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I’m writing a modern-day thriller, probably set in Colorado or another heavily forested portion of America. A surveyor from Japan has brought his two children on a working holiday, and they’re at a semi-abandoned construction site.

After some playing around, the children realise their parent is missing - and when they find him, he’s in a diabetic coma (due to hypoglycemia).

I propose that this is caused by a malfunctioning insulin pump (possibly a twisted catheter), resulting in a failure to deliver sufficient insulin and a dangerous level of glucose in the blood (as per this web page).

Due to the mountainous terrain, cell phones are useless. Over the next hour or so, the children attempt (while dealing with additional adversity) to call in medical attention.

Does this seem reasonable? A diagnosed diabetic falling into an unresponsive coma, surviving for a few hours, then being revived through later (~2 hours later?) medical attention?

Thank you in advance...!

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  • An EpiPen isn't going to be of any use to someone in diabetic coma. This site requires questions to demonstrate some degree of prior research, so you need to go find out what an EpiPen is for and revise your question.
    – Carey Gregory ♦
    Sep 9, 2021 at 0:01
  • Thank you for your note, changes made, hope this is useful. I have done some related research, but I'd rather take advice on this topic from specialists rather than rely on my interpretations of medical websites and wiki pages, hence this question. =D
    – Reverend Speed
    Sep 9, 2021 at 1:08
  • No worries, just fix your question. Add whatever links you think are useful, and keep in mind that insulin isn't necessarily the right treatment for diabetic coma. Diabetic coma is a general term for coma caused by diabetes, and the coma can be caused by completely opposite things (too much sugar, too little sugar). In your scenario, too little sugar is almost certainly the cause and it's probably because he took insulin at the wrong time, wrong amount, without eating, or something similar.
    – Carey Gregory ♦
    Sep 9, 2021 at 5:52
  • Being more direct , you apparently mean hypoglycemia, not hyperglycemia. And a friend of mine survived hypoglycemia coma ( orange juice and sugar) of likely 2 or more hours with no side affects ( interestingly in Denver CO, but in a nice hotel).
    – blacksmith37
    Sep 9, 2021 at 20:11
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    That's fascinating - and lucky for your friend! Hmm. In my story, it's the children of the adult (6 and 12) that discover him unresponsive. They're in a somewhat remote location - their first instinct is to get help, but I wonder if they might be prepared, have some emergency orange juice or something? 'Light supper, vigorous exercise, then bed' - also useful. Cheers!
    – Reverend Speed
    Sep 10, 2021 at 22:44

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Your scenario is easy to work out. The character injects his usual dose of insulin prior to a meal he's about to eat, but he gets interrupted by something and never finishes the meal. End result: hypoglycemia sufficient to render him unresponsive. When he's found, those finding him are educated enough to know they can't pour anything down his throat while he's unresponsive, so they lodge hard candies between his cheek and gums and wait for them to dissolve and give him the sugar he needs.

A more nuanced treatment of the question can be found here:

Give sugar until the responsive patient regains an adequate level of responsiveness. If the patient is unresponsive, place the patient on their side and rub sugar into their gums with a gloved finger. Make sure to protect the patient’s airway.

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  • I might make the hard candies unavailable, but otherwise this is somewhat more elegant that using the insulin pump, as I had in mind. Great reference.
    – Reverend Speed
    Sep 11, 2021 at 14:36
  • I was just informed by another medic that, quote: "It will depend on whether it’s a hypoglycaemic (low sugar) or hyperglycaemic (high sugar) coma. The low one, wave bye bye without immediate treatment. The high one, we can treat, even if a few hours have passed." This seems to conflict with the advice here to employ a hypoglycemic coma for the character and... frankly, I'm getting kinda confused. Any thoughts on this?
    – Reverend Speed
    Sep 11, 2021 at 14:47
  • Relevant reference: diabetes.co.uk/diabetes-complications/… Apologies, I'm not a doctor, just trying to work out seeming contradictions here.
    – Reverend Speed
    Sep 11, 2021 at 14:56
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    Don't overthink this. That article on HHNS isn't really relevant to your issue. I've seen hundreds of diabetic emergencies (former EMT), and hypoglycemia isn't necessarily a case of bye bye without immediate treatment. It depends on how low the blood sugar drops. It can drop to comatose levels and then level off. The problem with hyperglycemia is it doesn't happen suddenly and recovery isn't rapid. He would most likely be clearly ill long before reaching levels so high he would be comatose, and unlike hypoglycemia, he wouldn't recover immediately.
    – Carey Gregory ♦
    Sep 11, 2021 at 15:17

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