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Immediate Complications of Diabetes

Jessica Evert, MD, edited by Benjamin McDonald, MD

man outsideThe immediate risk faced by people with any type of diabetes is hypo- or hyperglycemia, conditions where blood glucose concentrations are either dangerously low or dangerously high. As the prefix "hyper" means "greater than normal", hyperglycemia means "greater than normal blood sugar". Similarly, the prefix "hypo" means "less than normal", and the term "hypoglycemia" means "less than normal blood sugar".

Hyperglycemia occurs when your blood glucose levels become too high, indicating the body's inability to use the sugar that is present in the bloodstream.  This occurs either because insulin is not available (Type 1 diabetes) or because the cells are resistant to the present insulin (Type 2 diabetes). Hyperglycemia is a sign that the body's tissues are, to one degree or another, starving for glucose. In extreme and untreated cases, hyperglycemia can be very serious, leading to ketoacidosis, coma and even death.

For all the danger that can be associated with hyperglycemia, it is to some extent, a difficult-to-avoid experience for people with diabetes. It is likely to be the means through which diabetes is first diagnosed. It can be brought on due to poor diet, overeating, sedentary lifestyle, an episode of the flu or a cold, or even stressful experiences including personal and work-related problems. It takes careful maintenance of a health-preserving routine to insure that a person with diabetes will not become hyperglycemic.

Ketoacidosis is a situation that can occur when individuals with diabetes become severely hyper- or hypoglycemic. It occurs most commonly in people dealing with Type 1 diabetes, but anyone with severe hyper- or hypoglycemia is at risk. Unable to gain access to blood sugar to feed itself the body turns to a secondary mechanism for obtaining fuel; it starts to metabolize stored fats instead. Ketones are an acid byproduct of the fat-burning process. Prolonged fat-burning creates many ketones which can build up to toxic levels in the blood and poison the body.

Hypoglycemia occurs when blood glucose levels become dangerously low, generally because there is too much insulin in the blood compared to available glucose. Several circumstances can cause hypoglycemia: it can be brought on as a side effect of some medicines, as a result of kidney failure (where the kidneys cannot remove insulin from the blood fast enough), as a result of an insulin injection error (where too much insulin is injected into the blood), or as a side effect of eating a high-sugar meal (causing sugar levels to surge and excess insulin to enter the blood in compensation). The later example is known as reactive hypoglycemia. Hypoglycemia can be a deadly condition in that without glucose to draw on, body tissues and organs, especially the brain, begin to starve to death. People who are hypoglycemic for extended periods run the risk of permanent brain damage, coma and death.

Hypoglycemia most commonly occurs when a person with diabetes skips meals following insulin injection or fails to monitor blood sugar levels. However, the condition can occur even when you have done everything you can to keep your glucose levels optimal.

Diabetic Comas. Failure to properly manage hyperglycemia or hypoglycemia can lead to diabetic coma (unconsciousness). Ketoacidotic coma can occur as part of the progression of ketoacidosis (described above). Hyperosmolar coma can occur as the body tries to compensate for hyperglycemia by excreting excessive sugars in the urine and ends up excreting so much fluid in this process that the body becomes severely dehydrated. Finally, hypoglycemic coma occurs when blood sugar simply falls below safe levels and body tissues cannot fuel themselves adequately. Any type of coma is life threatening and should be immediately brought to the attention of medical professionals.