Warning signs and what to do

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Diabetes symptoms can sometimes turn into an emergency quite quickly and suddenly. It is crucial to know the signs and symptoms of an emergency and what to do if one arises.

According to the Centers for Disease Control and Prevention (CDC), around 12.6 percent of the population in the United States have diabetes, with or without a diagnosis.

In the past, diabetes was often fatal, but recent progress in science and medication mean that most people with diabetes can now enjoy a normal lifespan.

However, the CDC state that diabetes, or complications related to it, is still the seventh most frequent form of death in the U.S., and it was responsible for nearly 25 deaths in every 100,000 in 2016.

Hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), diabetic ketoacidosis (DKA), greater susceptibility to infections, and a range of complications all increase the risk.

Knowing the signs and being able to respond promptly may save lives. Read on to find out how and why diabetes can become dangerous, and what to do about it.

Any sudden, unexplained symptom warrants a call to the doctor.

Share on PinterestA headache can signal hypoglycemia. Without attention, this can lead to an emergency.

Both type 1 and type 2 diabetes prevent the body from managing blood sugar levels effectively.

In type 1 diabetes, the immune system destroys the cells that produce insulin. Type 2 diabetes reduces the body’s ability to respond to insulin. Consequently, the body does not produce enough insulin to manage the glucose in the body.

Most diabetic emergencies relate to disruptions in a person’s blood sugar levels, but complications relating to diabetes can also lead to problems.

Here are some of the most common emergencies that can arise, their warning signs, and what to do.

Hypoglycemia happens when blood sugar levels are too low, usually below 70 milligrams per deciliter (mg/dl).

Without treatment, such low levels of blood sugar can lead to seizures and become life-threatening. It is a medical emergency. However, it is easy to put right in the short-term as long as a person recognizes the signs.

Hypoglycemia can occur for many reasons, but, in diabetes, it usually stems from the use of insulin or other medications that control blood sugar.

Blood sugar levels may drop dangerously low when a person:

• takes more insulin than they need for their current food intake or exercise levels
• consumes too much alcohol
• misses or delays meals
• does more exercise than they expected to do

Early warning signs

The warning signs of hypoglycemia include:

• confusion, dizziness, and nausea
• feeling hungry
• feeling shaky, nervous, irritable or anxious
• sweating, chills, and pale, clammy skin
• rapid heartbeat
• weakness and tiredness
• tingling in the mouth area
• headaches
• seizures
• coma or loss of consciousness
• weight loss if hypoglycemia persists

If a person tests their blood sugar levels when they experience these symptoms, they may find that they are below 70 mg/dl.

Action to take

If the symptoms appear suddenly, the person should take a high-carb snack to resolve them, such as:

• a glucose tablet
• a sweet juice
• a candy
• a sugar lump

The American Diabetes Association (ADA) recommend the following action:

1. Take 15 grams (g) of carbohydrate and wait 15 minutes before testing blood sugar levels.
2. If levels are still below 70 mg/dl, take another 15 g of carbs, wait, and test again.
3. When glucose levels are above 70 mg/dl, eat a meal.
4. If symptoms persist, seek medical help for any underlying condition.

If the person is conscious but unable to eat, someone who is with them should put a little honey or other sweet syrup inside their cheek and monitor their condition.

If they lose consciousness, any bystander should call 911 and ask for emergency medical help.

If a person experience regular hypoglycemia despite following the treatment plan, or if changes in blood sugar level occur suddenly in response to a medication change, they should see a doctor.

Hyperglycemia is when blood sugar levels are too high because insulin is not present or the body is not responding to the insulin that is present.

It can happen if a person with diabetes does not receive treatment.

Early warning signs

The person may notice:

• increased thirst
• the need to urinate more frequently
• headaches
• blurry vision
• fatigue

Tests will show high levels of sugar in the blood and urine.

Action to take

In mild cases, ways of resolving this include:

• exercising more
• eating less
• changing the dose of insulin or other medication

However, very high blood sugar levels can lead to life-threatening complications, such as diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome.

If symptoms worsen or if a person experiences difficulty breathing or has a very dry mouth or a fruity smell on their breath, they should see a doctor as soon as possible.

Click here to find out more about hyperglycemia.

Diabetic ketoacidosis (DKA) occurs when the body does not have enough insulin to allow glucose to enter the cells properly.

The cells do not have enough glucose to use for energy, so, instead, the body breaks down fat for fuel.

When this happens, the body produces substances known as ketones. High levels of ketones are toxic because they can raise the acidity levels of the blood.

Reasons why DKA might happen include:

• low insulin levels, due to not taking insulin or because another factor stops the insulin from working correctly
• not eating enough
• having an insulin reaction

People with both type 1 and type 2 diabetes can develop DKA.

Warning signs

The warning signs include:

• feeling thirsty or having a dry mouth
• frequent urination
• fatigue
• dry or flushed skin
• nausea, vomiting, or abdominal pain
• difficulty focusing
• confusion
• difficulty breathing
• a fruity smell on the breath

Action to take

If a ketone test shows that ketones are present and a blood glucose test shows that a person’s blood sugar levels are 240 m/dl or above, the ADA advise them to see a doctor.

Anyone with these symptoms should seek medical help as soon as possible, as DKA can become a medical emergency.

People can buy testing kits for ketones and blood sugar levels online.

According to the American Academy of Family Physicians (AAFP), hyperglycemic hyperosmolar syndrome (HHS) occurs when blood sugar levels become dangerously high, usually above 600 mg/dl.

This may happen with or without DKA, and it can be life-threatening.

People with poorly controlled type 2 diabetes are more prone to HHS, but people without diabetes — or a without diagnosis of diabetes — might experience it.

According to the AAFP, the following factors may increase the risk:

Some of these can also occur with diabetes and may be a complication of diabetes.

Early warning signs

Symptoms include:

• a dry mouth
• a weak and rapid pulse
• a low-grade fever (in adults)
• a headache, nausea, and vomiting (in children)
• seizures
• a loss of consciousness
• temporary partial paralysis

Blood tests may show that the person’s blood glucose level is above 600 mg/dl.

Action to take

If a person has these symptoms, they or someone else should seek medical help at once.

The person will require treatment in the hospital, which will include rehydration, the use of insulin, and any necessary treatment for an underlying cause.

Researchers note that the processes that occur with diabetes can also affect the immune system.

As a result, a person with diabetes will have a higher chance of developing an infection. When a person has diabetes, any symptoms and complications of an infection may be more severe and possibly life-threatening.

Common infections that can occur with diabetes include:

Minor infections can spread to deeper tissue, possibly leading to sepsis and other potentially life-threatening complications.

Factors that increase the risk include:

• a recent injury or illness
• an open wound
• exposure to pathogens, such as viruses, fungus, or bacteria

People with poorly controlled diabetes and those with other complications should take care to:

• avoid infections where possible, for example, by having any vaccinations that the doctor recommends
• checking the skin, and especially the feet, for wounds
• getting early treatment for any wound or possible infection

Warning signs and action

If a person experiences a fever, pain, and swelling in any part of their body, they should seek medical advice.

An infection can become rapidly become serious when a person has diabetes.

Share on PinterestPeople with diabetes have a higher risk of heart attack and stroke than others.

Diabetes can harm almost every system in the body and increase the risk of many other diseases.

People with diabetes can experience a range of problems, including:

• cardiovascular disease, which may lead to a heart attack or a stroke
• poor circulation that leads to ulcers in the legs
• vision loss
• kidney failure
• obesity

Poorly controlled diabetes, a history of infections, and having other health conditions all increase the risk of these complications.

A diabetic emergency happens when symptoms relating to diabetes overwhelm the body.

At this point, home treatment is unlikely to help, and delaying medical care could cause permanent damage or death.

Some of the signs that can indicate a serious problem include:

• chest pain that radiates down the arm
• difficulty breathing
• a fever
• a severe headache and weakness in one side of the body
• seizures
• loss of consciousness

If there are signs of an emergency, the person should go to the emergency room, or they or someone with them should call 911 immediately.

Without rapid help, some diabetic emergencies can be life-threatening.

It is not always possible to prevent an emergency, but being able to recognize the signs can improve the chances of early treatment and a full recovery.

Strategies that can help to reduce the risk of an emergency include:

Following the treatment plan: Use medications as a doctor prescribes and keep in touch with the healthcare team. If a person cannot remember whether or not they took their last dose of drugs, they should ask a doctor before taking a further dose. This can help to prevent hypoglycemia. Anyone who notices a change in their symptoms should see a doctor.

Eating healthful, balanced, regular meals: People who use insulin or other medications that lower blood glucose should ask their doctor about what foods to eat, how much, and when, in order to maintain stable blood sugar levels. Small, frequent meals are better than fewer larger meals.

Limiting alcohol and sugary drinks: These drinks contain carbs, which can raise blood sugar and contribute to obesity. Alcohol consumption can also increase the risk of other health conditions.

Treating infections early: Diabetes can compromise the immune system and the body’s organs, making it easier for infections to develop. Prompt treatment can prevent minor problems from becoming more serious.

Exercising regularly: Exercise helps the body control blood sugar. It can also help with symptoms that often accompany diabetes, such as high blood pressure, obesity, and poor circulation.

No specific medication or procedure can stop a diabetic emergency once it occurs, but emergency planning can increase the chances of getting prompt help.

People with diabetes should:

• let their friends know they have diabetes
• wear a medical ID so that people will know what to do in an emergency
• keep a mobile phone charged and ready to contact emergency responders
• know who to call with questions about diabetes emergencies

Diabetes is a serious and complex condition, and an emergency can arise for various reasons.

Managing the condition through medication and a healthful lifestyle, ensuring that others know the person has diabetes, and learning as much as possible about diabetes and its complications can reduce the risk of an emergency arising.

Warning signs and what to do

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Diabetes symptoms can sometimes turn into an emergency quite quickly and suddenly. It is crucial to know the signs and symptoms of an emergency and what to do if one arises.

According to the Centers for Disease Control and Prevention (CDC), around 12.6 percent of the population in the United States have diabetes, with or without a diagnosis.

In the past, diabetes was often fatal, but recent progress in science and medication mean that most people with diabetes can now enjoy a normal lifespan.

However, the CDC state that diabetes, or complications related to it, is still the seventh most frequent form of death in the U. S., and it was responsible for nearly 25 deaths in every 100,000 in 2016.

Hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), diabetic ketoacidosis (DKA), greater susceptibility to infections, and a range of complications all increase the risk.

Knowing the signs and being able to respond promptly may save lives. Read on to find out how and why diabetes can become dangerous, and what to do about it.

Any sudden, unexplained symptom warrants a call to the doctor.

Share on PinterestA headache can signal hypoglycemia. Without attention, this can lead to an emergency.

Both type 1 and type 2 diabetes prevent the body from managing blood sugar levels effectively.

In type 1 diabetes, the immune system destroys the cells that produce insulin. Type 2 diabetes reduces the body’s ability to respond to insulin. Consequently, the body does not produce enough insulin to manage the glucose in the body.

Most diabetic emergencies relate to disruptions in a person’s blood sugar levels, but complications relating to diabetes can also lead to problems.

Here are some of the most common emergencies that can arise, their warning signs, and what to do.

Hypoglycemia happens when blood sugar levels are too low, usually below 70 milligrams per deciliter (mg/dl).

Without treatment, such low levels of blood sugar can lead to seizures and become life-threatening. It is a medical emergency. However, it is easy to put right in the short-term as long as a person recognizes the signs.

Hypoglycemia can occur for many reasons, but, in diabetes, it usually stems from the use of insulin or other medications that control blood sugar.

Blood sugar levels may drop dangerously low when a person:

• takes more insulin than they need for their current food intake or exercise levels
• consumes too much alcohol
• misses or delays meals
• does more exercise than they expected to do

Early warning signs

The warning signs of hypoglycemia include:

• confusion, dizziness, and nausea
• feeling hungry
• feeling shaky, nervous, irritable or anxious
• sweating, chills, and pale, clammy skin
• rapid heartbeat
• weakness and tiredness
• tingling in the mouth area
• headaches
• seizures
• coma or loss of consciousness
• weight loss if hypoglycemia persists

If a person tests their blood sugar levels when they experience these symptoms, they may find that they are below 70 mg/dl.

Action to take

If the symptoms appear suddenly, the person should take a high-carb snack to resolve them, such as:

• a glucose tablet
• a sweet juice
• a candy
• a sugar lump

The American Diabetes Association (ADA) recommend the following action:

1. Take 15 grams (g) of carbohydrate and wait 15 minutes before testing blood sugar levels.
2. If levels are still below 70 mg/dl, take another 15 g of carbs, wait, and test again.
3. When glucose levels are above 70 mg/dl, eat a meal.
4. If symptoms persist, seek medical help for any underlying condition.

If the person is conscious but unable to eat, someone who is with them should put a little honey or other sweet syrup inside their cheek and monitor their condition.

If they lose consciousness, any bystander should call 911 and ask for emergency medical help.

If a person experience regular hypoglycemia despite following the treatment plan, or if changes in blood sugar level occur suddenly in response to a medication change, they should see a doctor.

Hyperglycemia is when blood sugar levels are too high because insulin is not present or the body is not responding to the insulin that is present.

It can happen if a person with diabetes does not receive treatment.

Early warning signs

The person may notice:

• increased thirst
• the need to urinate more frequently
• headaches
• blurry vision
• fatigue

Tests will show high levels of sugar in the blood and urine.

Action to take

In mild cases, ways of resolving this include:

• exercising more
• eating less
• changing the dose of insulin or other medication

However, very high blood sugar levels can lead to life-threatening complications, such as diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome.

If symptoms worsen or if a person experiences difficulty breathing or has a very dry mouth or a fruity smell on their breath, they should see a doctor as soon as possible.

Click here to find out more about hyperglycemia.

Diabetic ketoacidosis (DKA) occurs when the body does not have enough insulin to allow glucose to enter the cells properly.

The cells do not have enough glucose to use for energy, so, instead, the body breaks down fat for fuel.

When this happens, the body produces substances known as ketones. High levels of ketones are toxic because they can raise the acidity levels of the blood.

Reasons why DKA might happen include:

• low insulin levels, due to not taking insulin or because another factor stops the insulin from working correctly
• not eating enough
• having an insulin reaction

People with both type 1 and type 2 diabetes can develop DKA.

Warning signs

The warning signs include:

• feeling thirsty or having a dry mouth
• frequent urination
• fatigue
• dry or flushed skin
• nausea, vomiting, or abdominal pain
• difficulty focusing
• confusion
• difficulty breathing
• a fruity smell on the breath

Action to take

If a ketone test shows that ketones are present and a blood glucose test shows that a person’s blood sugar levels are 240 m/dl or above, the ADA advise them to see a doctor.

Anyone with these symptoms should seek medical help as soon as possible, as DKA can become a medical emergency.

People can buy testing kits for ketones and blood sugar levels online.

According to the American Academy of Family Physicians (AAFP), hyperglycemic hyperosmolar syndrome (HHS) occurs when blood sugar levels become dangerously high, usually above 600 mg/dl.

This may happen with or without DKA, and it can be life-threatening.

People with poorly controlled type 2 diabetes are more prone to HHS, but people without diabetes — or a without diagnosis of diabetes — might experience it.

