Diabetes – managing and preventing acute complications

Hypoglycemia (low blood sugar/glucose) occurs when your brain and body aren’t getting enough sugar. Taking insulin-releasing pills or insulin puts you at risk because sometimes your medication reduces your blood sugar too much.

Hypoglycaemia is generally defined as when blood sugar drops below 3.9 mmol/L – but check with your doctor for your specific blood sugar target range.

Early hypoglycaemia symptoms may include:

• Shaking, sweating, rapid heartbeat
• Vision changes
• Hunger
• Headache
• Sudden moodiness

If you experience any of these symptoms or your blood sugar level is low, have a simple sugar snack e.g. sweets or juice to return your blood sugar to normal and feel better.

Left untreated, early hypoglycaemia symptoms can become severe: these require emergency medical attention, and may include:

• Unusual behaviour; slurred speech
• Co-ordination problems, weakness
• Blurred vision
• Inattention, confusion
• Extreme sleepiness/drowsiness
• Seizures
• Loss of consciousness

Ask your doctor about glucagon (hormone to raise blood sugar), which people taking insulin carry with them in case of severe hypoglycaemia; it can be used by someone trained to administer it while waiting for emergency services.

More on Hypoglycaemia

DKA – a condition caused by inadequate insulin – is a medical emergency usually affecting people with Type 1 diabetes.

DKA is usually (not always) indicated by high blood sugar levels. Without enough insulin, the body can’t burn glucose efficiently. Fat moves from fat cells to the liver and glucose builds up in the bloodstream. The liver makes ketoacids (ketones) from the fat. The result is toxic levels of excess glucose and ketoacids.

The lack of insulin that causes DKA is usually from:

• Unknown or newly diagnosed type 1 diabetes
• Missed or inadequate insulin doses
• Another severe illness e.g. severe infection
• Steroid medications

Call emergency services immediately if you notice any symptoms of DKA, which may include:

• Nausea, vomiting
• Stomach pain
• Fruity breath – scent of ketoacids
• Frequent urination
• Excessive thirst
• Weakness, fatigue
• Speech problems, confusion
• Heavy, deep breathing
• Unconsciousness

HHS is an uncommon medical emergency associated with very high blood sugars that occurs in people with type 2 diabetes.

Call emergency services immediately if you notice any symptoms of HHS, which may include: excessive urination, dehydration, extreme fatigue, confusion. Seizures and coma may occur. There iss usually just enough insulin available to prevent ketone formation, so ketone levels are normal or slightly elevated.

HHS usually happens to people unaware they have diabetes, or to those diagnosed with diabetes who develop another illness and don’t check their blood sugar or drink enough fluid.