DIABETES SHORT TERM COMPLICATIONS

One of the problems with diabetes is that the person with the disease usually feels fine and there are no symptoms even when the glucose levels are in the 100 to 200 mg/dl range. Therefore, it is easy to ignore the diabetes. Eventually, there are symp­toms, but often, they are due to diabetes-related complications. It is therefore impor­tant for people with diabetes to understand the consequences of poor glucose control and to make the effort to control the diabetes even when they feel well. Short-term complications are due to high glucose levels for a period of hours, days, or weeks.

The short-term complications that occur in people with diabetes include the following:

• Dehydration
• Weakness and fatigue
• Vaginal or penile yeast infections
• Weight loss
• Blurred vision
• Confusion

The degree of insulin deficiency and the level of blood glucose elevation will deter­mine which of these short-term complications are present. If glucose levels are only slightly elevated, there may not be any symptoms, and diabetes is diagnosed only if the glucose is measured as part of a regular screening.

Glucose does not appear in the urine until the blood glucose level is above 200 mg/dl. When this happens, glucose in the urine can cause bladder or kidney infec­tions (especially in women), vaginal yeast infections, and an infection of the skin of the penis (balanoposthitis). High levels of glucose impair the kidneys’ ability to concentrate the urine, and so there is increased urine production and symptoms of frequent urination, thirst, and dehydration. The loss of calories in the urine can cause weight loss, especially if blood glucose levels are very high. 

Short-term elevations in glucose can also affect the lens of the eye, causing blurred vision. This is reversible, and the vision returns to normal once the diabetes is treated. Sometimes the blurred vision causes a person to see an ophthalmologist or an optometrist, who then makes the diagnosis of diabetes.

In people who have a severe insulin deficiency, a very serious condition called diabetic ketoacidosis (DKA) can develop.

Following are the symptoms of diabetic ketoacidosis

• A significant amount of weight loss

• Thirst and frequent urination

• Rapid heart rate

• Nausea and vomiting

• Breathlessness

• Stomach pain

• Severe fatigue

• Blurred vision

• Confusion or coma (if left untreated)

A person who is in DKA has a characteristic appearance: the eyes are sunken, the skin flushed but dry and cool, the tongue is dry, and the breath smells of acetone (like nail polish remover or a room in which apples are kept). The heart rate is fast, and as the illness gets worse, the pulse becomes feeble. Most people are awake, but confusion or coma can occur if the DKA is severe. The urine of a person with DKA has large amounts of glucose and ketones, and there are characteristic abnormalities in the blood tests.

If left untreated, DKA can be life threatening, and people with this condition are usually admitted to the hospital for treatment with intravenous fluids and insulin.

A significant proportion of people who develop type 1 diabetes first discover their illness when they are in DKA and they get admitted to hospital. Many of these people never get DKA again. Some individuals, however, have another or many episodes of DKA. Infections are an important cause of these repeat DKA episodes. Failure to take insulin, lack of health-care insurance, and psychological trauma are also risk factors for recurrent DKA.

Sometimes, the insulin deficiency is not severe enough to cause DKA but is still of a sufficient degree to cause very high glucose levels, often 800 mg/dl or more. These very high glucose levels can lead to coma (called a hyperosmolar coma). A person in hyperosmolar coma has severe dehydration—the eyes are sunken, the mouth is dry, and the blood pressure is very low. Hyperosmolar coma typically occurs in older individuals, for example, someone living in a nursing home that may not drink enough fluids, but it can also happen in younger individuals who quench their thirst by drinking large amounts of fluids with high sugar content such as juices or regular sodas. Hyperosmolar coma is a very serious medical condition requiring hospital treatment.