According to the AAFP, the following factors may increase the risk:

Some of these can also occur with diabetes and may be a complication of diabetes.

Early warning signs

Symptoms include:

• a dry mouth
• a weak and rapid pulse
• a low-grade fever (in adults)
• a headache, nausea, and vomiting (in children)
• seizures
• a loss of consciousness
• temporary partial paralysis

Blood tests may show that the person’s blood glucose level is above 600 mg/dl.

Action to take

If a person has these symptoms, they or someone else should seek medical help at once.

The person will require treatment in the hospital, which will include rehydration, the use of insulin, and any necessary treatment for an underlying cause.

Researchers note that the processes that occur with diabetes can also affect the immune system.

As a result, a person with diabetes will have a higher chance of developing an infection. When a person has diabetes, any symptoms and complications of an infection may be more severe and possibly life-threatening.

Common infections that can occur with diabetes include:

Minor infections can spread to deeper tissue, possibly leading to sepsis and other potentially life-threatening complications.

Factors that increase the risk include:

• a recent injury or illness
• an open wound
• exposure to pathogens, such as viruses, fungus, or bacteria

People with poorly controlled diabetes and those with other complications should take care to:

• avoid infections where possible, for example, by having any vaccinations that the doctor recommends
• checking the skin, and especially the feet, for wounds
• getting early treatment for any wound or possible infection

Warning signs and action

If a person experiences a fever, pain, and swelling in any part of their body, they should seek medical advice.

An infection can become rapidly become serious when a person has diabetes.

Share on PinterestPeople with diabetes have a higher risk of heart attack and stroke than others.

Diabetes can harm almost every system in the body and increase the risk of many other diseases.

People with diabetes can experience a range of problems, including:

• cardiovascular disease, which may lead to a heart attack or a stroke
• poor circulation that leads to ulcers in the legs
• vision loss
• kidney failure
• obesity

Poorly controlled diabetes, a history of infections, and having other health conditions all increase the risk of these complications.

A diabetic emergency happens when symptoms relating to diabetes overwhelm the body.

At this point, home treatment is unlikely to help, and delaying medical care could cause permanent damage or death.

Some of the signs that can indicate a serious problem include:

• chest pain that radiates down the arm
• difficulty breathing
• a fever
• a severe headache and weakness in one side of the body
• seizures
• loss of consciousness

If there are signs of an emergency, the person should go to the emergency room, or they or someone with them should call 911 immediately.

Without rapid help, some diabetic emergencies can be life-threatening.

It is not always possible to prevent an emergency, but being able to recognize the signs can improve the chances of early treatment and a full recovery.

Strategies that can help to reduce the risk of an emergency include:

Following the treatment plan: Use medications as a doctor prescribes and keep in touch with the healthcare team. If a person cannot remember whether or not they took their last dose of drugs, they should ask a doctor before taking a further dose. This can help to prevent hypoglycemia. Anyone who notices a change in their symptoms should see a doctor.

Eating healthful, balanced, regular meals: People who use insulin or other medications that lower blood glucose should ask their doctor about what foods to eat, how much, and when, in order to maintain stable blood sugar levels. Small, frequent meals are better than fewer larger meals.

Limiting alcohol and sugary drinks: These drinks contain carbs, which can raise blood sugar and contribute to obesity. Alcohol consumption can also increase the risk of other health conditions.

Treating infections early: Diabetes can compromise the immune system and the body’s organs, making it easier for infections to develop. Prompt treatment can prevent minor problems from becoming more serious.

Exercising regularly: Exercise helps the body control blood sugar. It can also help with symptoms that often accompany diabetes, such as high blood pressure, obesity, and poor circulation.

No specific medication or procedure can stop a diabetic emergency once it occurs, but emergency planning can increase the chances of getting prompt help.

People with diabetes should:

• let their friends know they have diabetes
• wear a medical ID so that people will know what to do in an emergency
• keep a mobile phone charged and ready to contact emergency responders
• know who to call with questions about diabetes emergencies

Diabetes is a serious and complex condition, and an emergency can arise for various reasons.

Managing the condition through medication and a healthful lifestyle, ensuring that others know the person has diabetes, and learning as much as possible about diabetes and its complications can reduce the risk of an emergency arising.

Warning signs and what to do

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Diabetes symptoms can sometimes turn into an emergency quite quickly and suddenly. It is crucial to know the signs and symptoms of an emergency and what to do if one arises.

According to the Centers for Disease Control and Prevention (CDC), around 12.6 percent of the population in the United States have diabetes, with or without a diagnosis.

In the past, diabetes was often fatal, but recent progress in science and medication mean that most people with diabetes can now enjoy a normal lifespan.

However, the CDC state that diabetes, or complications related to it, is still the seventh most frequent form of death in the U.S., and it was responsible for nearly 25 deaths in every 100,000 in 2016.

Hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), diabetic ketoacidosis (DKA), greater susceptibility to infections, and a range of complications all increase the risk.

Knowing the signs and being able to respond promptly may save lives. Read on to find out how and why diabetes can become dangerous, and what to do about it.

Any sudden, unexplained symptom warrants a call to the doctor.

Share on PinterestA headache can signal hypoglycemia. Without attention, this can lead to an emergency.

Both type 1 and type 2 diabetes prevent the body from managing blood sugar levels effectively.

In type 1 diabetes, the immune system destroys the cells that produce insulin. Type 2 diabetes reduces the body’s ability to respond to insulin. Consequently, the body does not produce enough insulin to manage the glucose in the body.

Most diabetic emergencies relate to disruptions in a person’s blood sugar levels, but complications relating to diabetes can also lead to problems.

Here are some of the most common emergencies that can arise, their warning signs, and what to do.

Hypoglycemia happens when blood sugar levels are too low, usually below 70 milligrams per deciliter (mg/dl).

Without treatment, such low levels of blood sugar can lead to seizures and become life-threatening. It is a medical emergency. However, it is easy to put right in the short-term as long as a person recognizes the signs.

Hypoglycemia can occur for many reasons, but, in diabetes, it usually stems from the use of insulin or other medications that control blood sugar.

Blood sugar levels may drop dangerously low when a person:

• takes more insulin than they need for their current food intake or exercise levels
• consumes too much alcohol
• misses or delays meals
• does more exercise than they expected to do

Early warning signs

The warning signs of hypoglycemia include:

• confusion, dizziness, and nausea
• feeling hungry
• feeling shaky, nervous, irritable or anxious
• sweating, chills, and pale, clammy skin
• rapid heartbeat
• weakness and tiredness
• tingling in the mouth area
• headaches
• seizures
• coma or loss of consciousness
• weight loss if hypoglycemia persists

If a person tests their blood sugar levels when they experience these symptoms, they may find that they are below 70 mg/dl.

Action to take

If the symptoms appear suddenly, the person should take a high-carb snack to resolve them, such as:

• a glucose tablet
• a sweet juice
• a candy
• a sugar lump

The American Diabetes Association (ADA) recommend the following action:

1. Take 15 grams (g) of carbohydrate and wait 15 minutes before testing blood sugar levels.
2. If levels are still below 70 mg/dl, take another 15 g of carbs, wait, and test again.
3. When glucose levels are above 70 mg/dl, eat a meal.
4. If symptoms persist, seek medical help for any underlying condition.

If the person is conscious but unable to eat, someone who is with them should put a little honey or other sweet syrup inside their cheek and monitor their condition.

If they lose consciousness, any bystander should call 911 and ask for emergency medical help.

If a person experience regular hypoglycemia despite following the treatment plan, or if changes in blood sugar level occur suddenly in response to a medication change, they should see a doctor.

Hyperglycemia is when blood sugar levels are too high because insulin is not present or the body is not responding to the insulin that is present.

It can happen if a person with diabetes does not receive treatment.

Early warning signs

The person may notice:

• increased thirst
• the need to urinate more frequently
• headaches
• blurry vision
• fatigue

Tests will show high levels of sugar in the blood and urine.

Action to take

In mild cases, ways of resolving this include:

• exercising more
• eating less
• changing the dose of insulin or other medication

However, very high blood sugar levels can lead to life-threatening complications, such as diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome.

If symptoms worsen or if a person experiences difficulty breathing or has a very dry mouth or a fruity smell on their breath, they should see a doctor as soon as possible.

Click here to find out more about hyperglycemia.

Diabetic ketoacidosis (DKA) occurs when the body does not have enough insulin to allow glucose to enter the cells properly.

The cells do not have enough glucose to use for energy, so, instead, the body breaks down fat for fuel.

When this happens, the body produces substances known as ketones. High levels of ketones are toxic because they can raise the acidity levels of the blood.

Reasons why DKA might happen include:

• low insulin levels, due to not taking insulin or because another factor stops the insulin from working correctly
• not eating enough
• having an insulin reaction

People with both type 1 and type 2 diabetes can develop DKA.

Warning signs

The warning signs include:

• feeling thirsty or having a dry mouth
• frequent urination
• fatigue
• dry or flushed skin
• nausea, vomiting, or abdominal pain
• difficulty focusing
• confusion
• difficulty breathing
• a fruity smell on the breath

Action to take

If a ketone test shows that ketones are present and a blood glucose test shows that a person’s blood sugar levels are 240 m/dl or above, the ADA advise them to see a doctor.

Anyone with these symptoms should seek medical help as soon as possible, as DKA can become a medical emergency.

People can buy testing kits for ketones and blood sugar levels online.

According to the American Academy of Family Physicians (AAFP), hyperglycemic hyperosmolar syndrome (HHS) occurs when blood sugar levels become dangerously high, usually above 600 mg/dl.

This may happen with or without DKA, and it can be life-threatening.

People with poorly controlled type 2 diabetes are more prone to HHS, but people without diabetes — or a without diagnosis of diabetes — might experience it.

According to the AAFP, the following factors may increase the risk:

Some of these can also occur with diabetes and may be a complication of diabetes.

Early warning signs

Symptoms include:

• a dry mouth
• a weak and rapid pulse
• a low-grade fever (in adults)
• a headache, nausea, and vomiting (in children)
• seizures
• a loss of consciousness
• temporary partial paralysis

Blood tests may show that the person’s blood glucose level is above 600 mg/dl.

Action to take

If a person has these symptoms, they or someone else should seek medical help at once.

The person will require treatment in the hospital, which will include rehydration, the use of insulin, and any necessary treatment for an underlying cause.

Researchers note that the processes that occur with diabetes can also affect the immune system.

As a result, a person with diabetes will have a higher chance of developing an infection. When a person has diabetes, any symptoms and complications of an infection may be more severe and possibly life-threatening.

Common infections that can occur with diabetes include:

Minor infections can spread to deeper tissue, possibly leading to sepsis and other potentially life-threatening complications.

Factors that increase the risk include:

• a recent injury or illness
• an open wound
• exposure to pathogens, such as viruses, fungus, or bacteria

People with poorly controlled diabetes and those with other complications should take care to:

• avoid infections where possible, for example, by having any vaccinations that the doctor recommends
• checking the skin, and especially the feet, for wounds
• getting early treatment for any wound or possible infection

Warning signs and action

If a person experiences a fever, pain, and swelling in any part of their body, they should seek medical advice.

An infection can become rapidly become serious when a person has diabetes.

Share on PinterestPeople with diabetes have a higher risk of heart attack and stroke than others.

Diabetes can harm almost every system in the body and increase the risk of many other diseases.

People with diabetes can experience a range of problems, including:

• cardiovascular disease, which may lead to a heart attack or a stroke
• poor circulation that leads to ulcers in the legs
• vision loss
• kidney failure
• obesity

Poorly controlled diabetes, a history of infections, and having other health conditions all increase the risk of these complications.

A diabetic emergency happens when symptoms relating to diabetes overwhelm the body.

At this point, home treatment is unlikely to help, and delaying medical care could cause permanent damage or death.

Some of the signs that can indicate a serious problem include:

• chest pain that radiates down the arm
• difficulty breathing
• a fever
• a severe headache and weakness in one side of the body
• seizures
• loss of consciousness

If there are signs of an emergency, the person should go to the emergency room, or they or someone with them should call 911 immediately.

Without rapid help, some diabetic emergencies can be life-threatening.

It is not always possible to prevent an emergency, but being able to recognize the signs can improve the chances of early treatment and a full recovery.

Strategies that can help to reduce the risk of an emergency include:

Following the treatment plan: Use medications as a doctor prescribes and keep in touch with the healthcare team. If a person cannot remember whether or not they took their last dose of drugs, they should ask a doctor before taking a further dose. This can help to prevent hypoglycemia. Anyone who notices a change in their symptoms should see a doctor.

Eating healthful, balanced, regular meals: People who use insulin or other medications that lower blood glucose should ask their doctor about what foods to eat, how much, and when, in order to maintain stable blood sugar levels. Small, frequent meals are better than fewer larger meals.

Limiting alcohol and sugary drinks: These drinks contain carbs, which can raise blood sugar and contribute to obesity. Alcohol consumption can also increase the risk of other health conditions.

Treating infections early: Diabetes can compromise the immune system and the body’s organs, making it easier for infections to develop. Prompt treatment can prevent minor problems from becoming more serious.

Exercising regularly: Exercise helps the body control blood sugar. It can also help with symptoms that often accompany diabetes, such as high blood pressure, obesity, and poor circulation.

No specific medication or procedure can stop a diabetic emergency once it occurs, but emergency planning can increase the chances of getting prompt help.

People with diabetes should:

• let their friends know they have diabetes
• wear a medical ID so that people will know what to do in an emergency
• keep a mobile phone charged and ready to contact emergency responders
• know who to call with questions about diabetes emergencies

Diabetes is a serious and complex condition, and an emergency can arise for various reasons.

Managing the condition through medication and a healthful lifestyle, ensuring that others know the person has diabetes, and learning as much as possible about diabetes and its complications can reduce the risk of an emergency arising.

Warning signs and what to do

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Diabetes symptoms can sometimes turn into an emergency quite quickly and suddenly. It is crucial to know the signs and symptoms of an emergency and what to do if one arises.

According to the Centers for Disease Control and Prevention (CDC), around 12.6 percent of the population in the United States have diabetes, with or without a diagnosis.

In the past, diabetes was often fatal, but recent progress in science and medication mean that most people with diabetes can now enjoy a normal lifespan.

However, the CDC state that diabetes, or complications related to it, is still the seventh most frequent form of death in the U.S., and it was responsible for nearly 25 deaths in every 100,000 in 2016.

Hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), diabetic ketoacidosis (DKA), greater susceptibility to infections, and a range of complications all increase the risk.

Knowing the signs and being able to respond promptly may save lives. Read on to find out how and why diabetes can become dangerous, and what to do about it.

Any sudden, unexplained symptom warrants a call to the doctor.

Share on PinterestA headache can signal hypoglycemia. Without attention, this can lead to an emergency.

Both type 1 and type 2 diabetes prevent the body from managing blood sugar levels effectively.

In type 1 diabetes, the immune system destroys the cells that produce insulin. Type 2 diabetes reduces the body’s ability to respond to insulin. Consequently, the body does not produce enough insulin to manage the glucose in the body.

Most diabetic emergencies relate to disruptions in a person’s blood sugar levels, but complications relating to diabetes can also lead to problems.

Here are some of the most common emergencies that can arise, their warning signs, and what to do.

Hypoglycemia happens when blood sugar levels are too low, usually below 70 milligrams per deciliter (mg/dl).

