidosis and dehydration.

There are five types of diabetic coma a person with diabetes must be aware of

1. Diabetic Ketoacidosis (DKA; Diabetic Coma)

Diabetic Ketoacidosis occurs when there is a severe increase in blood sugar associated with poorly controlled diabetes. As a result there is an increase in the metabolism of fat and protein for energy sources. When fats are metabolized this results in the production of fatty acids that are converted into ketone bodies. An increase in the number of circulating ketone bodies leads to acidosis. This occurs mainly with type 1 diabetics. The onset can be rapid or over several days. This can be caused from stress, surgery, infection, or lack of insulin control.

With DKA (diabetic ketoacidosis) there is severe hyperglycemia 300 to 1500 mg/dl. DKA is often caused due to infection, emotional stress, fever, increased food intake, pregnancy or inadequate insulin dose. Hyperkalemia (increased potassium), metabolic acidosis, weakness, thirst, urine ketones and sugar are increased, nausea, vomiting, diarrhea, fruity breath, kussmaul respirations, abdominal pain, level of consciousness decreases, confusion increasing to coma, skin will be warm dry and flushed. Kussmaul respirations are very deep respirations that occur as the body attempts to blow off carbon dioxide.

Heart rate will be increased. Urine output is increased. Due to the dehydration there will be an increased body temp, polyuria, polydispia, weight loss, dry skin, sunken eyes. Large amounts of ketones will be in urine and serum Ph will be below 7.25 (acidotic). Hematocrit will be high due to dehydration. BUN and creatinine will be elevated due to dehydration. DKA occurs in all age groups with primarily type 1 diabetes but can occur with severe distress with type 2 diabetics. If left untreated DKA leads to coma and death.

2. HHNC – Hyperosmolar Hyperglycemia Non Ketotic Coma

This is a condition where there is enough insulin produced to prevent the breakdown of fat but severe hyperglycemia occurs. HHNC can be caused by infection, diarrhea, vomiting, failure to comply with dietary and medication regimen, stress, prolonged exposure to drugs that induce hyperglycemia such as steroids or poor fluid intake. In the absence of the acidotic state there is a severe dehydration and electrolyte imbalance. With HHNC hyperglycemia ranges from 700 to 2000 mg/100dL. This is seen mostly with geriatric type 2 diabetics. Because the body is able to maintain a very low level of insulin production this keeps the fat from being broken down resulting in ketone bodies and acidosis.

What does happen is osmotic diuresis because of the hyperglycemia causing the patient to become dehydrated quickly. HHNC will present with skin that is warm and flushed, lethargy, decreased LOC ( Level of Consciousness), weakness, thirst, increased body temp due dehydration, hematocrit will be high due to dehydration, increased heart rate, hypertension ( increased blood pressure), hyperglycemia, increased urine output, and glycosuria. BUN (Blood, Urea, Nitrogen) and creatinine levels will be increased. HHNC occurs often in elderly people that are undiagnosed type 2 diabetics. Elderly are also at a greater risk for dehydration due to their altered thirst perception.

As the patient becomes acidotic potassium moves out of the cell leaving the cell depleted of potassium, serum potassium remains normal due to the excessive excretion. With the hyperglycemia/hyperosmolar state osmotic diuresis is the result causing the serum potassium to be excreted. With dehydration the serum potassium becomes concentrated and does not show the loss of cellular potassium. When the acidosis and osmolarity are corrected and insulin is given the potassium will shift back into the cells causing hypokalemia (decreased potassium) to occur.

3. Exogenously induced hypoglycemia (insulin coma)

This occurs when the blood glucose level falls below 60 mg/dl. This can be a side effect of insulin therapy or hypoglycemic medications taken by mouth. It can occur when a meal is skipped, diabetic patient takes too much insulin, vomits a meal, or is over exercising. The signs and symptoms that are seen are a result of the sympathetic nervous system being stimulated or due to the reduced supply of glucose to the brain. What will be felt by the patient is muscle weakness, diplopia, feeling faint, tingling and numbness of the fingers lips and tongue. What will we be able to see? Diaphoresis, shaking, increased heat rate, and confusion. The patient should be given glucose orally if alert. Glucagon may be given intravenously to stimulate glycogenolysis. Patient maybe given 50% dextrose via IV if necessary.

4. Endogenously induced Hypoglycemia (Reactive Hypoglycemia)

Blood glucose falls below 60 mg/dl. This is caused by an overproduction of insulin or an insulin-like substance. This maybe caused by a tumor with the ability to produce insulin, or an autoimmune disease. This can be brought on by the under production of glucose due the hormonal deficiency including ACTH, glucagon and catecholamine’s. This can be the result of liver disease or brought on by drugs such as alcohol, propranolol and salicylate’s.

Depending on the cause the patient may need surgery to remove the insulin producing tumor, diazoxide therapy to suppress insulin production or hormone replacement to correct deficiencies. Patient should discontinue drugs that cause hypoglycemia. If possible correction of liver disease will also mitigate this condition. Patients should eat a low carbohydrate diet with high protein and avoid simple sugars and fasting.

5. Reactive (functional) Hypoglycemia

Reactive Hypoglycemia is due to rapid gastric emptying and often occurs after gastric surgery. This rapid gastric emptying stimulates the production of excessive amounts of insulin resulting in a low blood sugar. The patient will feel anxious, irritable, weak, fatigued. You will be able to observe hypoglycemia, pallor, and diaphoresis. Rapidly absorbed sugars should be avoided. Frequent meals are helpful. Patients who experience reactive hypoglycemia should increase protein, complex carbohydrates and fiber due to their ability to slow gastric emptying and slow glucose absorption.

A diabetic coma is a life threatening condition that needs to be dealt with quickly. Knowing the signs and symptoms is the first step to preventing this deadly occurrence.