Can Diabetes Mellitus Cause Any Complications?

A patient that has been diagnosed to having diabetes mellitus should seek immediate treatment as soon as possible. But what could happen if treatment is not sought immediately? A person who has been diagnosed with diabetes mellitus, and refuses to get treated may start developing certain health complications. Though, these complications are not limited to diabetic patients who do not seek treatment, but also diabetic patients who are currently treating and managing their diseases but at the same not monitoring their blood sugar levels appropriately.

Diabetes mellitus complications usually arise due to extreme or prolonged high blood sugar levels, and they include Emergency (short-term complications) and Long-term complications.

EMERGENCY OR SHORT–TERM COMPLICATIONS

People who have diabetes may experience a diabetic emergency, where their blood sugar becomes too high or too low. This is why It is crucial to know the signs and symptoms of an emergency and what can be done if an emergency arises.

For persons with relatives with diabetes, it may be worth having a conversation with them about what can be done in an emergency. These emergency complications include:

• Hyperglycemia (High Blood Sugar)
• Hypoglycemia (Low Blood Sugar)

HYPERGLYCEMIA (High Blood Sugar)

Hyperglycemia happens when the blood sugar levels are too high due to the absence of insulin in the body or when the body is not responding to the insulin that is present. It usually affects people with diabetes who do not seek treatment. Also, it may be caused by a person with diabetes who has not had the correct dose of medication, eaten too much sugary or starchy food, or, may be unwell with an infection.

Several factors can play a role in hyperglycemia in people with diabetes. These include food and physical activity, and illness. Skipping doses or not taking enough insulin or oral hyperglycemic agents to lower blood sugar can cause hyperglycemia

Symptoms of hyperglycemia develop slowly over several days or weeks. The longer blood sugar levels stay high, the more serious symptoms may become.

Recognizing early symptoms of hyperglycemia can help identify and treat it right away. This is why there is a need to take note of the following symptoms

• Frequent urination
• Increased thirst
• Blurred vision
• Feeling weak or unusually tired

If hyperglycemia isn't treated, it can cause an emergency hyperglycemic crisis. This condition, when it occurs in type 1 diabetes is called ketoacidosis.

Treatment of the hyperglycemic crisis may include intravenous normal saline and insulin. If a patient with the above symptoms should see a doctor to take emergency treatment immediately.

Hyperglycemia can be prevented by exercising regularly, taking medication appropriately, monitoring blood sugar levels, strictly following the diabetes plan outlined, and adjusting insulin doses or medication if physical activities change.

DIABETIC KETOACIDOSIS (DKA)

This condition occurs when the body does not have enough insulin to allow the glucose to function properly (energy building) or enter the cells properly. This allows the sugar level to rise, and the body begins to break down fat for energy.

When the fat is broken down for energy use in the body, it produces toxic substances called ketones which then pile up in the urine. And when DKA is not treated, it can lead to a diabetic coma that can be life-threatening.

DKA is the most common complication for type 1 diabetes patients but can happen in type 2 diabetes patients, happening due to low insulin levels, having insulin reactions (especially while sleeping), having an infection, and not eating appropriately.

Symptoms of diabetic ketoacidosis (DKA) can include:

• Extreme thirst or dryness in the mouth
• Frequent urination
• Frequently feeling fatigued
• Dry mouth
• Dry or flushed skin
• Nausea, vomiting, or abdominal pain
• Fruity-smell breath
• Difficulty breathing
• Confusion, or feeling unconscious

Once these signs are noticed early, it is best to encourage such persons to have a ketone test using their pee. And if the tests show the presence of ketones and blood sugar levels at 240m/dl or above, then they should be taken for emergency admission to a hospital.

HYPEROSMOLAR HYPERGLYCEMIC NONKETOTIC SYNDROME (HHNS)

A serious condition that is caused by hyperglycemia. This condition is a complication of type 2 diabetes with a blood sugar level of over 600mg/dL, but no or very few ketones (with or without DKA) and can be life-threatening. People without diabetes can also experience this if they make use of diabetic medications without a doctor’s advice.

This condition happens most often in older people with uncontrolled diabetes who may have an infection or feel sick, and also in obese pregnant women with uncontrolled diabetes. This causes the blood sugar to rise over days or weeks, with the body trying to get rid of excess glucose through frequent urination, thus making them extremely dehydrated.