Without treatment, such low levels of blood sugar can lead to seizures and become life-threatening. It is a medical emergency. However, it is easy to put right in the short-term as long as a person recognizes the signs.

Hypoglycemia can occur for many reasons, but, in diabetes, it usually stems from the use of insulin or other medications that control blood sugar.

Blood sugar levels may drop dangerously low when a person:

• takes more insulin than they need for their current food intake or exercise levels
• consumes too much alcohol
• misses or delays meals
• does more exercise than they expected to do

Early warning signs

The warning signs of hypoglycemia include:

• confusion, dizziness, and nausea
• feeling hungry
• feeling shaky, nervous, irritable or anxious
• sweating, chills, and pale, clammy skin
• rapid heartbeat
• weakness and tiredness
• tingling in the mouth area
• headaches
• seizures
• coma or loss of consciousness
• weight loss if hypoglycemia persists

If a person tests their blood sugar levels when they experience these symptoms, they may find that they are below 70 mg/dl.

Action to take

If the symptoms appear suddenly, the person should take a high-carb snack to resolve them, such as:

• a glucose tablet
• a sweet juice
• a candy
• a sugar lump

The American Diabetes Association (ADA) recommend the following action:

1. Take 15 grams (g) of carbohydrate and wait 15 minutes before testing blood sugar levels.
2. If levels are still below 70 mg/dl, take another 15 g of carbs, wait, and test again.
3. When glucose levels are above 70 mg/dl, eat a meal.
4. If symptoms persist, seek medical help for any underlying condition.

If the person is conscious but unable to eat, someone who is with them should put a little honey or other sweet syrup inside their cheek and monitor their condition.

If they lose consciousness, any bystander should call 911 and ask for emergency medical help.

If a person experience regular hypoglycemia despite following the treatment plan, or if changes in blood sugar level occur suddenly in response to a medication change, they should see a doctor.

Hyperglycemia is when blood sugar levels are too high because insulin is not present or the body is not responding to the insulin that is present.

It can happen if a person with diabetes does not receive treatment.

Early warning signs

The person may notice:

• increased thirst
• the need to urinate more frequently
• headaches
• blurry vision
• fatigue

Tests will show high levels of sugar in the blood and urine.

Action to take

In mild cases, ways of resolving this include:

• exercising more
• eating less
• changing the dose of insulin or other medication

However, very high blood sugar levels can lead to life-threatening complications, such as diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome.

If symptoms worsen or if a person experiences difficulty breathing or has a very dry mouth or a fruity smell on their breath, they should see a doctor as soon as possible.

Click here to find out more about hyperglycemia.

Diabetic ketoacidosis (DKA) occurs when the body does not have enough insulin to allow glucose to enter the cells properly.

The cells do not have enough glucose to use for energy, so, instead, the body breaks down fat for fuel.

When this happens, the body produces substances known as ketones. High levels of ketones are toxic because they can raise the acidity levels of the blood.

Reasons why DKA might happen include:

• low insulin levels, due to not taking insulin or because another factor stops the insulin from working correctly
• not eating enough
• having an insulin reaction

People with both type 1 and type 2 diabetes can develop DKA.

Warning signs

The warning signs include:

• feeling thirsty or having a dry mouth
• frequent urination
• fatigue
• dry or flushed skin
• nausea, vomiting, or abdominal pain
• difficulty focusing
• confusion
• difficulty breathing
• a fruity smell on the breath

Action to take

If a ketone test shows that ketones are present and a blood glucose test shows that a person’s blood sugar levels are 240 m/dl or above, the ADA advise them to see a doctor.

Anyone with these symptoms should seek medical help as soon as possible, as DKA can become a medical emergency.

People can buy testing kits for ketones and blood sugar levels online.

According to the American Academy of Family Physicians (AAFP), hyperglycemic hyperosmolar syndrome (HHS) occurs when blood sugar levels become dangerously high, usually above 600 mg/dl.

This may happen with or without DKA, and it can be life-threatening.

People with poorly controlled type 2 diabetes are more prone to HHS, but people without diabetes — or a without diagnosis of diabetes — might experience it.

According to the AAFP, the following factors may increase the risk:

Some of these can also occur with diabetes and may be a complication of diabetes.

Early warning signs

Symptoms include:

• a dry mouth
• a weak and rapid pulse
• a low-grade fever (in adults)
• a headache, nausea, and vomiting (in children)
• seizures
• a loss of consciousness
• temporary partial paralysis

Blood tests may show that the person’s blood glucose level is above 600 mg/dl.

Action to take

If a person has these symptoms, they or someone else should seek medical help at once.

The person will require treatment in the hospital, which will include rehydration, the use of insulin, and any necessary treatment for an underlying cause.

Researchers note that the processes that occur with diabetes can also affect the immune system.

As a result, a person with diabetes will have a higher chance of developing an infection. When a person has diabetes, any symptoms and complications of an infection may be more severe and possibly life-threatening.

Common infections that can occur with diabetes include:

Minor infections can spread to deeper tissue, possibly leading to sepsis and other potentially life-threatening complications.

Factors that increase the risk include:

• a recent injury or illness
• an open wound
• exposure to pathogens, such as viruses, fungus, or bacteria

People with poorly controlled diabetes and those with other complications should take care to:

• avoid infections where possible, for example, by having any vaccinations that the doctor recommends
• checking the skin, and especially the feet, for wounds
• getting early treatment for any wound or possible infection

Warning signs and action

If a person experiences a fever, pain, and swelling in any part of their body, they should seek medical advice.

An infection can become rapidly become serious when a person has diabetes.

Share on PinterestPeople with diabetes have a higher risk of heart attack and stroke than others.

Diabetes can harm almost every system in the body and increase the risk of many other diseases.

People with diabetes can experience a range of problems, including:

• cardiovascular disease, which may lead to a heart attack or a stroke
• poor circulation that leads to ulcers in the legs
• vision loss
• kidney failure
• obesity

Poorly controlled diabetes, a history of infections, and having other health conditions all increase the risk of these complications.

A diabetic emergency happens when symptoms relating to diabetes overwhelm the body.

At this point, home treatment is unlikely to help, and delaying medical care could cause permanent damage or death.

Some of the signs that can indicate a serious problem include:

• chest pain that radiates down the arm
• difficulty breathing
• a fever
• a severe headache and weakness in one side of the body
• seizures
• loss of consciousness

If there are signs of an emergency, the person should go to the emergency room, or they or someone with them should call 911 immediately.

Without rapid help, some diabetic emergencies can be life-threatening.

It is not always possible to prevent an emergency, but being able to recognize the signs can improve the chances of early treatment and a full recovery.

Strategies that can help to reduce the risk of an emergency include:

Following the treatment plan: Use medications as a doctor prescribes and keep in touch with the healthcare team. If a person cannot remember whether or not they took their last dose of drugs, they should ask a doctor before taking a further dose. This can help to prevent hypoglycemia. Anyone who notices a change in their symptoms should see a doctor.

Eating healthful, balanced, regular meals: People who use insulin or other medications that lower blood glucose should ask their doctor about what foods to eat, how much, and when, in order to maintain stable blood sugar levels. Small, frequent meals are better than fewer larger meals.

Limiting alcohol and sugary drinks: These drinks contain carbs, which can raise blood sugar and contribute to obesity. Alcohol consumption can also increase the risk of other health conditions.

Treating infections early: Diabetes can compromise the immune system and the body’s organs, making it easier for infections to develop. Prompt treatment can prevent minor problems from becoming more serious.

Exercising regularly: Exercise helps the body control blood sugar. It can also help with symptoms that often accompany diabetes, such as high blood pressure, obesity, and poor circulation.

No specific medication or procedure can stop a diabetic emergency once it occurs, but emergency planning can increase the chances of getting prompt help.

People with diabetes should:

• let their friends know they have diabetes
• wear a medical ID so that people will know what to do in an emergency
• keep a mobile phone charged and ready to contact emergency responders
• know who to call with questions about diabetes emergencies

Diabetes is a serious and complex condition, and an emergency can arise for various reasons.

Managing the condition through medication and a healthful lifestyle, ensuring that others know the person has diabetes, and learning as much as possible about diabetes and its complications can reduce the risk of an emergency arising.

Diabetic Shock and Insulin Reactions: Causes, Symptoms, and Treatments

Severe hypoglycemia, or insulin shock, is a serious health risk for anyone with diabetes. Also called insulin reaction, bcause of too much insulin, it can occur anytime there is an imbalance between the insulin in your system, the amount of food you eat, or your level of physical activity. It can even happen while you are doing all you think you can do to manage your diabetes.

The symptoms of insulin shock may seem mild at first. But they should not be ignored. If it isn’t treated quickly, hypoglycemia can become a very serious condition that causes you to faint, requiring immediate medical attention. Insulin shock can also lead to a coma and death. It’s important that not only you, but your family and others around you, learn to recognize the signs of hypoglycemia and know what to do about them. It could save your life.

What Is Hypoglycemia?

Hypoglycemia is a low level of blood sugar. The cells in your body use sugar from carbohydrates for energy. Insulin, which normally is made in the pancreas, is necessary for sugar to enter the cells. It helps keep the levels of sugar in the blood from getting too high.

Continued

It’s important to maintain the proper level of sugar in your blood. Levels that are too high can cause severe dehydration, which can be life-threatening. Over time, excess sugar in the body does serious damage to organs such as your heart, eyes, and nervous system.

Ordinarily, the production of insulin is regulated inside your body so that you naturally have the amount of insulin you need to help control the level of sugar. But if your body doesn’t make its own insulin or if it can’t effectively use the insulin it does produce, you need to inject insulin as a medicine or take another medication that will increase the amount of insulin your body does make. So if you need to medicate with insulin, it becomes your responsibility to see that you have the amount of insulin you need when you need it.

When to take insulin or another medication and how much to use depends on when, what, and how much food you eat. It also depends on your level of physical activity since the cells in your body use more sugar when you are active. Hypoglycemia is a reaction to too much insulin in your system. The insulin speeds up the lowering of the blood glucose level. Then without eating or with your body burning sugar faster because of physical activity, the level of sugar becomes dangerously low.

What Causes Hypoglycemia?

Several things can cause hypoglycemia. Your blood sugar level could be low if you:

• Become more physically active than usual
• Miss a meal
• Change when or how much you normally eat
• Take your insulin or medication in a different amount or at a different time than usual
• Drink alcohol excessively without eating

Are There Symptoms of Hypoglycemia or Warning Signs of Insulin Shock?

The symptoms of hypoglycemia can be classified as mild or early, moderate, and severe. Mild symptoms include:

When hypoglycemia becomes severe, symptoms may include:

Hypoglycemia can also occur overnight while you sleep. Symptoms may include:

• Crying out in your sleep
• Nightmares
• Damp pajamas or sheets resulting from perspiration
• Waking tired, irritable, or confused

If you experience any possible signs of mild hypoglycemia, it’s important to check your blood sugar if you can to make sure it isn’t low. If it is, you should treat it quickly or seek emergency care. If you can’t check your blood sugar level for some reason, you should go ahead and treat yourself for low blood sugar if you notice symptoms or seek emergency care. If symptoms are severe or you are unable to help yourself, seek emergency medical attention.

How Is Hypoglycemia Treated?

If your hypoglycemia is mild or moderate, the best way to raise your blood sugar level quickly is to eat or drink something that contains 15 to 20 grams of glucose or other sugar. You might take 3 to 4 glucose tablets or 1/3 to 1/2 tube of glucose in gel form, which you can buy at the drugstore. Or you may want to drink a half cup of fruit juice (orange juice or apple juice).

Other snacks you can use to raise your sugar level include:

• One-half cup of regular soda — not diet
• Cup of milk
• 1 tablespoon of sugar
• 1 tablespoon of honey, molasses, or corn syrup
• One-quarter cup raisins
• 2 large or 6 small sugar cubes dissolved in water
• 5 hard candies

Continued

You can also ask your doctor or dietitian for recommendations for other snack items that can help raise your blood sugar level when you need to.

After you’ve taken a snack, wait 15 minutes and check your blood sugar level again. If it is still low, eat another snack, then wait 15 minutes and check it again. Repeat the process until your blood sugar level is in its normal target range. Following that, eat another small snack if your regular meal is more than an hour away, such as half a sandwich, 1 ounce of cheese with 4 to 6 crackers, or 1 tablespoon peanut butter with 4 to 6 crackers.

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If you lose consciousness, you will need immediate medical attention. It’s important that you educate the people in your family and the people you work with about insulin shock and about what to do if it happens. Someone should call 911 or arrange to get you to an emergency room if that’s not possible. If you go to the hospital, doctors may give sugar through a vein (intravenously).

You can ask your doctor to prescribe a glucagon rescue kit and then teach others how to use it. Glucagon is a natural hormone that rapidly causes the level of sugar in your blood to rise. If you are unconscious, someone injecting you with glucagon even before emergency help arrives can prevent further complications and help you recover.

Diabetic hypoglycemia – Symptoms and causes

Overview

Diabetic hypoglycemia occurs when someone with diabetes doesn’t have enough sugar (glucose) in his or her blood. Glucose is the main source of fuel for the body and brain, so you can’t function well if you don’t have enough.

Low blood sugar (hypoglycemia) is defined as a blood sugar level below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L).

Pay attention to the early warning signs of hypoglycemia, and treat low blood sugar promptly. You can raise your blood sugar quickly by eating or drinking a simple sugar source, such as glucose tablets or fruit juice. Tell family and friends what symptoms to look for and what to do if you’re not able to treat the condition yourself.

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Symptoms

Early warning signs and symptoms

Initial signs and symptoms of diabetic hypoglycemia include:

• Shakiness
• Dizziness
• Sweating
• Hunger
• Fast heartbeat
• Inability to concentrate
• Confusion
• Irritability or moodiness
• Anxiety or nervousness
• Headache

Nighttime signs and symptoms

If diabetic hypoglycemia occurs when you’re sleeping, signs and symptoms that may awaken you include:

• Damp sheets or nightclothes due to perspiration
• Nightmares
• Tiredness, irritability or confusion upon waking

Severe signs and symptoms

If diabetic hypoglycemia isn’t treated, signs and symptoms of severe hypoglycemia can occur. These include:

• Clumsiness or jerky movements
• Inability to eat or drink
• Muscle weakness
• Difficulty speaking or slurred speech
• Blurry or double vision
• Drowsiness
• Confusion
• Convulsions or seizures
• Unconsciousness
• Death, rarely

Symptoms can differ from person to person or from episode to episode. Some people don’t have any noticeable symptoms. It’s also possible you won’t have any symptoms of hypoglycemia, so it’s important to monitor your blood sugar levels regularly and keep track of how you’re feeling when your blood sugar is low.

When to see a doctor

Severe hypoglycemia can lead to serious problems, including seizures or unconsciousness, that require emergency care. Make sure your family, friends and co-workers know what to do in an emergency.

If you’re with someone who loses consciousness or can’t swallow due to low blood sugar:

• Don’t inject insulin, as this will cause blood sugar levels to drop even further
• Don’t give fluids or food, because these could cause choking
• Give glucagon — a hormone that stimulates the release of sugar into the blood — through injection or nasally
• Call 911 or emergency services in your area for immediate treatment if glucagon isn’t on hand

If you have symptoms of hypoglycemia several times a week or more, see your doctor. You may need to change your medication dosage or timing, or otherwise adjust your diabetes treatment regimen.

