Living with diabetes blog

Control your diabetes to prevent acute complications

By Sara J. Carlson, R.N., C.D.E. May 12, 2015

We often hear about the chronic complications of diabetes such as heart disease, stroke, blindness, kidney failure, neuropathy and gum disease.

There are also acute complications of diabetes which can be life-threatening.

Diabetic ketoacidosis (DKA)

DKA is a state of extreme insulin deficiency which most often occurs in people with type 1 diabetes, but can also occur in people with type 2 diabetes.

DKA usually comes on rapidly and may occur at the onset of diabetes, during periods of illness, injury or infection, or whenever diabetes is poorly controlled.

Lack of insulin keeps glucose from entering the body's cells where it is used for energy. If the body can't use glucose for energy, it begins to use fat instead. The breakdown of fat causes acids called ketones to build up in the blood and urine. A large amount of ketones in the body can make you very ill.

Signs and symptoms of DKA include:

  • High blood glucose levels, high ketone levels in the urine
  • Excessive thirst, frequent urination
  • Nausea and vomiting, abdominal pain
  • Weakness or fatigue
  • Shortness of breath, fruity-scented breath
  • Confusion

Hyperglycemic hyperosmolar syndrome (HHS)

HHS happens when the body doesn't produce enough insulin or use insulin efficiently. In this case, neither glucose nor fat can be used for energy. Large amounts of glucose are dumped into the urine causing increased urination and extreme dehydration.

HHS is most common in people with type 2 diabetes. Your risk of HHS may be higher if you are over age 65, have another chronic health condition, have an infection, or are taking certain medications such as steroids, diuretics or anti-seizure medications.

Symptoms develop gradually over several days or weeks. They include:

  • Extremely high blood glucose levels (sometimes as high as 600 mg/dL)
  • Excessive thirst, dry mouth, increased urination
  • Warm, dry skin; fever; drowsiness
  • Confusion, hallucinations, loss of vision, seizures and coma

Treatment of DKA or HHS typically includes:

  • Intravenous fluids to counter dehydration
  • Intravenous insulin to lower blood glucose levels
  • Intravenous electrolytes

Good daily control of your diabetes can help prevent DKA or HHS:

  • Follow your diabetes treatment plan carefully.
  • Monitor your blood sugar levels. Regular testing is the only way to know if your blood sugar is in your goal range.
  • Ask your health care provider for a sick day management plan. When ill, you may need to test your blood sugar more frequently, test your urine for ketones, drink extra fluids, or adjust your insulin dosage.
  • Wear a medical ID bracelet or necklace in case you are unable to speak for yourself.
  • Stay current on vaccinations to prevent illness or infection.

Warm regards,

May 12, 2015