Diabetes Complications
When Diabetes Goes Wrong

Most times when diabetes goes wrong it is due to mismanagement of your diabetes but, with care, most problems are rare. Diabetes complications can be dangerous, however.

Diabetics Having High Blood Sugar (Hyperglycaemia)

If you suffer from diabetes mellitus then you may sometimes have too little insulin (perhaps you have eaten more than usual, or you are ill, or have forgotten to take your insulin), and this then means the level of sugar in your blood is unregulated and so may increase to unacceptable levels.

If you have too much sugar in your blood then you may notice one or more of the following symptoms:

• drowsiness

• urgent need to wee frequently

• thirst or hunger or both

• blurry vision

High blood sugar is known as hyperglycaemia, and it can lead to Diabetic Ketoacidosis (DKA), when your body starts to get its energy from your fat instead of from your glucose -- one symptom is that your breath begins to smell. This condition is VERY SERIOUS if untreated, can lead to coma and can even be fatal. DKA is a serious medical emergency and you must seek immediate medical attention. Ask family and friends to watch for the symptoms in you. Prompt treatment usually leads to full recovery.

Diabetics Low Blood Sugar (Hypoglycaemia)

Even though the word "hypoglycaemia" is very similar to the word "hyperglycaemia", they are very different conditions indeed – almost complete opposites. Low blood sugar is also known by its shortened form "hypo". This happens because a diabetic has too much insulin in their blood, or has the correct amount but has not eaten the usual amount of food, or has exercised too much. When this happens you have a low blood sugar level (under 4 mmol/l in a blood test – note that urine tests do not detect hypoglycaemia) and you may notice one or more of the following symptoms:

• quivering or shaking

• quickened pulse

• sweats

• dizziness

• hunger

• drowsiness and weakness

Hypoglycaemia can be managed by eating sugar cubes or drinking a sugary drink, or by consuming anything else containing fast-acting carbohydrates. Some diabetics carry around a pack of glucose tablets with them everywhere just in case of a hypo attack.

If left untreated you might become unconscious; but in most cases your body will find glucose from its own stores eventually and your blood sugar level will return to normal. It is not unknown for a diabetic to have a hypo in their sleep and come to no harm.

Obviously becoming unconscious can be dangerous (eg if driving; there is also a risk of choking); if you find a diabetic unconscious you should call an ambulance – it might just be some other type of diabetic complication.

And if they are unconscious don't try to raise their blood sugar by giving them any food or drink – they could choke.

Other Problems with Diabetes

There are other problems that diabetics could encounter:

• Retina Damage and Blindness: Diabetics are at risk from developing retinopathy – the blood vessels feeding the retinas at the back of your eyes don't work properly and your sight can become reduced or even damaged. If you are diabetic you should have your eyes checked at least once a year.

• Stroke, Heart and Blood Vessel Disease: Poorly-controlled blood sugar levels can affect the lining of your arteries, making them narrower or blocked, causing parts of your body to receive lower amounts of the oxygen they need in order to stay healthy. This can lead to angina, heart attacks, and strokes (and sometimes to amputation if the problem is in your legs or feet).

• Kidney Damage: In diabetes, kidney disease develops very slowly, over several years, and is caused by damage to the small blood vessels in your kidneys. Keeping your blood sugar level normal (4-6 mmol/l before meals, 10 mmol/l two hours after meals) can greatly reduce the risk here (in fact it helps with other complications too).

• Miscarriage: Diabetic women with poorly-controlled blood sugar level run an increased risk of miscarriage. Tell your birth care team you have diabetes and they will ensure the correct procedures are in place to reduce the risk.

• Nerve Damage: High blood sugar levels can cause damage to your nerves and to the blood vessels feeding them.

• Female Sexual Dysfunction: Not as common as male erectile dysfunction, but femal diabetics can suffer from a lack of desire, reduced arousal, pain during intercourse, and reduced or no sexual pleasure.

• Erectile Dysfunction (ie impotence): The inability to reach or maintain an erection for sexual intercourse is common in male diabetics who are on certain medicines or having some other diabetic complications.

• Feet: If your diabetes is poorly controlled then the nerves, muscles, and blood vessels in your feet and legs can be damaged; in severe cases this can require amputation. Have your feet checked once a year, and get any cuts, grazes, or ulcers treated carefully and immediately.

• Insulin Reactions: Some people are allergic to insulin or to some types of insulin. If you suffer allergic reactions such as swelling, intching, or inflammation where you are injected, or feel sick or actually vomit, you should see your doctor immediately. Also, insulin can interact adversely with some other drugs; your doctor should be able to advise you here.