Causes

Low blood sugar is most common among people who take insulin, but it can also occur if you’re taking certain oral diabetes medications.

Common causes of diabetic hypoglycemia include:

• Taking too much insulin or diabetes medication
• Not eating enough
• Postponing or skipping a meal or snack
• Increasing exercise or physical activity without eating more or adjusting your medications
• Drinking alcohol

Blood sugar regulation

The hormone insulin lowers blood sugar levels when blood sugar is too high. If you have type 1 or type 2 diabetes and need insulin to control your blood sugar, taking more insulin than you need can cause your blood sugar level to drop too low and result in hypoglycemia.

Your blood sugar can also drop too low if, after taking your diabetes medication, you eat less than usual (most of the body’s glucose comes from food), or if you exercise more than you normally do, which uses extra glucose. Maintaining the balance between insulin, food and activity isn’t always easy, but your doctor or diabetes educator can work with you to try to prevent low blood sugar levels.

Risk factors

Some people have a greater risk of diabetic hypoglycemia, including:

• People using insulin
• People taking certain oral diabetes drugs (sulfonylureas)
• Young children and older adults
• Those with impaired liver or kidney function
• People who’ve had diabetes for a longer time
• People who don’t feel low blood sugar symptoms (hypoglycemia unawareness)
• Those taking multiple medications
• Anyone with a disability that prevents a quick response to falling blood sugar levels
• People who drink alcohol

Complications

If you ignore the symptoms of hypoglycemia too long, you may lose consciousness. That’s because your brain needs glucose to function. Recognize the signs and symptoms of hypoglycemia early, because if untreated, hypoglycemia can lead to:

• Seizures
• Loss of consciousness
• Death

Take your early symptoms seriously. Diabetic hypoglycemia can increase the risk of serious — even deadly — accidents.

Prevention

To help prevent diabetic hypoglycemia:

• Monitor your blood sugar. Depending on your treatment plan, you may check and record your blood sugar level several times a week or multiple times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.
• Don’t skip or delay meals or snacks. If you take insulin or oral diabetes medication, be consistent about the amount you eat and the timing of your meals and snacks.
• Measure medication carefully, and take it on time. Take your medication as recommended by your doctor.
• Adjust your medication or eat additional snacks if you increase your physical activity. The adjustment depends on the blood sugar test results, the type and length of the activity, and what medications you take.
• Eat a meal or snack with alcohol, if you choose to drink. Drinking alcohol on an empty stomach can cause hypoglycemia. Alcohol may also cause delayed hypoglycemia hours later, making blood sugar monitoring even more important.
• Record your low glucose reactions. This can help you and your health care team identify patterns contributing to hypoglycemia and find ways to prevent them.
• Carry some form of diabetes identification so that in an emergency others will know that you have diabetes. Use a medical identification necklace or bracelet and wallet card.

Hypoglycemia (Low Blood Glucose) | ADA

Throughout the day, depending on multiple factors, blood sugar (also called blood glucose) levels will vary—up or down. This is normal. If it varies within a certain range, you probably won’t be able to tell. But if it goes below the healthy range and is not treated, it can get dangerous.

Low blood sugar is when your blood sugar levels have fallen low enough that you need to take action to bring them back to your target range. This is usually when your blood sugar is less than 70 mg/dL. However, talk to your diabetes care team about your own blood sugar targets, and what level is too low for you.

Low blood sugar may also be referred to as an insulin reaction, or insulin shock.

Signs and symptoms of low blood sugar (happen quickly)

Each person’s reaction to low blood sugar is different. Learn your own signs and symptoms of when your blood sugar is low. Taking time to write these symptoms down may help you learn your own symptoms of when your blood sugar is low. From milder, more common indicators to most severe, signs and symptoms of low blood sugar include:

• Feeling shaky
• Being nervous or anxious
• Sweating, chills and clamminess
• Irritability or impatience
• Confusion
• Fast heartbeat
• Feeling lightheaded or dizzy
• Hunger
• Nausea
• Color draining from the skin (pallor)
• Feeling sleepy
• Feeling weak or having no energy
• Blurred/impaired vision
• Tingling or numbness in the lips, tongue or cheeks
• Headaches
• Coordination problems, clumsiness
• Nightmares or crying out during sleep
• Seizures

The only sure way to know whether you are experiencing low blood sugar is to check your blood sugar, if possible. If you are experiencing symptoms and you are unable to check your blood sugar for any reason, treat the hypoglycemia. 

A low blood sugar level triggers the release of epinephrine (adrenaline), the “fight-or-flight” hormone. Epinephrine is what can cause the symptoms of hypoglycemia such as thumping heart, sweating, tingling and anxiety.

If the blood sugar level continues to drop, the brain does not get enough glucose and stops functioning as it should. This can lead to blurred vision, difficulty concentrating, confused thinking, slurred speech, numbness, and drowsiness. If blood sugar stays low for too long, starving the brain of glucose, it may lead to seizures, coma and very rarely death. 

Treatment—The “15-15 Rule”

The 15-15 rule—have 15 grams of carbohydrate to raise your blood sugar and check it after 15 minutes. If it’s still below 70 mg/dL, have another serving.

Repeat these steps until your blood sugar is at least 70 mg/dL. Once your blood sugar is back to normal, eat a meal or snack to make sure it doesn’t lower again.

This may be:

• Glucose tablets (see instructions)
• Gel tube (see instructions)
• 4 ounces (1/2 cup) of juice or regular soda (not diet)
• 1 tablespoon of sugar, honey, or corn syrup
• Hard candies, jellybeans or gumdrops—see food label for how many to consume

Make a note about any episodes of low blood sugar and talk with your health care team about why it happened. They can suggest ways to avoid low blood sugar in the future. 

Many people tend to want to eat as much as they can until they feel better. This can cause blood sugar levels to shoot way up. Using the step-wise approach of the “15-15 Rule” can help you avoid this, preventing high blood sugar levels.

Note:

• Young children usually need less than 15 grams of carbs to fix a low blood sugar level: Infants may need 6 grams, toddlers may need 8 grams, and small children may need 10 grams. This needs to be individualized for the patient, so discuss the amount needed with your diabetes team.
• When treating a low, the choice of carbohydrate source is important. Complex carbohydrates, or foods that contain fats along with carbs (like chocolate) can slow the absorption of glucose and should not be used to treat an emergency low.

Severe hypoglycemia

When low blood sugar isn’t treated and you need someone to help you recover, it is considered a severe event. 

Treating severe hypoglycemia

Glucagon is a hormone produced in the pancreas that stimulates your liver to release stored glucose into your bloodstream when your blood sugar levels are too low. Glucagon is used to treat someone with diabetes when their blood sugar is too low to treat using the 15-15 rule.

Glucagon is available by prescription and is either injected or administered or puffed into the nostril. For those who are familiar with injectable glucagon, there are now two injectable glucagon products on the market—one that comes in a kit and one that is pre-mixed and ready to use. Speak with your doctor about whether you should buy a glucagon product, and how and when to use it.

The people you are in frequent contact with (for example, friends, family members and coworkers) should be instructed on how to give you glucagon to treat severe hypoglycemia. If you have needed glucagon, let your doctor know so you can discuss ways to prevent severe hypoglycemia in the future.

Find products for dealing with low blood glucose

Steps for treating a person with symptoms keeping them from being able to treat themselves.

1. If the glucagon is injectable, inject it into the buttock, arm or thigh, following the instructions in the kit. If your glucagon is inhalable, follow the instructions on the package to administer it into the nostril.
2. When the person regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting. 

Don’t hesitate to call 911. If someone is unconscious and glucagon is not available or someone does not know how to use it, call 911 immediately.

Do NOT:

• Inject insulin (it will lower the person’s blood sugar even more)
• Provide food or fluids (they can choke)

Causes of low blood sugar

Low blood sugar is common for people with type 1 diabetes and can occur in people with type 2 diabetes taking insulin or certain medications. The average person with type 1 diabetes may experience up to two episodes of mild low blood sugar each week, and that’s only counting episodes with symptoms. If you add in lows without symptoms and the ones that happen overnight, the number would likely be higher.

Insulin

Too much insulin is a definite cause of low blood sugar. One reason newer insulins are preferred over NPH and regular insulin is that they’re less likely to cause blood sugar lows, particularly overnight. Insulin pumps may also reduce the risk for low blood sugar. Accidentally injecting the wrong insulin type, too much insulin, or injecting directly into the muscle (instead of just under the skin), can cause low blood sugar.

Food

What you eat can cause low blood sugar, including:

• Not enough carbohydrates.
• Eating foods with less carbohydrate than usual without reducing the amount of insulin taken. 
• Timing of insulin based on whether your carbs are from liquids versus solids can affect blood sugar levels. Liquids are absorbed much faster than solids, so timing the insulin dose to the absorption of glucose from foods can be tricky. 
• The composition of the meal—how much fat, protein, and fiber are present—can also affect the absorption of carbohydrates.

Physical activity

Exercise has many benefits. The tricky thing for people with type 1 diabetes is that it can lower blood sugar in both the short and long-term. Nearly half of children in a type 1 diabetes study who exercised an hour during the day experienced a low blood sugar reaction overnight. The intensity, duration and timing of exercise can all affect the risk for going low. 

Medical IDs

Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.

In the event of a severe hypoglycemic episode, a car accident or other emergency, the medical ID can provide critical information about the person’s health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can’t speak for themselves.

Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person’s full medical record for use in an emergency.

Hypoglycemia unawareness

Very often, hypoglycemia symptoms occur when blood sugar levels fall below 70 mg/dL. As unpleasant as they may be, the symptoms of low blood sugar are useful. These symptoms tell you that you your blood sugar is low and you need to take action to bring it back into a safe range. But, many people have blood sugar readings below this level and feel no symptoms. This is called hypoglycemia unawareness.

People with hypoglycemia unawareness can’t tell when their blood sugar gets low so they don’t know they need to treat it. Hypoglycemia unawareness puts the person at increased risk for severe low blood sugar reactions (when they need someone to help them recover). People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night. People with hypoglycemia unawareness need to take extra care to check blood sugar frequently. This is especially important prior to and during critical tasks such as driving. A continuous glucose monitor (CGM) can sound an alarm when blood sugar levels are low or start to fall. This can be a big help for people with hypoglycemia unawareness.

Hypoglycemia unawareness occurs more frequently in those who:

• Frequently have low blood sugar episodes (which can cause you to stop sensing the early warning signs of hypoglycemia).
• Have had diabetes for a long time.
• Tightly control their diabetes (which increases your chances of having low blood sugar reactions).

If you think you have hypoglycemia unawareness, speak with your health care provider. Your health care provider may adjust/raise your blood sugar targets to avoid further hypoglycemia and risk of future episodes.

Regaining hypoglycemia awareness

It’s possible to get your early warning symptoms back by avoiding any, even mild, hypoglycemia for several weeks. This helps your body re-learn how to react to low blood sugar levels. This may mean increasing your target blood sugar level (a new target that needs to be worked out with your diabetes care team). It may even result in a higher A1C level, but regaining the ability to feel symptoms of lows is worth the temporary rise in blood sugar levels.

Other causes of symptoms

Other people may start to have symptoms of hypoglycemia when their blood sugar levels are higher than 70 mg/dL. This can happen when your blood sugar levels are very high and start to go down quickly. If this is happening, discuss treatment with your diabetes care team.

How can I prevent low blood sugar?

Your best bet is to practice good diabetes management and learn to detect hypoglycemia so you can treat it early—before it gets worse.

Monitoring blood sugar, with either a meter or a CGM, is the tried and true method for preventing hypoglycemia. Studies consistently show that the more a person checks blood sugar, the lower his or her risk of hypoglycemia. This is because you can see when blood sugar levels are dropping and can treat it before it gets too low.

If you can, check often!  

• Check before and after meals.
• Check before and after exercise (or during, if it’s a long or intense session).
• Check before bed.
• After intense exercise, also check in the middle of the night.
• Check more if things around you change such as, a new insulin routine, a different work schedule, an increase in physical activity, or travel across time zones.

Why am I having lows?

If you are experiencing low blood sugar and you’re not sure why, bring a record of blood sugar, insulin, exercise and food data to a health care provider. Together, you can review all your data to figure out the cause of the lows. 

The more information you can give your health care provider, the better they can work with you to understand what’s causing the lows. Your provider may be able to help prevent low blood sugar by adjusting the timing of insulin dosing, exercise and meals or snacks. Changing insulin doses or the types of food you eat may also do the trick.

If you’re new to type 2 diabetes, join our free Living With Type 2 Diabetes program to get help and support during your first year.

90,000 Symptoms and signs of diabetes

What are the symptoms and signs of diabetes mellitus?

²

Type 1 diabetes

Type 1 diabetes can develop unexpectedly and cause symptoms such as:

• Abnormal thirst and dry mouth
• Frequent urination
• Nocturnal urinary incontinence
• Lack of energy and extreme fatigue
• Constant hunger
• Sudden weight loss
• Blurred vision

Type 1 diabetes is diagnosed when these symptoms are combined with a test showing high blood glucose.

Type 2 diabetes

The symptoms of type 2 diabetes are as follows:

• Frequent urination
• Excessive Thirst
• Extremely severe hunger
• Blurred vision
• Lack of energy and extreme fatigue
• Numbness and tingling in hands and feet
• Slow wound healing and recurrent infections

Many people with type 2 diabetes are unaware of their condition for a long time because the symptoms of the disease are usually not as obvious as the symptoms of type 1 diabetes, and it can take years before a diagnosis is made.

How is diabetes diagnosed?

There are several ways to diagnose diabetes. The following blood tests are commonly used to diagnose diabetes ³ :

• Glycated hemoglobin assay (HbA1c). Measures the average blood sugar level over the past 2-3 months. You do not need to starve or drink anything special to perform this test.
• Fasting plasma glucose analysis. Tests fasting glucose levels.To do this, you must not eat or drink anything other than water for 8 hours, usually at night, before testing. The analysis is usually scheduled in the morning, before breakfast.
• Oral glucose tolerance test (OGTT). Tests your body’s response to a sugar load. For this analysis, you need to drink a special sweet drink. Blood sugar is measured before and after you drink the drink.
• Anytime Plasma Glucose Measurement (TPG). Checks your blood sugar at a specific point in time, at any time of the day, without prior preparation for the test. This test is usually done when you have obvious symptoms of diabetes, such as unexpected weight loss, extreme fatigue, and / or other signs of diabetes.

² IDF Diabetes Atlas (Edition 8) (2017). International Diabetes Federation: Brussels, Belgium. Online version May 5, 2018 at http://diabetesatlas.org/IDF_Diabetes_Atlas_8e_interactive_EN/

³ American Diabetes Association.(ADA) Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41, Suppl. 1. Online version May 6, 2018 at http://care.diabetesjournals.org/content/diacare/suppl/2017/12/08/41.Supplement_1.DC1/DC_41_S1_Combined.pdf

90,000 Skin lesions in diabetes mellitus. Dermatologist in Tashkent

Diabetes mellitus is the most common endocrine disease with an ever-increasing prevalence. This disease affects the blood vessels, nerve fibers, eyes, kidneys and

skin, which leads to significant financial losses and a decrease in the quality of life in affected patients.Long-term diabetes mellitus can disrupt skin homeostasis, resulting in cutaneous manifestations in at least one third of patients. Skin lesions may be the first sign of diabetes mellitus, so the corresponding skin symptoms can lead to a diagnosis of diabetes mellitus. In addition, skin symptoms can reflect the course of the disease as well as the success of therapeutic interventions.

