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Acute diabetic complications
- What is hypoglycemia? What are the serious consequences?
- What to do when there is hypoglycaemia?
- Diabetic ketoacidosis
- Hyperosmolar hyperglycemic state
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What is hypoglycaemia (low blood sugar)? What are the serious consequences?
Blood sugar level below 2.2 mmol/l (40 mg/dl) can lead to loss of consciousness and if sugar is not given immediately, permanent brain damage can result. Symptoms of low blood glucose level appear quite rapidly, over 10 – 15 minutes. It is therefore very important to recognize the symptoms of hypoglycaemia such as sweating, palpitations, shaking, hunger, lack of concentration, confusion, drowsiness, aggressive behaviour, headaches, etc. Early recognition of these symptoms will prevent progression to more severe stages.
The most common causes of hypoglycaemia in a person with diabetes are:
- Insufficient food intake or delayed meals especially insulin treated patients
- Strict blood glucose control
- Hypoglycaemia unawareness
- Excess physical activities
- Alcohol or other drugs
Hypoglycaemia is also a common side-effect of treatment with insulin and some sulphonylureas. |
What to do when there is hypoglycaemia?
Early symptoms of hypoglycaemia can be treated by eating foods containing sugar e.g. soft drinks, juices, sweet drinks or sweets. Symptoms should improve within 5 to 10 minutes. This should be followed by a meal. If a person is unconscious, give nothing by mouth, put the person on the side, clean the mouth and nose and call the doctor.
Monitoring blood glucose levels is extremely helpful when there is hypoglycaemia. |
Diabetic ketoacidosis (DKA)
Diabetic ketoacidosis is a state of severe, uncontrolled diabetes due to insulin deficiency. It is characterised by high blood glucose and ketone body concentrations and acidosis. Lack of insulin causes the breakdown of fats. The by-product of the fats breakdown is ketones which is then released into the blood and make the blood acidic, hence the term “diabetic ketoacidosis”.
Patients usually present with thirst, increased urination, nausea, vomiting, dehydration, drowsiness and sometimes abdominal pain. It is often precipitated by an infection. Hospital admission should not be delayed because it requires immediate treatment by insulin and intravenous fluids. Without prompt treatment it can lead to shock, coma and even death. Diabetic ketoacidosis is a serious condition with mortality of 5-10% in Western countries. However, deaths due to DKA can nearly always be prevented if rising ketone levels are detected early enough. |
Monitoring ketone levels
Three distinct ketones are produced during fat metabolism. They are β-hydroxybutyrate, acetoacetate and acetone. β-hydroxybutyrate accounts for about 75-85% of circulating blood ketones which change rapidly in response to the development and treatment of DKA.
Urine ketone tests measure indirectly the levels of acetoacetate or acetone. They lag 2-4 hours behind blood levels, therefore may not show up a serious rise in ketones until ketosis is well established.
Blood tests measure levels of β-hydroxybutyrate. Normal level is <0.6 mmol/l. A blood ketone level of >1.5 mmol/l usually mean a diabetic individual at risk of developing DKA, and if >3mmol/l, emergency medical treatment will be needed. |
Hyperosmolar hyperglycaemic state
(previously known as hyperosmolar non-ketotic diabetic coma - HONK)
Patients usually present with marked hyperglycaemia and dehydration. There is no ketosis or acidosis. It is commonly occurs in the middle aged or elderly who often have undiagnosed type 2 diabetes. Precipitating causes include infection, diuretic treatment and consumption of large quantities of glucose-rich drinks to quench thirst. Treatment in the hospital includes intravenous insulin and fluids. |
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