Symptoms of HHNS include:

• Dry mouth
• Headache, nausea, vomiting (common in children), and abdominal pain
• Fever
• Feeling thirst
• Frequent urination
• Fast heartbeat
• Cold hands and feet
• Warm skin yet no sweat
• Dark urine
• Confusions
• Temporary partial paralysis (weakness on one side of the body)
• Slurred speech

Hyperosmolar hyperglycemic nonketotic syndrome, if not treated can lead to life-threatening dehydration, coma, and even death. And once this happens, seek emergency medical treatment. The person will require treatment in the hospital, which will include rehydration, the use of insulin, and any necessary treatment for an underlying cause.

HYPOGLYCEMIA (Low Blood Sugar)

Hypoglycemia happens when the blood sugar level drops below a healthy range i.e., usually below 70mg/dL. It is more common in people with type 1 diabetes but also occurs in people with type 2 diabetes. It can occur for many reasons, but in diabetes mellitus, it usually stems from the use of insulin or oral hyperglycemic agents like sulfonylureas, such as glipizide (Glucotrol), glimepiride (Amaryl) or glyburide (Diabeta, Glynase) that control blood sugar level.

It can also be caused when a diabetic patient is not eating enough, skipping a meal or snack, taking too much insulin, increasing exercise or physical activity without eating more or adjusting their medications, and drinking alcohol.

Most people with diabetes can tell when their blood sugar is low because of early warning signs like shakiness and hunger. They need to treat hypoglycemia as soon as possible to stop it from getting severe, which can lead to a seizure or a diabetic coma, and even death.

Some people do not know when their blood sugar is low. That's called hypoglycemia unawareness. They might have early signs, but not every time. Instead, they can get severe hypoglycemia without warning, and become unconscious.

The warning signs of hypoglycemia include:

• Confusion, dizziness, and nausea
• Feeling hungry
• Feeling shaky, nervous, irritable, or anxious
• Sweating, chills, and pale, clammy skin
• Rapid heartbeat
• Weakness and tiredness
• Tingling in the mouth area
• Headaches
• Seizures
• Coma or loss of consciousness
• Weight loss if hypoglycemia persists

If there are signs or symptoms of low blood sugar, diagnosis of hypoglycemia can be done by checking the blood sugar level with a blood glucometer - a small device that measures and displays the blood sugar level. A person has hypoglycemia when their blood sugar level drops below 70mg/dL. Drinking sugary drinks can prevent or treat hypoglycemia during warning signs.

If there are symptoms of low blood sugar but there is an inability to check the blood sugar level right away, assume the blood sugar is low and treat hypoglycemia with sugary drinks.

Action to Take During Hypoglycemia Crisis (Treatment)

If the symptoms appear suddenly, the following procedures can be done

• Eat or drink something that is mostly sugar or carbohydrates to raise the blood sugar level quickly - pure glucose (3-4 tablets)
• A serving of glucose gel
• 120 milliliters of fruit juice or regular — not diet — soda
• One tablespoon (15 milliliters) of sugar, corn syrup, or honey
• Foods with more fat, such as chocolate should be avoided because they do not raise blood sugar as quickly. And diet soft drinks cannot be used to treat an episode of hypoglycemia because they do not have any sugar
• In general, food or drink with 15 to 20 grams of carbohydrates is often enough to raise blood sugar levels back into a safe range
• Check the blood sugar level 15 minutes after eating or drinking something to treat hypoglycemia. If blood sugar is still low, eat or drink another 15 to 20 grams of carbohydrates. Repeat this pattern until the blood sugar level is above 70mg/dL
• Have a snack or a meal to keep the blood sugar from dropping again. If one typically takes insulin with food, additional insulin is not needed if one is eating a snack after having a low blood sugar level. If a meal is to be taken, there may be a need to reduce the dose of insulin to ensure that the blood sugar does not rise too quickly

Emergency Treatment

When someone becomes unconscious from hypoglycemia, it is a medical emergency and should be treated with intravenous glucose injection and drip-containing glucose.

Glucagon is a hormone that raises blood sugar quickly. It comes in an emergency syringe kit or as a pre-mixed injection that is ready to use. It is also available as a powdered nasal spray given in one nostril.

About 15 minutes after getting glucagon, the person should be alert and able to eat. But if the person does not respond within 15 minutes, seek emergency medical attention. If someone quickly responds to glucagon, it is still recommended to seek medical attention.