Introduction

The International Diabetes Federation estimates that about 285 million adults worldwide suffer from diabetes (2010 data), and at least one third of patients have some type of skin manifestation associated with diabetes.These include bacterial and fungal infections, skin lesions that are complications of diabetes mellitus, drug-induced skin lesions. Thus, this review can be useful for both dermatologists and general practitioners, specialists in the field of diabetes mellitus, it will allow them to be more attentive in relation to the cutaneous manifestations of diabetes mellitus. The purpose of this review is to draw the attention of physicians to typical skin symptoms associated with impaired glucose metabolism.

Changes in the epidermal barrier

Diabetes mellitus can lead to disruption of skin homeostasis both through primary disorders of skin metabolism and through secondary associated complications such as vasculopathy and neuropathy. Literary sources are of the opinion that hyperglycemia-induced non-enzymatic glycation of structural and regulatory proteins plays a major role in the pathogenesis of complications of diabetes mellitus. Excessive glucose levels lead to non-enzymatic chemical interactions between the amino acids in the protein and the carbonyl groups of glucose – the Maillard reaction.The first stage of nonenzymatic glycation begins with the formation of Schiff bases, which are subsequently converted into stable compounds (Amadori rearrangement). Subsequent chemical transformations of Amadori rearrangement products lead to the formation and accumulation of advanced glycation end products (AGEs) in patients with diabetes mellitus (Figure 1). Specific receptors for AGEs (RAGE) have been found on the surface of various cell types. The accumulation of AGEs and their interaction with RAGE initiates various signaling pathways involved in the pathogenesis of possible complications of diabetes mellitus.In addition, in patients with diabetes mellitus, dysfunction of keratinocytes caused by the influence of insulin on their proliferation, differentiation and migration is often found, which leads to disruption of the normal functioning of the epidermal barrier and slowing down wound healing.

Opinions of literary sources about the influence of diabetes mellitus on the hydration of the stratum corneum are still controversial. Sakai et al. found a decrease in the level of hydration of the stratum corneum, a decrease in the amount of surface lipids and sebum secretion in mice with diabetes mellitus, while Seirafi et al.found no difference between the level of hydration of the stratum corneum in patients with diabetes mellitus and in a healthy population. In addition, the pH of the skin surface plays a key role in creating the skin barrier. Excessively high pH of the skin surface leads to excessive bacterial colonization, which is also found in the area of ​​chronic wounds. It is known that diseases such as atopic dermatitis or diaper dermatitis also affect skin pH. According to Yosipovitch et al, the pH of the skin surface in intertriginous areas in patients with diabetes mellitus is significantly higher than in patients without diabetes.It was also found that in patients with diabetes mellitus, the activity of the sebaceous glands is reduced, the elasticity of the skin is impaired against the background of normal hydration of the stratum corneum. Thus, there is not enough data in the literature on this issue; additional studies are required to clarify the role of skin pH in diabetes mellitus.

Table 1. Skin manifestations of diabetes mellitus

1. 1. Skin infections

• Bacterial etiology
• Fungal etiology
• 2.Skin lesions that are complications of diabetes mellitus
• Diabetic ulcers
• Diabetic foot syndrome

3. 3. Skin lesions associated with diabetes mellitus

• Finger seals
• Papillomas
• Eruptive xanthomas
• Lichen planus
• Itching
• Annular granuloma
• Vitiligo
• Acanthosis Black
• Lipoid necrobiosis
• Skleredema Adults Buske
• Diabetic blisters
• Acquired reactive perforating collagenosis
• Yellow nails

4. 4.Skin lesions that are complications of diabetes therapy

• Skin reactions to insulin administration
• Skin reactions to oral hypoglycemic drugs

Skin infections

Violation of the integrity of the skin barrier in diabetes mellitus leads to an increased predisposition of patients to bacterial infections. Moreover, diabetes-induced vasculopathies and neuropathies also increase susceptibility to bacterial infections.For patients with diabetes mellitus, the development of bacterial and viral infections is characteristic, they occur in every second patient. The doctor’s attention should be attracted by recurrent bacterial infections – vulgar impetigo, abscesses, erythrasma, folliculitis, erysipelas or common fungal infections, this is the reason for examining the patient for diabetes. Severe and rare bacterial infections, often associated with diabetes mellitus – malignant otitis externa, mainly caused by Pseudomonas aeruginosa and associated with a high mortality rate.

The high concentration of glucose in the epidermis of patients with diabetes mellitus creates an optimal environment for the vital activity of saprophytic microorganisms, including fungi of the genus Candida. Literature data on the incidence of dermatophytes in patients with diabetes mellitus are very contradictory. It is reported that about 30% of patients (with and without diabetes mellitus) suffer from fungal infections, with Trichophyton rubrum being the most common. Infections caused by fungi of the genus Candida are found in 15-28% of cases.Also, with diabetes, the risk of developing vulvovaginal candidiasis increases. Thus, recurrent vulvovaginal candidiasis may indicate the presence of diabetes mellitus in the patient.

Skin lesions associated with diabetic vasculopathy and neuropathy

Vasculopathy is one of the most typical complications of diabetes mellitus, leading to retinopathy, nephropathy, skin lesions. The pathogenesis of this phenomenon has not been completely elucidated. The formation of AGEs is thought to contribute to the development of macro- and microangiopathy.

Diabetic ulcers and diabetic foot syndrome

Diabetic foot syndrome is a severe cutaneous manifestation of diabetes mellitus that occurs in 15-20% of patients. (Figure 2) Micro- and macroangiopathy, as well as peripheral neuropathy, play a key role in the development of diabetic foot syndrome, however, most often it is based on a combination of causes – both sensory impairment and vasculopathy. In almost a quarter of cases, diabetic foot syndrome leads to limb amputation.The most common causes of diabetic ulcers are inadequate foot hygiene, foot deformities, and poorly fitted shoes. The most characteristic areas of ulceration are places of maximum pressure: under the heads of the metatarsal bones, in the area of ​​callosities. In addition, patients with diabetes mellitus suffer from impaired wound healing, as hyperglycemia leads to a decrease in the level of signaling mediators (neuropeptides, inflammatory cytokines) involved in the wound healing process.Thus, diabetic ulcers often delay various phases of wound healing, eventually leading to the formation of chronic ulcers. Treatment of diabetic ulcers includes eliminating excess plantar pressure by fitting orthopedic shoes, removing callosities, proper foot hygiene, moisturizing and maintaining the wound surface.

Gangrene in diabetes mellitus

The risk of gangrene and limb amputation is much higher in patients with diabetes mellitus.It is reported that about 70% of lower limb amputations in Germany have been associated with diabetes. Dry gangrene more often affects the toes due to impaired tissue perfusion, while self-amputation of the toe is possible (Figure 3). In contrast, wet gangrene occurs when ulcers become infected and may require urgent surgery.

Diabetic dermopathy

Other signs of diabetic microangiopathy include diabetic dermopathy. It occurs in 10% of patients with diabetes mellitus and is most likely associated with peripheral neuropathy.Clinically, hyperpigmented, atrophic, well-defined skin lesions are found, localized mainly on the skin of the legs. A link has been established between diabetic dermopathy and damage to large vessels (especially coronary arteries), neuropathy, nephropathy, retinopathy. Thus, diabetic dermopathy can serve as a clinical marker reflecting the severity of systemic complications of diabetes mellitus.

Various skin symptoms

Finger seals

In 1986, Huntley et al.showed that the incidence of finger pebbles in diabetes mellitus is about 75% and 21% in non-diabetic patients. Digital seals – multiple small, grouped, dense papules localized on the extensor surface of the fingers of the hand with a pronounced emphasis in the interphalangeal joints. Histologically, hyperkeratosis is detected, as well as the proliferation of the papillae of the dermis. In comparison with chronic mechanical damage to the skin, in this case, the stratum corneum is usually intact.The pathogenesis has not been definitively identified. Among the various hypotheses of etiopathogenesis, nonenzymatic glycation, disorders of collagen metabolism, and the action of growth factors are considered. The presence of digital seals is considered an important dermatological sign of diabetes mellitus.

Papillomas

Papillomas – benign skin neoplasms, soft consistency, located on the leg, normal skin color, or hyperpigmented, most often localized on the neck, armpits, groin and eyelids.Multiple papillomas are associated with impaired glucose metabolism, which is associated with insulin-induced proliferation of keratinocytes. Sudy et al. showed that the presence of multiple papillomas on the skin in a patient is a more sensitive cutaneous marker of impaired glucose metabolism than acanthosis nigricans. On the skin of patients with diabetes mellitus, papillomas are found in 23% of cases, while in a healthy population this figure is 8%. A positive relationship was also found between the number of papillomas on the skin and blood glucose levels.Treatment is necessary only for cosmetic reasons. Surgical intervention or cryosurgery is possible.

Eruptive xanthomas

Eruptive xanthomas are associated with hypertriglyceridemia, which leads to the accumulation of chylomicrons and very low density lipoproteins (VLDL). Poorly controlled diabetes mellitus and alcohol abuse can cause secondary hypertriglyceridemia. Xanthomas are grouped papules that range in color from reddish to yellowish, located on an erythematous background; most often localized in the gluteal region, on the extensor surfaces of the limbs.Histologically, they are an accumulation of foam cells (macrophages), an inflammatory infiltrate of lymphocytes and neutrophils, localized in the dermis. Treatment is aimed at normalizing lipid metabolism by changing diet and taking appropriate medications. Fast results can be achieved with surgical removal, curettage, laser therapy (CO2 or Erb: YAG laser)

Lichen planus

Based on data from Seyhan et al. impaired glucose metabolism is observed in half of patients with lichen planus.About 25% of patients with lichen planus suffer from diabetes mellitus. The association with diabetes mellitus is observed in 27% of patients with lichen planus of the oral mucosa. In addition, the relationship between lichen planus and thymoma, viral hepatitis C, liver disease and ulcerative colitis was found. Clinical symptoms of lichen planus are itchy polygonal erythematous papules and Wickham mesh. Typical localization is the skin of the wrist, ankles. The defeat of the oral mucosa is found in 30-70% of patients with lichen planus; represented by asymptomatic white mesh plaques.The first line of therapy is topical corticosteroids. Other therapeutic options are also possible – systemic corticosteroids, oral retinoids, phototherapy. Also, it is necessary to remember about the possibility of malignant transformation of lichen planus of the oral mucosa.

Itching

Xerosis accompanied by itching occurs in 25% of patients with diabetes mellitus and is one of the most common cutaneous manifestations of diabetes mellitus. One of the causes of hypohidrosis and dry skin is dysfunction of sympathetic nerve fibers (including sudomotor dysfunction).Also, itching can be caused by damage to sensitive c-fibers associated with diabetic polyneuropathy. Since itching often occurs with dry skin, regular use of emollients can partially prevent this complication.

Annular granuloma

Annular granuloma is most often localized on the extremities, mainly in the area of ​​the joints, dorsal surface of the hands and feet. It manifests itself as multiple erythematous-purple papules forming a ring with a resolution in the center, without atrophy.Lesions are usually asymptomatic. The etiology is not known, it is possible that the generalized annular granuloma may be associated with malignant neoplasms, thyroid diseases, viral hepatitis B and C, HIV infection, and diabetes mellitus. However, the opinions of literary sources about the association of granuloma annular with diabetes mellitus remain controversial. Histologically, granulomatous infiltration is determined in the dermis, consisting of lymphocytes and histiocytes with the presence of degenerative collagen fibers and giant cells in the center.The effectiveness of topical corticosteroids, intralesional administration of corticosteroids, PUVA therapy, topical calcineurin inhibitors, and systemic drugs such as adalimumab and dapsone has been shown. Solitary lesions tend to resolve spontaneously.

Vitiligo

Vitiligo is a pigmentation disorder with a frequency of about 1%. The lower extremities are most often affected. The pathogenesis of the disease is not fully understood. The affected skin lacks normal, intact melanocytes. The relationship of vitiligo with other autoimmune diseases, for example, thyroid gland damage, diabetes mellitus, has been found.The autoimmune pathogenesis of vitiligo confirms the fact that only insulin-dependent diabetes mellitus is associated with vitiligo (there is no such relationship with insulin-independent diabetes mellitus). Therapeutic options for this disease are often unsatisfactory. It is very important to use photoprotective products. In the treatment of generalized vitiligo, UV-B phototherapy may be effective.

Acanthosis black

Skin lesions are represented by black-brown plaques.(Figure 4) Most of the folds and flexion surfaces are affected, most often the neck and axillary region. It is believed that the underlying pathogenesis is the excessive binding of elevated insulin levels to insulin-like growth factor receptors, which leads to proliferation of keratinocytes. Histologically, with acanthosis nigricans, the proliferation of epidermal keratinocytes and fibroblasts is determined, leading to a thickening of the stratum corneum. Acanthosis nigricans can also serve as a marker of malignant neoplasms, in particular, gastrointestinal adenocarcinoma.However, acanthosis nigricans are most often associated with obesity and insulin resistance. This is most likely due to the increasing number of patients with type 2 diabetes and metabolic syndrome. Acanthosis nigricans are an important indicator of diabetes mellitus. The presence of this syndrome should attract the attention of the doctor, suggest the exclusion of insulin resistance in the patient. The main thing in therapy is the correction of the underlying disease.

Lipoid necrobiosis in diabetes mellitus

Lipoid necrobiosis is a chronic inflammatory granulomatous skin disease.The most characteristic features are the presence of yellow-brown plaques with raised erythematous edges, an atrophic center and expanded telangiectatic vessels visible on the surface. The legs are often affected. (Figure 5) About two-thirds of cases are associated with diabetes mellitus, however, data on the correlation between the severity of diabetes and the activity of necrobiosis lipoidosis remain controversial. The pathogenesis of the disease is not known. Rashes can resolve on their own, however, they often become chronic or ulcerate with the addition of a secondary infection.Lipoid necrobiosis is, to a greater extent, a clinical diagnosis. Histologically, necrobiosis (collagen degeneration) of the entire dermis, atrophy of the epidermis with infiltration of inflammatory cells is determined. In several cases, the possibility of transformation into squamous cell carcinoma of the skin has been described. Treatment options include topical corticosteroids, intralesional corticosteroids, systemic corticosteroids, topical tacrolimus, phototherapy, cyclosporine, fumaric acid esters, TNF-a inhibitors.

Skleredema Adult Buschke

Adult Skleredema was first described by Buschke.The disease manifests itself as a symmetrical dense edema, localized, as a rule, in the upper back, on the neck and face. Many variants of the etiology of this disease have been proposed. Scleredema of adults Buschke can be observed after infectious diseases (benign form), possible association with systemic diseases such as paraproteinemia, malignant neoplasms, as well as poorly controlled type 2 diabetes mellitus (chronic form). The adult Buschke scleredema associated with diabetes mellitus often has a slowly progressive course, without a tendency to resolve spontaneously.Possible pathogenic factors are slow collagen degradation and stimulation of collagen synthesis by fibroblasts in response to excess glucose. In rare cases, damage to internal organs, generalization of the process (respiratory failure) is possible. The histological picture is characterized by thickened bundles of collagen fibers, separated by areas of mucin deposition, which leads to a thickening of the dermis. The epidermis remains intact. Treatment is difficult. The use of physiotherapy, high doses of penicillin, phototherapy (PUVA baths, UVA1 phototherapy) can be successful.In severe cases, radiotherapy may be effective.

