Diabetic coma is life-threatening

In this state, absolute insulin deficiency exists. Loss of consciousness occurs as a result of dehydration and overacidification of the blood. The diabetic feels jaded and tired; has a great thirst and passes large volumes of urine. Nausea, vomiting and abdominal pains occur. The diabetic's breath smells of acetone; immediate admission to hospitals is necessary.

If coma occurs, irr.mediate admission to hospital is required

This severe metabolic breakdown can c about in various ways:

• if you on your own initiative interrup' . therapy with insulin or tablets
• if the prescribed diet is not observe
• when an infection or other severe second illness occurs.

Whereas hypoglycaemia occurs quite suddenly, the warning signs for hyperglycaemia appear gradually; thes· also become obvious to persons arou~ the diabetic. Above all, danger threate~ when the breath of the diabetic smells acetone (similar to overripe fruit).

The smell of acetone is a serious warning signal!

You can, however, do something decis to reduce this type of danger. Check y( metabolic state at home regularly. In th way you can give the doctor important information.

Self-monitoring is important

Your doctor only sees you at lengthy Intervals. He should, however, be able to follow the stabilisation of your diabetes in every-day life in order to be in a position to make changes if necessary. Your self­monitoring helps both you and your doctor to find the best possible stabilisation for you

Self-monitoring = the pre-requisite for good diabetic control

With test-strips, which are very easy to use, every diabetic can test his urine fa sugar and acetone at home. I nspecial cases there is also the possibility of checking the blood sugar by means of test-strips. The doctor will advise you as which test-strips to use, but:

Self-monitoring cannot replace the doctor

When checking the excretion of sugar urine you must remember that sugar de not appear in the urine until the blood sugar has exceeded a certain level (9-10 mmol/ I). This critical point is calll the "renal threshold". Hence, if there is sugar in your urine, then your blood SU( is also in the pathological range alread.

If sugar appears in the urine, then VI blood sugar is too high!

By regular self-monitoring, you can noli metabolic decompensation at an early stage and consult the doctor in good time

How often should you examine your urine for sugar?

This is dependent upon the severity of your diabetes and the type of treatment you are receiving. If you are stabilised on tablets and the blood sugar is well controlled, then you do not need to test so often. Diabetics stabilised on insulin-in which the blood sugar value often vary greatly-should regularly test their urine for sugar. Your doctor will give you exact instructions as to the times of the day at which the test is necessary.

The frequency and time of the test is decided by the doctor

You can also test your urine with a teS strip for acetone. This becomes necessary when the urine sugar has b! found to be very high several times in succession. If you also find acetone in your urine, this is a warning signal; go t the doctor.

When high urine sugar values and acetone are present-consult the doctor immediately I

In particular cases it may be necessa~ the diabetic to determine his blood SU~ himself. For this purpose, there are simple to-use blood sugar test-strips which sh within a few minutes whether the blood sugar has perhaps fallen too greatly (hypoglyceamia) or-perhaps triggered an infection--:-has risen too greatly.

Blood sugar test-strips help in particular situations

Should you .be one of the diabetics in whom stabilisation is difficult despite a precisely kept diet, the correct way of and exact self-monitoring of urine SUgi then your doctor will check to see wh! self-monitoring of the blood sugar is indicated for you. This involves not on single blood sugar determination during in the day, but a daily blood sugar profile, i.e. blood sugar determinations at various times of the day. The results give your doctor an insight into your every-day diabetic state and indicate whe(e changes-e.g. in the insulin dosage-are necessary.

For problem cases-self-monitoring of blood sugar