Diabetes would not be as difficult of a disease were it not for the secondary acute and chronic complications.
The acute complications include hypo- and hyperglycemia (low and high blood sugar levels) and diabetic ketoacidosis (DKA). Normal blood sugar levels and desired ranges for people with diabetes are shown in Table 1.
Low Blood Sugar (Hypoglycemia, Insulin Reaction)
Anyone who has been given insulin can have low blood sugar (hypoglycemia, or a “reaction”). Blood sugars below 70 mg/dL (3.9 mmol/L) are considered low and are usually related to the person having one or more of the signs outlined in Table 2. A “true low” blood sugar is a value less than 60 mg/dL (3.3 mmol/L), which is a level not likely to occur in people who do not have diabetes or another disorder.
All families must be trained at the time of initial education to know what hypoglycemia is, what to check for and how to treat it. The causes, symptoms and treatment of hypoglycemia are shown in Table 2.
Treatment of Low Blood Sugar (see Table 2)
The treatment of hypoglycemia depends on the severity of the episode. Mild lows may be treated with 2 to 8 ounces of sugary fluid (the amount is dependent on age). Moderate reactions in which the person is confused but is conscious are treated with small sips of sugary fluid or Insta-Glucose or cake gel put between the gums and cheeks. Severe lows (loss of consciousness, seizure) are treated with shots of glucagon given with an insulin syringe. Intranasal glucagon is now in development.
High Blood Sugar (Hyperglycemia)
High levels for blood sugar are shown in Table 1. High levels result in higher HbA1c values which are associated with the chronic complications of diabetes discussed below. Causes of high blood sugar levels can be the result of many factors, including:
• Forgetting to take insulin or other medications
• Too low a dose of insulin or other medications
• Eating too many carbohydrates
• Physical trauma (e.g., accident, surgery, heart attack, etc.)
• For people using an insulin pump, having the infusion tubing become clogged or come out from under the skin
• “Spoiled” insulin (frozen or above 90° F or 32° C)
• Taking medications that increase blood sugars (e.g., steroids)
Diabetic Ketoacidosis (Acidosis, DKA)
DKA does not occur as frequently as severe hypoglycemia, however, it is more dangerous. It occurs when ketones build up in the body because there isn’t enough insulin. All families must be trained at the time of initial education to know when to check for ketones and how to treat elevated levels. With proper education, DKA is almost completely avoidable. The causes, symptoms and treatment of ketoacidosis are shown in Table 2.
Chronic Complications of Diabetes
The chronic complications of Type 1 diabetes generally occur after many years of suboptimal glucose control. Complications of small blood vessels include changes in the eyes (diabetic retinopathy), changes in the kidneys (diabetic nephropathy) and in the nerves (neuropathy). The Diabetes Control and Complications Trial (DCCT) showed that the risk for these small blood vessel complications is decreased by more than 50 percent with optimal blood sugar control. The trial also showed that people who had a history of poor sugar control had improvements or slowing of complications when blood sugar levels became better controlled. This means that no matter what your past is for blood sugar levels, better control and more attention starting today will help relieve complications in the future.
With uncontrolled diabetes, there is also risk of developing complications related to the medium to large blood vessels in the body. The cardiovascular (heart and blood vessel) system and the extremities (especially the feet) take precedence in people with diabetes. These changes generally occur only in people who have had diabetes for many years. They are the main cause of mortality for people who have had a long duration of diabetes. The risk factors for medium to large blood vessel complications are listed in the table below.
Rick Factors and Prevention of Chronic Complications
Risk Factors Aim for Cardiovascular Complications Prevention
glucose (sugar) control HbA1c below 7.5% (58 mmol/mol)
blood pressure below 130/80
tobacco use don’t use
elevated total cholesterol below 200 mg/dL (5.2 mmol/L)
elevated LDL-cholesterol below 100 mg/dL (2.6 mmol/L)
elevated (fasting) triglyceride below 150 mg/dL (1.7 mmol/L)
If any of the levels are elevated, it is important to discuss with your physician.