Diabetic blisters

Diabetic blisters – a rare phenomenon of diabetes mellitus on the skin, which occurs in 0.5% of cases. It is characterized by the formation of tense blisters localized on the acral areas of the limbs, often in the area of ​​\ u200b \ u200bthe feet. (Figure 6) The skin of the trunk is rarely affected. Diabetic blisters often appear suddenly, are located in isolation, their contents can be transparent or hemorrhagic.The pathogenesis has not been fully understood. It is believed that diabetic angiopathy leads to increased vulnerability of the skin, which provokes the formation of blisters. The predominant localization of lesions on the lower extremities is explained by the presence of diabetic polyneuropathy in patients. It is mandatory to take a patient’s history, as well as to exclude immunoassociated bullous dermatoses, such as pemphigus and pemphigoid. Spontaneous blistering, especially limited to the skin of the acral extremities, should alert the physician and require screening to rule out diabetes mellitus.Histologically, a subepidermal bladder is found at the level of the lamina lucida. Immunofluorescence study is negative. Diabetic blisters are usually a self-limiting process that tends to resolve spontaneously without scarring over several weeks. Adequate blood glucose levels must be maintained. Complications are possible in the form of secondary chronic ulcers, the addition of a bacterial infection. Most patients suffer from chronic recurrent episodes of diabetic bladder.

Acquired reactive perforating collagenosis

Acquired reactive perforating collagenosis is a rare skin disease associated with diabetes mellitus. In addition, the disease often accompanies chronic renal failure and other systemic diseases, as well as malignant neoplasms. The clinical picture is characterized by the appearance in patients of erythematous papules or plaques with a central keratotic plug. (Figure 7) Skin lesions are often accompanied by itching.The pathogenesis of the disease is unknown. The appearance of new loose elements can be provoked by the type of the Kebner phenomenon. Acquired reactive perforating collagenosis is thought to result from transepidermal collagen elimination. The histological features of the disease are defined by basophilic bundles of collagen fibers located in the upper dermis, keratin and neutrophils, which form epidermal ulceration, which may be covered with a hyperkeratotic crust. Treatment is often difficult.Treatment of the underlying disease is required. It is possible to use topical GCS, antihistamines, phototherapy, doxycycline, systemic retinoids. Significant improvement has been reported with allopurinol. The key point remains the treatment of the underlying disease (diabetes mellitus, renal failure).

Yellow nails

Another complication of diabetes mellitus affecting the nail plate. Yellow nail staining occurs in 40% of patients with diabetes.(Figure 8) A possible cause of yellow nail discoloration is non-enzymatic glycation, which also results in yellow skin staining in diabetic patients. It is necessary to carry out differential diagnosis with onychomycosis.

Skin complications associated with the treatment of diabetes mellitus

Skin reactions to insulin

The classic side effect of insulin therapy is the development of lipoatrophy at the injection site, characterized by local loss of subcutaneous fat.The incidence of this complication was significantly reduced with the use of highly purified insulin. It is believed that the origin of lipoatrophy is an immunological reaction. In the immunofluorescence analysis of the affected skin, an increased accumulation of immunoglobulins and complement in the blood vessels of the dermis is determined, which leads to the activation of the signaling cascade and suppression of adipocyte differentiation. The likelihood of lipoatrophy is reduced by constantly changing the site of insulin injections.Lipohypertrophy, on the other hand, is characterized by excessive deposition of subcutaneous adipose tissue. This is the most common side effect of insulin therapy and occurs in 27% of patients with diabetes. Impaired insulin absorption in the area of ​​lipohypertrophy is of particular clinical importance, as it leads to impaired glycemic control. Local allergic reactions to insulin such as pruritus, erythema, induration are noted in less than 1% of cases. With the introduction of highly purified insulin and new delivery systems, local skin reactions to insulin have become a very rare complication.When treating an allergic reaction to insulin, it is possible to change the drug to insulin lispro as it is less allergic, desensitization, and the use of insulin pumps. In rare cases, adverse skin reactions have been reported to m-methylphenol, a preservative used in virtually all commercially available insulin variants. It is worth remembering the rare systemic IgE-dependent type I hypersensitivity reaction to insulin, which can lead to a life-threatening anaphylaxis reaction.

Skin reactions to oral antidiabetic drugs

Skin reactions to oral glucose-lowering drugs are a very rare complication.In the literature, there are cases of allergic reactions, leukocytoclastic vasculitis, erythema multiforme exudative when taking metformin biguanide. Moreover, have been described reactions such as vulgar peptic ulcer, psoriasiform drug reactions that occur when taking sulfonylurea glibenclamide. It must be remembered that most sulfonylurea preparations induce cutaneous photosensitivity. Previously, generalized exanthematous pustulosis and generalized exudative erythema multiforme have been described, most likely arising from acarbose.In several cases, the development of lichenoid drug reactions associated with sulfonylurea preparations – chloropropamide, tolazamide, glimepiride – has been described.

Conclusion

Almost all patients with diabetes mellitus have skin symptoms associated with diabetes mellitus. The appearance of skin manifestations of diabetes mellitus is possible before the diagnosis and the onset of symptoms from the internal organs. Thus, certain skin reactions should be considered as warning markers of diabetes mellitus.Tight glycemic control is known to reduce the incidence of vasculopathy, neuropathy, and nephropathy. It is very likely that this has a positive effect on the cutaneous manifestations of diabetes mellitus. Thus, in the treatment of patients with diabetes mellitus, the interaction of a dermatologist and an endocrinologist is important.

Behm B, Schreml S, Landthaler M, Babilas P. Skin signs in diabetes mellitus.

Böhm B., Schreml S., Landthaler M., Babilas P., Department of Dermatology, University Hospital Regensburg

This material was taken from the dermatology site.Common crawl en

Six dangerous consequences of diabetes that few people know about – Rossiyskaya Gazeta

422 million people worldwide, according to WHO statistics, suffer from diabetes today, most of them from preventable type 2 diabetes. In our country, due to the ongoing obesity epidemic, the number of diabetes patients is also growing and, according to experts, may reach eight million.

Serious complications of diabetes associated with vascular lesions are well known – these are cardiovascular diseases, kidney damage, rhinopathy (up to blindness).In an interview with AiF, endocrinologist Elena Syurakshina spoke about the less well-known, but no less formidable, consequences of this disease.

“All problems appear due to unstable sugar levels in the blood plasma, – explains the doctor. – Increased glucose contributes to a change in the properties of blood, disrupts the functions of the brain, cardiovascular system, damages the kidneys and nerve cells. The catalyst for complications is most often stress. , as well as infections, viruses that can suppress the immune system.Against their background, both one or several complications can appear at once. “

What pathologies threaten patients with uncompensated diabetes?

Ketoacidosis

Decompensation of diabetes mellitus often leads to ketoacidosis. This is an acute breakdown of metabolic regulation mechanisms, characterized by an increase in the level of glucose and ketone bodies Symptoms: thirst, increased urination, dry skin, odor of acetone from the mouth, abdominal pain, headaches, lethargy, irritability, drowsiness, lethargy.”The mainstay of treatment is insulin therapy, rehydration measures and correction of pathological changes in electrolyte metabolism. In this condition, you should definitely consult a doctor as soon as possible, since without proper treatment, ketoacidosis can be fatal,” the doctor warns.

Hypoglycemia

This condition, caused by very low blood sugar levels, is often associated with the treatment of diabetes itself. The main symptoms are: malaise, fatigue, pale skin, excessive sweating.Treatment should be as quick as possible to bring blood sugar back to the normal range, and involves the use of foods and drinks that are high in sugar. And here it is important not to allow the development of such a state. Therefore, it is imperative to consult a doctor to correct the situation and select prevention. After all, a sharp drop in sugar can lead to hypoglycemic coma and even death.

Coma

With diabetes in humans, several variants of coma can occur against the background of surges in blood glucose levels.

Hyperosmolar non-ketone coma is an acute complication of diabetes mellitus, characterized by impaired glucose metabolism and an increase in its level in the blood, a sharp increase in plasma osmolarity (negative changes in blood composition), including dehydration within cells, absence of ketoacidosis. The main symptoms are increased urination, dehydration, muscle hypertonia, convulsions, increasing drowsiness, incoherent speech. Treatment includes rehydration, restoration of normal insulin levels, and elimination and prevention of complications.There should be no self-medication in such a situation.

Lactacidemic coma – characterized by an insignificant level of glycemia, a decrease in the alkaline reserve of the blood, pH and an increase in the level of lactic acid. The cause of development may be chronic hypoxia, severe dehydration of the body with hyperosmolar coma. Symptoms: increasing weakness, pain in the muscles and heart. If such signs appear, you should immediately seek specialized help. In such a situation, hospitalization is laid, since paralysis of the respiratory center with a threat of death is possible.

Vision problems

High blood sugar levels increase the likelihood of eye problems. This is due to damage to small vessels and is called microangiopathy. Diabetic retinopathy refers to complications of a vascular nature in diabetes mellitus. This pathology leads to irreversible blindness. It is clear that in such a situation it is better to prevent than to try to stop the disease. Therefore, for the purpose of prevention, one should constantly and responsibly control the level of sugar in the blood, also monitor the level of cholesterol so that the vessels do not break down even more, and it is worth maintaining normal blood pressure.

Diabetic foot

Diabetic foot syndrome – damage to the skin, large and small vessels, nerves, bones and muscles of the foot. The cause is the toxic effect of high blood sugar levels on large and small vessels, nervous, musculoskeletal tissue. First of all, it is manifested by pain in the lower extremities, numbness, burning sensation, cooling of the feet, parasthesia (goose bumps, tingling sensations). At an advanced stage, poorly healing ulcers, infectious lesions, gangrene appear.Patients with diabetes need to be especially careful in the presence of such problems as an ingrown toenail, darkening of the nail, fungal lesions of the nail plates, calluses and corns, cuts, burrs, cracked heels. For treatment, you should contact specialists, for example, podiatrists, who will carry out the necessary manipulations, taking into account the main diagnosis. The prevention of diabetic foot is based on the treatment of diabetes mellitus as an underlying disease.

Skin diseases

People with diabetes mellitus most often face numerous and varied skin lesions, most of which are bacterial and fungal infections.Infection occurs with uncompensated diabetes mellitus. As a result, wounds, cracks, and non-healing ulcers begin to appear more often on the skin. Those who are diagnosed with diabetes require special adherence to personal hygiene: regular shower, use of skin protection products.

Diabetes mellitus / Diseases / EXPERT Clinic

For patients suspecting a possible development of diabetes mellitus, the doctors of the EXPERT Clinic have created a list of studies for the basic examination.

Treatment

Once a diagnosis of diabetes mellitus is established, achieving and maintaining normal blood sugar is paramount.This is the main goal in the treatment of the disease.
This is achieved through:

• diet therapy
• drug treatment

Treatment of any type of diabetes mellitus is impossible without diet therapy. This is the first thing that needs to be adjusted according to the characteristics of the disease. Diets for different types of diabetes differ slightly from each other. Wider diet for type 1 diabetes and significant dietary restrictions for type 2 diabetes, especially in combination with obesity.With gestational diabetes, dietary recommendations will also be “special”.

In our clinic, detailed conversations are held, dietary recommendations are given, which allows the patient to feel more comfortable when choosing and preparing certain products.

In type 1 diabetes mellitus, the use of insulin is mandatory.
In type 2 diabetes mellitus, dietary therapy alone may sometimes be sufficient if glucose levels are maintained at normal levels.

Most often, diet therapy for type 2 diabetes is supplemented with medication tablets to achieve normoglycemia. Only an endocrinologist can select and correct the treatment.

In our clinic, we carry out medical correction of treatment in accordance with international recommendations for the treatment of diabetes mellitus. The process of selecting therapy can take some time.

While type 2 diabetes mellitus is non-insulin dependent, the use of insulin in its treatment may also be quite likely.The need for insulin administration may arise in case of a long-term uncompensated disease, other acute diseases and conditions. Insulin therapy for type 2 diabetes mellitus will be permanent or temporary, it will only show the course of the disease. In this case, dependence on the administration of insulin is not formed.

Treatment of gestational diabetes mellitus begins with the obligatory specific dietary therapy. In the absence of normalization of blood glucose levels, insulin therapy is prescribed. Patients are referred to a specialized maternity hospital for follow-up and subsequent delivery.

Do not postpone and make an appointment with an endocrinologist!

Forecast

Today, diabetes is an incurable disease. Therefore, close cooperation between doctor and patient is of particular importance. Only in this case it is possible to predict stable compensation for the disease and prevent the development of complications of diabetes mellitus.

Recommendations

Even in the absence of an established diagnosis of diabetes mellitus, it is recommended to control blood sugar once a year – this is the simplest and most accessible method for early diagnosis of the disease.There is no specific prevention of diabetes mellitus, therefore it is recommended to maintain a healthy lifestyle: rational physical activity and proper nutrition.

In the event that this diagnosis is confirmed, constant contact between the patient and the doctor is necessary. Only under this condition is it possible to prevent the destructive effects of diabetes on the body.

Frequently asked questions

I was diagnosed with type 2 diabetes, but I do not notice anything bad in my health.Is diabetes really so dangerous?

Diabetes mellitus type 2 most often begins like this – “not noticeably” and is detected only when the patient donates blood for analysis for a completely different reason. Such “silence” of the disease is very insidious. Until the moment when the patient learned about the diagnosis, there may already be chronic complications of the disease in the form of damage to the eyes, kidneys, and legs. These complications are very dangerous and difficult to treat. Plus, with diabetes mellitus, atherosclerosis begins to progress very quickly, which is fraught with stroke, heart attack, ischemia of the lower extremities.Therefore, diabetes mellitus is a dangerous disease.

Is it possible to completely recover from diabetes?

Today, unfortunately, there is no such possibility. We establish the diagnosis of diabetes mellitus once in a lifetime and save it forever. You can ideally compensate for diabetes mellitus and then your blood sugar will not differ from people without diabetes mellitus, therefore, you will not risk developing complications of the disease. Usually doctors write in the diagnosis like this: “Diabetes mellitus (type 1 or 2) is compensated.

Should I follow a diet for diabetes mellitus if my blood sugar returned to normal during treatment?

Diet therapy for diabetes mellitus should never be canceled. Diet is the first ingredient in the treatment of this complex disease. Even if it seems to you that “one piece of cake” will not hurt, and even if you do not see high blood sugar on the meter after errors in nutrition, this is not a reason to cancel the diet. Failure to comply with dietary measures leads to gradually increasing sugar levels, which are then quite difficult to return to normal.

Is it possible to play sports in case of diabetes mellitus?

Not possible, but absolutely necessary! Rational physical activity is useful not only for general well-being and maintaining muscle tone, but also playing sports reduces blood sugar, improves blood flow in the muscles, which means more oxygen enters the cells of the body and ischemia, so often associated with diabetes mellitus, does not occur.

