Living Day-To-Day With Short Term Complications

When you have diabetes, whether type 1 (T1D) or type 2 (T2D), you need to learn how to handle whatever course the disease may take. This includes managing many of the short-term complications.

What are the Short Term Complications of Diabetes?

It is perhaps a misnomer to call complications short-term. The symptoms may last a short time, but even when you think you have everything under control, these complications can present lifelong issues.  Nevertheless, they are considered short term as characterized by their duration when they appear. The list consists of some of the more common complications:

  • Hypoglycemia
  • Diabetic ketoacidosis
  • Hyperosmolar hyperlycemic state

You can, with determination and motivation and regular monitoring of your blood glucose levels, keep these short term complications under control.

Recognizing the Problems of Short-Term Complications

If you wish to manage your diabetes and control your life, you need to recognize the symptoms of the various short-term complications. It is essential to understand what they are, as well as any manifestations as they can be lifethreatening if not treated promptly.

Hypoglycemia

Hypoglycemia is low blood sugar – readings below 3.5 mmol/l or 75 mg/dl.[1] It can be mild, moderate or severe with the symptoms reflecting the degree of acuity. The early warning signs may include:

  • Sweating
  • Trembling
  • Anxiety
  • Pale appearance
  • Palpitations
  • Hunger

Later symptoms are more severe. They are prominent when the blood glucose levels are less than 50 mg/dl. They may include any of the following:

  • Difficulty in concentrating
  • Disoriented
  • Aggressive behavior
  • Acting differently than normally
  • Being uncooperative
  • Blurred vision
  • Headaches

It is possible to have frequent episodes. Over the years or after repeated incidents of hypoglycemia, you may develop a troublesome problem of reduced awareness. You are not responsive to the symptoms as quickly. To handle and treat hypoglycemia, no matter what the severity of symptoms, requires experience. Hypoglycemia has a learning curve. The faster you learn, the more level the graph of your blood glucose levels will be.

Diabetic Ketoacidosis (DKA)

The best way to describe DKA is by what causes it to occur. Essentially, it starts when your blood sugar levels are too high, but due to lack of insulin or insulin resistance, the body cannot use the sugars. As a result, the body burns off extreme amounts of fat for energy, but begins to produce ketones which enter the blood stream. Overwhelmed and unable to process all the fat, the blood becomes acidic.[2] One of the primary symptoms of DKA is significant dehydration.

DKA can present its symptoms in both adults and children. Yet, the odds for survival and a lesser severity of occurrence favor the adults. Children no more than 5 years old may suffer the most with diabetic ketoacidosis, which may be the first time they find out they have type 1 diabetes.  These children are members of a group of patients who develop the disease complication and have higher rates of mortality as a result. Unlike their diabetic adult counterparts, children with DKA are more likely to develop and die from cerebral edema – “water on the brain”.[3]

DKA develops as a result of several possible events which, according to percentages, are:

  • Infection – possibilities include diarrhea, vomiting, and/or high fever (40%)
  • Insufficient or overlooked insulin (25%)
  • Diabetes – either recently diagnosed or up to that time unknown (15%)

Symptoms for this problem are varied. The most common include the following:

  • Dehydration
  • Kussmaul’s respiration –deep, fast, and labored breathing[4]
  • Dry skin
  • Dry mouth
  • Parched tongue
  • Flushed face
  • Fruity smelling breath (as a result of the ketones)
  • Nausea and vomiting – in about 50 to 80 percent
  • Stomach pain
  • Weakness when you try to stand
  • Lethargy
  • Sleepiness
  • Confusion
  • Possible coma and death

DKA is one more short term complication of diabetes. It occurs more frequently in those who have type 1 diabetes. Adults suffer far less than either children or adolescents.  Since this is the case, it is necessary for parents and individual caretakers or guardians to teach children to manage their diabetes.

Hyperosmolar Hyperglycemic State or HHS

HHS is a combination of terms: hyperosmolar and hyperglycemic. Both refer to aspects of this long term complication of diabetes.

  • Hyperosmolar – refers to a high body fluid osmolar (solution) concentration, like in the blood, making the fluid thick (not enough fluid present); characterized by dehydration
  • Hyperglycemic – another aspect of diabetes, a condition in which the blood sugar levels are elevated.[5]

HHS is a very severe situation. It is also described as a complication specifically arising from type 2 diabetes (T2D) – particularly when the individual is not dependent upon insulin. Two specific names for the disease, hyperosmolar nonketotic coma (HONK) and hyperosmolar hyperglycemic nonketotic coma (HHNC), imply the person is non-ketotic.

If the individual has HHS,the person may exhibit any of the following symptoms:[6]

  • Weakness
  • Increased urination
  • Increased thirst
  • A high fever – more than 101 degrees F.
  • Nausea
  • Lethargy
  • Confusion – decreased mental awareness
  • Convulsions or seizures
  • Prune-wrinkled skin
  • Sunken eyes
  • Leg cramps
  • Rapid pulse
  • Coma

An initial diagnosis may be suggested by some of the above symptoms, but often is not discovered until the blood glucose measurements are taken and found to be higher than 600 mg/dl.

As a result, any treatment involves a need for rapid medical care. This involves hospitalization and the use of intravenous fluids and minerals. The two are required, with a little amount of insulin, to rehydrate the body and replenish it with the lost minerals e.g. potassium. However, to prevent the problem from occurring, diabetics and those who care for them, should be educated on the causes and symptoms of diabetes and its related short term (and long term) complications.

References

[1] Marcovitch, H (2006). Black’s Medical Dictionary 41st edition. Lantham, Maryland: Scarecrow Press.

[2] Guyton, AC; and Hall, JE (2011). Textbook of Medical Physiology, 12th ed. Philadelphia: Saunders.

[3] Steel, S; and Tibby, SM (2009). “Paediatric Diabetic Ketoacidosis.” Continuing Education in Anaesthesia Critical Care Pain, 9 (6): 194-199.

[4] Trachtenbarg, DE (2005).”Diabetic Ketoacidosis.” American Family Physician, 71(9):1705-1714.

[5] Levin, ME; and Pfeiffer, MA (editors) (2009). The Uncomplicated Guide to Diabetes Complications, 3rd ed. Alexandria, VA: ADA.

[6] Fowler, M (2009). “Hyperglycemic Crisis in Adults: Pathophysiology, Presentation, Pitfalls, and Prevention.”  Clinical Diabetes, 27 (1): 19-23.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.