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Hypoglycaemia or low blood glucose is a clinical state associated with low (less than 50 mg/dl) or relatively low plasma glucose concentration.
The most common cause of hypoglycaemia is iatrogenic i.e. drug induced oral hypoglycaemic agents or insulin. Hypoglycaemia secondary to alcohol, insulinoma, kidney and liver disease and that associated with endocrine dysfunction and neonatal hypoglycaemia are among the other cause of hypoglycaemia.
Sweating, palpitation, hunger, blurred vision, tremors, lack of concentration, confusion, tiredness, headache, seizure, unconsciousness.
Consistently high glucose levels can lead to a condition called diabetic ketoacidosis (DKA ). This happens when a severe lack of insulin means – the body cannot use glucose for energy, and body start to break down other body tissue as an alternative energy source. Ketones are the byproduct of this process. Ketones are poisonous chemicals which build up and, if left unchecked, will cause the body to become acidic – hence the name ‘acidosis’.
Ketones in the blood/urine, high blood sugar levels ( often but not always ), frequently passing urine, increased thirst, feeling tired and lethargic, blurry vision, abdominal pain, nausea , vomiting, deep sighing breaths, smell of ketones on breath, collapse/unconsciousness.
Hyperosmolar hyperglycemic state occurs in people with type 2 diabetes who experience very high blood glucose levels. It can develop over a course of weeks through a combination of illness and dehydration. Stopping medication during illness can contribute, but blood glucose rises despite the usual diabetes medication due to the effect of other hormones the body produces during illness.
Frequent urination, increased thirst, nausea, dry skin, disorientation and in later stages – drowsiness and loss of consciousness
Infection in DM is very common and important complication. DM predisposes to infection and infection in turn overwhelms the metabolic control. Effective control of each affects the control of the other condition. Diabetes is considered as a secondary immune deficiency disorder by WHO.
Bacterial : tuberculosis, pyelonephritis, cholecystitis, malignant otitis externa, erythrasma, staphylococcal infections, non-clostridial gas gangrene, periodontal infection
Fungal : candidiasis and mucormycosis
Viral : viral hepatitis particularly C, HIV infection
Damage to heart and blood vessels is collectively known as cardiovascular disease and people with diabetes have a higher chance of developing it.
Major blood vessels consist of arteries which carry blood away from heart, and veins which return it. Damage to these vessels is referred to as macrovascular disease.
Capillaries are the tiny vessels where the exchange of oxygen and carbon dioxide takes place. When damage occurs to these vessels it’s referred to as microvascular disease.
When fatty materials such as cholesterol form deposits on the walls of the vessels, flurring up the artery and reducing the space for blood to flow, this is described as arteriosclerosis or atherosclerosis. If the plaque ruptures the artery walls, blood cells (called platelets) try to repair the damage., but this will cause a clot to form. Over time, the walls of the blood vessels lose their elasticity. This can contribute to the development of high blood pressure or hypertension. The force of the blood being pumped from the heart can make the clot break away from the artery wall and travel through the system until it reaches a section too narrow to pass through. If this happens the narrow section will become partially or completely blocked. Blockage of an artery leads to the part of the body it supplies being starved of the oxygen and nutrients it needs. This is the cause of heart attack or strokes (affecting the brain).
Narrowing of the blood vessels can affect other parts of the body, such as the arms or legs. This is called peripheral vascular disease (PVD). PVD may produce intermittent claudication (pain in the calf muscle). If left untreated, it causes gangrene which ultimately leads to amputation of the limb.
Diabetic kidney disease is characterized by excessive urinary albumin excretion followed by loss of kidney function. Persistence albuminuria in the range of 30 to 299 mg/24 hours has shown to be the earliest stage of diabetic nephropathy.
The kidneys regulate the amount of fluid and various salts in the body, helping in the control of blood pressure. They also release several hormones. In the very early stages there are usually no symptoms and you may feel well, but this can mean there are changes in the blood pressure and in the fluid balance of the body. This can lead to swelling, especially in the feet and ankles. As kidney disease progresses, the kidneys become less and less efficient the person becomes very ill. This happens as a result of the buildup of waste products in the blood, which the body cannot get rid of, a condition called uremia.
Diabetic retinopathy is a retinal micro vasculopathy resulting from hyperglycemia. Diabetic retinopathy starts from hyperglycemia- induced vascular injury.
For vision, light must be able to pass from the front of the eye through to the retina, being focused by the lens. The retina is the light-sensitive layer of cells at the back of the eye – the ‘seeing’ part of the eye. It converts the light into electrical signals. These signals are sent to your brain through the optic nerve and your brain interprets them to produce the images that you see. A delicate network of blood vessels supplies the retina with blood. When those blood vessels become blocked, leaky or grow haphazardly, the retina becomes damaged and is unable to work properly. This is called Retinopathy. Uncontrolled diabetes is major cause of Retinopathy.
Neuropathy is one of the long term complications which affect the nerves. Nerves carry messages between the brain and every part of our body, making it possible to see, hear, feel and move. Nerves also carry signals to parts of the body that we are not aware of such as the heart – altering rate it beats at and the lungs – so we can breathe. Therefore, damage to the nerves can cause problem in various part of the body, including all systems.
There are three types of neuropathy: sensory, autonomic and motor
Sensory Neuropathy :
Sensory neuropathy affects the nerves that carry messages of touch, temperature, pain and other sensations from the skin, bones and muscles to the brain.
Symptoms: tingling and numbness, loss of ability to feel pain, loss of ability to detect changes in temperature, loss of coordination, burning or shooting pains
Autonomic Neuropathy :
Autonomic neuropathy affects nerves that carry information to your organs and glands.
Symptoms: bloating, constipation or diarrhea due to gastroparesis – when food can’t move through digestive system effectively, loss of bladder control – leading to incontinence, irregular heartbeats, impotence etc.
Motor Neuropathy :
Motor neuropathy affects the nerves which control movement. Damage to these nerves leads to weakness and wasting of the muscles that receive messages from the affected nerves. Also leads to problems like muscle twitching and cramps, paralysis of affected parts etc.
Diabetic foot is one of the most common chronic complications of diabetes. A classical triad of neuropathy, ischemia and infection characterizes the diabetic foot. If left untreated, these problems can cause foot ulcers and at worst may require amputation. However, most foot problems are preventable with tight glucose control and regular foot care and check up.
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