What blood glucose values ​​should you strive for in the treatment of diabetes mellitus?

Blood sugar in this disease is very desirable to have in the range of normal values, which are determined for all people.These are fasting blood sugar figures of 3.3-5.5 mmol / l (in capillary blood) and 4.8-6.1 mmol / l (in venous plasma) and up to 7.8 mmol / l 2 hours after eating. Reducing blood sugar and keeping it in a physiological norm will reduce the risk of developing chronic complications of the disease to a minimum. There are situations when an endocrinologist advises not to lower blood sugar to normal. This occurs when the risk of lowering blood glucose below normal is more dangerous than a moderate increase in blood sugar. Various neurological and psychiatric diseases, coronary heart disease, old age usually require less strict control over diabetes.Of course, this should not mean that you can have a sugar of 12-20 mmol / l. Everything should be reasonable.

If diabetes mellitus is a lifelong disease and proceeds “imperceptibly” without changing the general well-being, should it be treated and controlled so strictly?

Of course, diabetes mellitus needs to be treated and this is very important. For the time being (this period can be quite long) there are no specific complications of the disease, even with persistent hyperglycemia, and then they can appear “all at once” and this will quickly affect the quality and life expectancy of a patient with diabetes.

What complications should be feared in diabetes mellitus?

Diabetes mellitus has acute and chronic complications. As the name implies, acute complications develop rapidly, “acutely”. The most common acute conditions in diabetes mellitus are hypoglycemia (a sharp drop in blood sugar below normal) and diabetic ketoacidosis (a significant increase in blood sugar, against the background of which acetone appears in the blood and urine). Both of these complications can lead to significant damage to body systems and death in a short time.Chronic complications are a slow lesion of blood vessels and other tissues of the body against the background of chronic hyperglycemia. Eye Damage – Diabetic retinopathy can lead to complete blindness. Kidney damage leads the patient to a hemodialysis bed. Damage to the nervous tissue leads to disruption of higher nervous activity and to the development of “neuropathic ulcers”. These slow-onset complications do not lead to immediate death, but disable patients.

There are now a lot of pills for the treatment of diabetes mellitus.How do you know which drugs are best?

Only a doctor can understand which treatment will be the best for each specific patient after examining the patient and a follow-up examination. Eight classes of drugs exist to treat the disease, and more and more drugs are emerging. Pharmacotherapy of diabetes mellitus is perhaps the most “spoiled” branch of medicine. All drugs have their own indications and contraindications, and this is quite individual. The choice of the drug is the doctor’s task.

If insulin is prescribed for diabetes mellitus, is it “forever”? How to live “on injections”?

There are different types of diabetes mellitus, so there are different treatments.Insulin therapy is mandatory and vital for patients with type 1 diabetes. Without insulin, these patients die quickly. With type 2 diabetes, a temporary or permanent need for insulin treatment may also arise. With a sharp increase in blood sugar, with prolonged decompensation of diabetes mellitus, when the body’s reserve capabilities are practically exhausted, insulin administration is required. After normalization of blood sugar, insulin (only in type 2 diabetes mellitus!) Can be canceled and returned to pill therapy.It should be remembered that with type 2 diabetes, continuous insulin administration may be required. And this is not because there is a dependence on insulin (this is what patients who received insulin in the hospital often say), but because there is an insulin demand. its own pancreas is no longer able to produce enough insulin.

My relatives have diabetes. What can I do to avoid getting sick?

Diabetes mellitus belongs to diseases with a genetic predisposition and it can often be seen that in one family they suffer from this disease more often.The risk of getting sick, of course, exists, but it is in our power to try to reduce this risk. If, unfortunately, we cannot change the genetic predisposition, then we can completely exclude the provoking factors for the development of the disease. Rational nutrition and physical activity, a decrease in alcohol consumption, a decrease in body weight (in case of excess) – these are the measures for the prevention of diabetes mellitus. This set of measures – everyone knows and it is called a “healthy lifestyle”, but in terms of the prevention of diabetes – there is nothing better.

17 signs of diabetes mellitus – NEWS.ru

Diabetes mellitus can be a genetically programmed disease, but more often it goes hand in hand with obesity. The consequences of diabetes in an advanced stage are monstrous. However, the disease can be recognized in time, focusing on changes in the body, consult a doctor and further control.

Diabetes is a serious illness, and if not properly treated, it can lead to such dire complications as coronary heart disease (CHD) and stroke.However, according to Dr. Health, more than a third of Americans don’t even know they have diabetes. The longer you go without control of the disease, the higher the risk of developing serious complications. If you have at least a few of the manifestations listed below, you need to talk to your doctor and get tested.

1. Frequent urination (polyuria)

The body of a person with diabetes is not able to break down sugar properly. The unused sugar remains in the bloodstream.Excess blood sugar forces the kidneys to work harder to flush out excess blood glucose. The kidneys thus produce more urine.

2. Increased thirst

The kidneys produce more urine to eliminate sugar. As you urinate more often, you are losing fluid. Dehydration is in progress. As a result, the body tries to replenish the loss of fluid. Hence – the constant need to drink water.

3. Feeling hungry

In diabetes, the body becomes insulin resistant.High blood glucose levels force the body to produce too much insulin, and after a meal, glucose levels drop rapidly. As a result, you become more voracious and, as a rule, want sweet or starchy foods all the time.

4. Dry mouth (xerostomia)

One of the most common symptoms of type 1 and 2 diabetes is dry mouth. This could be due to exposure to high blood sugar levels. As a result of increased urination, the body loses fluid and becomes dehydrated.If you don’t drink enough water to replace fluid loss, your mouth becomes dry.

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Still from the movie “Bachelor Party in Vegas”

5. Headache

In people with diabetes, excruciating headaches are usually caused by changes in blood sugar levels. The more ups and downs sugar has, the more likely you are to get a headache. This is the reaction of the blood vessels of the brain to hormonal changes.

6. Blurred vision

In diabetes, there is an accumulation of glucose in the lens of the eye. As a result, your vision will be distorted – often double vision in diabetics. The good news is that this symptom is reversible: once blood sugar levels return to normal, vision will be restored.

7. Yeast infection

High blood sugar makes it a breeding ground for yeast and bacteria that cause infections. Recurrent infections such as foot fungus and thrush are ideal signs of diabetes.

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Still from “Sweeney Todd, Demon Barber of Fleet Street”

8. Cuts and bruises that will not heal

When blood sugar levels are constantly high, blood vessels are constricted, blood and oxygen cannot reach the wound and provide enough nutrients and oxygen to heal. Therefore, all wounds will heal slowly.

9. Numbness and tingling in the hands

High blood glucose levels over an extended period can damage nerves.This is called diabetic neuropathy and is the most worrying sign of diabetes. People with diabetic neuropathy experience tingling in the arms and legs, muscle cramps or weakness, pain that occurs mostly at night, and difficulty with coordination.

10. Sexual dysfunction

High sugar levels cause sexual dysfunction in both men and women due to damage to blood vessels and nerves. About 35 to 75% of men with diabetes experience erectile dysfunction.In order to open up in sex, people not only need to be sexually stimulated – they need healthy nerves and healthy blood vessels. Women may experience vaginal dryness and may have difficulty reaching orgasm due to loss of sensation in the genital area.

11. Unplanned weight loss

People with type 1 diabetes are more likely to suddenly lose weight. It is the product of two things that happen in your body due to exposure to high blood sugar levels.First, some of the weight is lost with the water you lose from excessive urination. And second, because your body produces less insulin, it cannot get glucose from the blood into the body for use as energy. The body will begin to burn its own fat and muscle for energy.

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Still from the movie “The Machinist”

12. Black spots on the neck (acanthosis nigricans)

High blood insulin levels cause skin cells to multiply rapidly.It manifests itself as dark spots on the neck, under the arms, in the elbows and under the knees.

13. Fruit breath

When the body is unable to produce insulin, cells do not receive fuel in the form of glucose. As a result, the body begins to burn fat and produces ketones that accumulate in the blood and urine. When ketones reach unsafe levels, diabetic ketoacidosis develops. One of the signs of this condition is a sweet fruity odor from the mouth. If you find this symptom in yourself, then you need to seek medical help immediately.

14. Shortness of breath

If you have diabetes and experience shortness of breath and symptoms such as fruity breath, nausea, vomiting, and abdominal pain, then this is diabetic ketoacidosis, a condition that requires hospitalization and insulin treatment.

15. High blood pressure

Uncontrolled diabetes mellitus can lead to high blood pressure (hypertension), which in turn puts other organs and systems in the body at risk.

16.Fatigue

When you eat, your body converts food into glucose using insulin. The glucose is then used by cells for energy. If your body does not produce the right amount of insulin, or if it becomes insulin resistant due to illness, then cells will not receive glucose and will not produce energy. As a result, you will feel constant fatigue.

17. Mood swings

Have you ever experienced unexplained mood swings? If your answer is yes, then you should consult your doctor and get tested for diabetes.Your brain is the center of your thoughts and emotions, it is the motor that provides you with everything you need. But just like your car’s engine, it needs fuel to do its job. For the brain, this fuel is glucose. If he gets too little or too much glucose, you may experience sudden mood swings.

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90,000 Symptoms and signs of diabetes mellitus in men and women

Diabetes mellitus is perhaps the most common disease in the world: according to official statistics, about 6% of the world’s population suffers from it.And most doctors agree that these data do not reflect reality: more than half of the cases have not been diagnosed. Meanwhile, early detection of diabetes can significantly increase the life expectancy of patients and prevent the development of many complications. We will talk about what signs indicate an elevated blood glucose level and what tests should be done to be sure that there is no disease.

Diabetes manifests itself, regardless of its type, is always the same – cells stop “extracting” energy from glucose and the substance in an undivided form accumulates in the body.Disruption of metabolic processes is due to a lack of the hormone insulin, which is responsible for the absorption of sugars. However, the causes, features, and symptoms differ for different types of diabetes.

With type 1 diabetes insulin is not produced by the body due to significant damage to the beta cells of the pancreas during an autoimmune attack. The onset of the disease is often preceded by viral infections. Typically, this type of diabetes does not depend on the patient’s physique and occurs at an early age – in children, adolescents and young people under the age of 25.

Co 2 type , according to various sources, refers to 95% of all cases of diabetes. Unlike type 1, the body continues to produce insulin, but it is not properly absorbed by the cells and is not absorbed. Obesity (especially the accumulation of fat in the abdomen and waist), hereditary factors, an inactive lifestyle, and unhealthy diet provoke the development of the disease. Type 2 diabetes is a disease of mature age, and it is more susceptible to citizens over 45 years of age.

Gestational diabetes is a rather rare and, fortunately, temporary type that develops exclusively during pregnancy and disappears with its end. The development of the disease can be considered an individual reaction of the body: the hormones produced block the perception of insulin by the cells of the expectant mother. In some cases, the pancreas simply cannot cope with the double production of insulin – the result is gestational diabetes. Risk factors include the late age of the woman in labor (over 40 years), smoking, overweight, heredity.

Reference
The term “diabetes” dates back to the 2nd century BC. e. in Ancient Greece. Initially, this name united a group of diseases manifested in patients by constant thirst, water incontinence in the body and frequent urination.

Clinical signs of diabetes

Diabetes is one of the most insidious diseases, according to doctors: its early stages are rarely accompanied by painful sensations and do not always have severe symptoms.To notice the first signs of diabetes, you need to listen carefully to your body and, of course, know what disorders you should pay attention to.

In general, the symptoms of all types of diabetes mellitus are similar and do not depend on gender and age: the occurrence of certain signs of the disease in men, women and children is purely individual.

Symptoms of type 1 diabetes mellitus

Type 1 diabetes develops rapidly and has pronounced manifestations. The patient, despite the increased appetite, quickly loses weight, feels constant fatigue, drowsiness, thirst.Frequent urge to urinate makes him wake up in the middle of the night several times, the amount of urine excreted significantly exceeds the norm. Symptoms come on suddenly and do not go unnoticed with careful attention.

Symptoms of type 2 diabetes mellitus

The second type of diabetes mellitus is the most common and at the same time the most difficult to recognize. The disease progresses slowly, and, despite the large number of possible symptoms, they are usually mild.

Type II diabetes is characterized by:

• dry mouth and thirst, the patient can consume up to three to five liters of fluid daily;
• weight reduction;
• copious urination;
• Constant tiredness, drowsiness, feeling of weakness, irritability;
• tingling sensation in the fingers, numbness of the limbs;
• significant sudden weight loss despite high appetite;
• nausea, sometimes vomiting;
• the skin is dry, severe itching is possible, long-term healing of wounds and abrasions;
• urinary tract infections;
• high pressure.

Both types of diabetes are fraught with serious complications. So, hyperosmolar and lacticidotic coma, hypoglycemia, ketoacidosis can develop literally within two to three hours and in some cases lead to death.

Also diabetes is the cause of vision problems (up to complete blindness), heart, kidney, nervous system, skin, blood vessels. Thrombosis, atherosclerosis, renal failure, myocardial infarction, stroke – these are just a small part of the list of dangerous diseases that can be observed with late diagnosis and improper treatment of diabetes.

Symptoms of gestational diabetes

This type of disease very rarely has external symptoms: it is usually found only during routine examinations, including urine and blood tests. In cases where the manifestations are still noticeable, they are similar to signs of type 1 and 2 diabetes: weakness, nausea, thirst, urinary tract infections.

Gestational diabetes, although it does not pose a direct threat to the child’s life, still negatively affects the condition of the mother and baby: the higher the blood glucose levels, the stronger the effect of the disease.As a rule, a baby is born with a weight exceeding the norm; in the future, he remains prone to obesity, diabetes. There is a small risk of fetal growth retardation, as well as hypoglycemia, jaundice and other diseases in the first weeks of a child’s life.

Laboratory signs of diabetes mellitus in men, women and children

Reliable confirmation of the diagnosis is possible only after a series of laboratory tests to assess the level of sugar (glucose) in the blood:

• Random analysis of glucose in blood plasma is usually carried out during mass examinations and clinical examination, as well as, if necessary, conduct an emergency study of indicators.A critical value can be considered an indicator of 7 mmol / l or more.
• Fasting blood glucose test is the most common type of analysis, although it does not differ in absolute accuracy, but it is simple to perform. As a rule, it is carried out in the morning, while the patient should not eat for 8-12 hours before the study. As with any blood test, you should not drink alcoholic beverages the day before, and also smoke an hour before taking the material. A good indicator is considered if the glucose level does not exceed 5.5 mmol / l.At 7 mmol / l or more, the patient will be referred for additional examination.
• Glucose Tolerance Test is usually prescribed to clarify the results of the tests described above. The test allows not only to accurately answer the question of the presence of diabetes, but also to diagnose impaired glucose tolerance. To do this, blood is taken from the patient on an empty stomach, then he must drink a glass of water with sugar dissolved in it (75 g for adults; 1.75 g per 1 kg of the child’s weight), and after two hours he must be tested again.In the normal state of the body, the first indicator is below 5.5 mmol / l, and the second is less than 7.8 mmol / l. Values ​​from 5.5 to 6.7 mmol / L and from 7.8 to 11.1 mmol / L, respectively, indicate the presence of prediabetes. Values ​​above these numbers indicate diabetes.
• Glycated Hemoglobin Test is a modern, reliable test recommended by the World Health Organization for the detection of diabetes. Its results show the average blood glucose value over the past 90 days, and accuracy is not affected by food intake, sampling time, or many other external factors.Normally, the indicator will be less than 6.5% HbA1C, which corresponds to a glucose level of 7.8 mmol / l, a value above this is a clear sign of the disease. At 6% (7 mmol / L), the risk of diabetes is considered increased, but the situation can still be corrected by changing the lifestyle.

