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The term ‘diabetic coma' is outdated, confusing and should probably no longer be used. Traditionally, it has been an alternative term for diabetic ketoacidosis (DKA), even when the child is not technically in coma. Although DKA remains the most common and important cause of coma in a child with diabetes, there can be other causes which must be borne in mind. This review will focus on the various causes of coma in children with diabetes, the underlying pathophysiology, clinical presentation and current thoughts on their management in an attempt to guide the paediatrician when faced with a comatose diabetic patient.

Summary Although DKA and hypoglycaemia are the main causes of coma in diabetes, a full critical assessment should include the possibility of other causes. The importance of regular neurological observations and careful monitoring of fluid balance in particular in these children is crucial to their management on the ICU.Fig. 1Flow diagram for management of hypoglycaemia in the unconscious or semi-conscious child with diabetes.