Acute complications of diabetes include those in which the blood sugar is high (hyperglycaemia) and those in which the blood sugar is low (hypoglycaemia)
Hypoglycaemia is covered in another section so we will only cover hyperglycaemic diabetic emergencies in this section. These include diabetic ketoacidosis and hyperosmolar non-ketotic coma.
Diabetic ketoacidosis occurs when there is insufficient insulin to deal with the amount of sugar in the blood stream. When this occurs, the body uses fat as an energy source and this results in the production of ketones that accumulate in the body. These ketones also appear in the urine and can be detected with a simple urine labstix test.
Diabetic ketoacidosis often occurs in type 1 diabetes mellitus when the patient does not give him/herself insulin injections. In type 2 diabetes mellitus, it usually occurs when a patient has some other illness at the same time. This would include all types of infections or fever such as urine infection or chest infections. Other types of stressful events can also lead to diabetic ketoacidosis such as a heart attack.
The symptoms of diabetic ketoacidosis include thirst, passing large volumes of urine, feeling very tired, nausea, vomiting and abdominal pain. Others may notice very deep, rapid breathing and a fruity smell on the breath. In severe cases, patients can become drowsy and become unconscious. This is an emergency and you must be seen immediately in a hospital.
You can prevent diabetic ketoacidosis by taking your insulin and medication regularly, especially when you are sick. When you are unwell, you should monitor your blood sugar frequently and give additional insulin when the blood sugar is high. Your doctor or diabetes nurse educator should be able to give you some advice on how to make these adjustments. If you are unable to eat, you should see your doctor as you may need to be put on a drip until you recover from your illness.
Compared to diabetic ketoacidosis, which can occur very quickly, hyperosmolar non ketotic coma occurs more gradually. You may feel thirst and pass large volumes of urine. This will result in your becoming more and more dehydrated. You will feel tired and may lose weight. Usually the urine ketones are negative or present only in small quantities. Patients may become more and more drowsy and become unconcious. This condition is more common in type 2 diabetes mellitus and may occur because of insufficient medication. More commonly, it occurs due to some other illness or injury such as infection. Once again, if the blood sugar is very high and you feel very unwell, it is important to consult you doctor quickly as this is also a diabetic emergency.