Modern methods of treatment in combination with the prescribed diet can make the life of a diabetic patient full and comfortable, as well as avoid many complications. The biggest problem is the timely diagnosis of this disease: many patients go to clinics only in the late stages of diabetes.To avoid irreversible consequences for the body, doctors recommend to undergo an examination at least once a year, especially if there are “risk factors” in the anamnesis, and even more so when the first signs of diabetes appear.

Neurological complications of diabetes mellitus uMEDp

The article provides data on the prevalence, pathogenesis, clinical features of the most frequent complications of type 2 diabetes mellitus – diabetic encephalopathy and diabetic polyneuropathy.Diabetic encephalopathy is a late complication of diabetes, contributing to the development of cognitive dysfunction, emotional disorders, disrupting the patient’s daily activities and quality of life. Diabetic polyneuropathy leads to a decrease in the quality of life and disability of the patient. Possibilities of pathogenetic treatment of these complications using dipyridamole and alpha-lipoic acid are discussed.

Introduction

The International Diabetes Federation predicts that by 2045diabetes mellitus will affect approximately 629 million people [1]. Currently, 425 million people worldwide have diabetes, of which two-thirds (327 million) are of working age, in the Russian Federation – about 8.5 million, and in every second case, diabetes is not diagnosed. The need for lifelong control of sugar levels and therapy, prevention and treatment of complications, a high level of disability and mortality in this disease determine its medical and socio-economic significance.It has been shown that 12% of health care costs worldwide are spent on the treatment of diabetes and its complications [1].

Diabetic encephalopathy

Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia due to impaired insulin secretion, a decrease in its action, or a combination of both of these factors. The disease is accompanied by damage and dysfunction of blood vessels, heart, kidneys, retina, gastrointestinal tract, peripheral and central nervous system [2].

It is generally accepted that diabetes mellitus can affect the function of the central nervous system. The most common complication of type 2 diabetes mellitus from the central nervous system is diabetic encephalopathy, which is considered a typical consequence of impaired metabolism of neurons and white matter of the central nervous system as a result of chronic hyperglycemia. Even in the absence of obvious manifestations in the form of strokes, repeated hypoglycemic reactions, or cerebral edema, prolonged uncontrolled hyperglycemia can cause gradually increasing impairment of cognitive functions [3, 4].

The development of cognitive dysfunction associated with diabetes mellitus has been discussed since 1922 [5]. Potential causes of central nervous system dysfunction in diabetes mellitus are vascular factors, changes in the permeability of the blood-brain barrier, metabolic changes such as repeated hypoglycemic episodes, chronic hyperglycemia, hyperosmolarity, acidosis, ketosis, neuroendocrine or neurochemical changes [3, 4]. Other factors damaging the central nervous system include concomitant arterial hypertension, uremia, peripheral and autonomic neuropathy.

The neuronal damage in diabetic encephalopathy is based on the activation of lipid peroxidation processes triggered by chronic hyperglycemia, insulin resistance and hyperinsulinemia. On the one hand, a cascade of pathological reactions leads to the formation of free radicals that damage the structure of enzyme proteins, DNA and lipids of cell membranes. On the other hand, hyperglycemia causes glycosylation and inactivation of antioxidants that protect cells from free radicals.Oxidative stress contributes to the development of endothelial dysfunction, which in turn becomes the initial link in the development of systemic atherosclerosis [6]. Atherosclerosis, together with arterial hypertension, increases the risk of stroke in patients with diabetes.

According to the UKPDS study, an increase in the level of glycosylated hemoglobin by 1% is accompanied by an increase in the incidence of stroke by 17% [7]. The risk of developing cognitive impairment increases due not only to clinically obvious cerebrovascular accidents, but also to the formation of “silent” lacunar infarctions, for which diabetes mellitus and arterial hypertension are the main risk factors [8].Hyperinsulinemia leads to an increase in the level of beta-amyloid and proinflammatory cytokines, promotes the formation of neurofibrillary glomeruli and senile plaques – markers of the degenerative process in the brain [9]. The role of insulin in the energy supply of brain neurons, as well as its neurotransmitter function, has been proven. The direct participation of insulin in the processes of memory consolidation is discussed [10]. In addition, recent studies have shown that elevated levels of dipeptidyl peptidase 4 (DPP-4) in type 2 diabetes act as an independent risk factor for the development of mild cognitive impairment in the elderly.The mechanism of this association is realized through the association of high levels of DPP-4 with inflammation and oxidative stress. DPP-4 can become a biological marker and a potential therapeutic target, since DPP-4 inhibitors have been widely used in the treatment of diabetes mellitus in recent years [11]. Another study linked an increased level of DPP-4 and a decrease in the level of cerebral neurotrophic factor with the development of moderate cognitive impairment and found an increased risk of developing cognitive impairment in patients with a high ratio of DPP-4 to cerebral neurotrophic factor [12].Data on a possible genetic predisposition to the development of encephalopathy in diabetes mellitus in the form of carriage of the epsilon 4 allele of the apolipoprotein E gene are also presented [10, 13].

Diabetic encephalopathy is characterized by a slow gradual development, and clinical manifestations become noticeable only at the advanced stage of the disease. The basis of the clinical picture of diabetic encephalopathy is cognitive impairment that develops against the background of structural and metabolic changes in the brain.Cognitive impairment occurs in most diabetic patients. The clinical features of diabetic encephalopathy, as well as the overwhelming number of dysmetabolic encephalopathy, are nonspecific. Disorders of cognitive functions, emotional lability, an increased level of anxiety and depressive symptoms, more often subclinical, are found [4, 10, 14, 15]. Cognitive impairments are mainly represented by mild to moderate cognitive impairments, dementia is much less common [10].The incidence of moderate cognitive impairment among patients with diabetes mellitus exceeds that in the general population by 3–10% [14, 15]. And only 36% of patients with type 2 diabetes mellitus do not have cognitive impairment of varying severity [15]. In a recent study by O. Albai et al. revealed moderate cognitive impairment in 42% of patients with type 2 diabetes mellitus [16].

Type 2 diabetes mellitus increases the risk of developing dementia at any age, and it correlates more strongly with vascular dementia (100–160%) than with Alzheimer’s disease (45–90%) [16, 17].F. Zeng et al. found a statistically significant relationship between an increase in the level of glycosylated hemoglobin for every 1 mmol / l and a decrease in the global assessment of cognitive functions, memory indicators and executive functions in elderly patients [18]. In a study conducted at the Department of Nervous Diseases of the First Moscow State Medical University. THEM. Sechenov (90 patients with diabetes mellitus lasting at least a year), cognitive impairment was absent in 28.9% of cases. Moderate cognitive impairment was detected in 51.1% of patients, and mild cognitive impairment – in 20.0% of patients.None of the examined patients suffered from dementia. In the structure of cognitive impairments, impairments of executive functions were predominantly presented – 59.4% of cases, primary failure of memorization occurred in only 6.3% of cases. The combination of dysmnestic disorders and dysfunctions of executive functions was observed in 34.4% of patients [10].

All of the above indicates the need for regular screening of the state of cognitive functions in patients with type 2 diabetes mellitus at any age.Cognitive impairments make treatment difficult as patients lose the ability to adequately control their blood sugar levels. They forget to take an insulin injection or an antidiabetic medication. Their adherence to strict adherence to the diet is deteriorating. All this increases the risk of developing disabling or life-threatening complications [4, 19]. Thus, in elderly patients with type 2 diabetes mellitus, cognitive dysfunction increases the risk of death by 20% in two years [20].

Cognitive impairment can be mitigated by optimizing blood glucose management, although the effects of specific glucose-lowering drugs on cognitive performance remain the subject of future research.Pathogenetic therapy of diabetic encephalopathy should include correction of endothelial dysfunction underlying microangiopathy in diabetes, including the use of endothelial and angioprotectors that improve rheological properties and blood flow by reducing platelet adhesion and aggregation.

Dipyridamole (Curantil) is a classic representative of antiplatelet drugs. Unlike acetylsalicylic acid, it has a lower risk of developing hemorrhagic complications and damage to the gastrointestinal tract.The main mechanism of action of dipyridamole is to reduce platelet aggregation by inhibiting phosphodiesterase, which inactivates cyclic adenosine monophosphate. In this regard, the levels of cyclic adenosine monophosphate in platelets increase (the level of Ca ²⁺ in the cytoplasm of platelets decreases) and adenosine (dipyridamole prevents the uptake of adenosine by erythrocytes and endothelial cells and inhibits adenosine deaminase). Adenosine activates adenylate cyclase via A2 receptors and therefore has antiplatelet properties.In addition, the release of the plasminogen activator increases, which, along with the antiplatelet effect, also contributes to the normalization of the blood coagulation system. An increase in the level of cyclic guanosine monophosphate in vascular smooth muscle cells causes a vasodilating effect [21].

In patients with diabetes, the additional properties of dipyridamole are of particular importance, primarily related to the correction of endothelial dysfunction. It is known that dipyridamole enhances the nitric oxide-mediated vasodilation effect and suppresses the formation of endothelial cells that release reactive oxygen species, which improves the redox balance of the endothelium [22].

As a result of the combined antiplatelet and vasodilatory effects, dipyridamole improves the perfusion of the nervous tissue. In addition, dipyridamole inhibits free radical oxidation, realizing angioprotective properties. According to research data, neutralization of free radicals prevents both the development of pathological vasoreactivity and impaired permeability of the blood-brain barrier, which is important for the prevention of cerebral microangiopathy [23, 24].Low doses of dipyridamole have been shown to be effective in preventing the development of induced angiopathy and nephropathy in experimental models of diabetes by reducing vasorenal oxidative stress [25]. In addition, dipyridamole stimulates the production of endothelial growth factor and the development of the capillary network due to the action of adenosine on adenosine receptors in the capillaries. Modern studies have also demonstrated the anti-inflammatory activity of dipyridamole, which can be used in the prevention of the progression of cognitive impairment in diabetic encephalopathy, regardless of the antiplatelet effect [26].

Diabetic polyneuropathy

The most common neurological complication of diabetes mellitus from the peripheral nervous system is distal symmetric sensory-motor polyneuropathy, which affects approximately 50% of patients with both types of diabetes. The diagnosis of diabetic polyneuropathy (DPN) suggests the presence of symptoms or signs of peripheral nerve dysfunction in patients with diabetes after excluding other possible causes of peripheral nerve damage [27].The prevalence of DPN varies from 50% on clinical examination to 90–100% upon more informative electroneuromyographic examination in patients with diabetes mellitus for more than 20 years [28, 29]. In type 1 diabetes, DPN becomes clinically evident after many years of hyperglycemia, and in type 2 diabetes, symptoms may appear within a few years after diagnosis or be present at the time of initial diagnosis. Approximately 8% of patients with newly diagnosed diabetes mellitus show clinical signs of DPN [30], and in 5% of patients, DPN symptoms are the basis for seeking medical attention [31].

It is generally accepted that the pathogenesis of DPN depends on many factors. In addition to long-term hyperglycemia itself, dyslipidemia, arterial hypertension, smoking, vitamin D deficiency [32] and exposure to other potentially neurotoxic agents, such as ethanol, affect the risk of DPN development. Genetic factors can also play a role [33]. In the development of the most common clinical form – distal symmetric polyneuropathy, the following biochemical mechanisms are involved: activation of the polyol pathway for glucose utilization, oxidative stress, accumulation of end products of glycation.Hyperglycemia causes an increase in the intracellular level of glucose in the nerves, as the peripheral nerves absorb it without the involvement of insulin receptors, which leads to saturation of the normal glycolytic pathway. Excess glucose is shunted into the polyol pathway and converted to sorbitol and fructose by the enzymes aldose reductase and sorbitol dehydrogenase [34]. The accumulation of sorbitol and fructose contributes to a decrease in the content of myo-inositol in the nerve, a decrease in the activity of Na ⁺ / K ⁺ -ATPase, a violation of axonal transport and the structural integrity of the nerve, which prevents the normal propagation of the action potential.Hyperglycemia stimulates non-enzymatic reactions with proteins, nucleotides, and lipids, resulting in the accumulation of advanced glycation end products that disrupt the structural integrity of neurons and reparative mechanisms by interfering with neuronal metabolism and axonal transport [35]. A decrease in antioxidant levels and an accumulation of reactive oxygen species form the basis of oxidative stress, a key pathogenetic mechanism leading to neuronal damage in diabetes. Lipid peroxidation contributes to the disruption of the structure of the neuron membrane, which ultimately leads to apoptosis of neurons and glial cells.Oxidative stress develops not only in neurons, but also in the vessels that feed the neurons ( vasa nervorum ). This process causes endothelial dysfunction, which in turn causes ischemic damage to neurons (microthrombosis and capillary occlusion) and disrupts the production of growth factors in the nervous tissue, reducing the regenerative potential of the neuron [36–38]. Activation of protein kinase C leads to a decrease in the formation of nitric oxide, which also causes endoneural hypoxia. Insufficient activity of antioxidant enzymes in diabetes is determined by genetic factors, which is confirmed by the study of gene polymorphism of such enzymes of the antioxidant system of the body as catalase (in diabetic retinopathy) and superoxide dismutase (in DPN) [37].In conditions of hyperglycemia, glial cells are also damaged, resulting in the release of pro-inflammatory cytokines: interleukin 1-beta, interleukin 16, tumor necrosis factor alpha. The action of these cytokines underlies the pathogenesis of the phenomena of allodynia and hyperalgesia [37].

The clinical symptoms of DPN are diverse and can include, in various combinations, sensory dysfunction, motor and autonomic disorders. In 90% of cases, patients with DPN have symmetrical distal sensory polyneuropathy.In the clinical picture of symmetric distal sensory polyneuropathy, positive and negative sensory symptoms of symmetric damage to the sensory nerves are distinguished. Positive symptoms include a burning sensation, tingling sensation, cutting, stabbing, shooting pain, the phenomenon of allodynia (the occurrence of pain in response to a non-painful stimulus, for example, when touched). Negative symptoms include hypalgesia and hypesthesia like gloves and socks, a feeling of numbness, tightness of the limb, loss of tendon reflexes, and sensitive ataxia.Patients with negative symptoms are at risk of developing a diabetic foot due to the lack of a protective function of pain and tactile sensitivity.

Motor symptoms such as muscle weakness and atrophy can be distal symmetrical, proximal, or focal. Distal weakness, as a rule, is minimally expressed and often occurs with a significant duration of the disease [39]. Proximal weakness in specific forms of DPN may be more severe.If significant proximal limb weakness is found, another cause, such as vasculitis or chronic inflammatory demyelinating polyneuropathy, should be ruled out [39].

The defeat of autonomic fibers is often combined with symmetrical distal sensory polyneuropathy. At the same time, the clinical picture is dominated by signs of dysfunction of the cardiovascular system (orthostatic hypotension, tachycardia at rest, fixed pulse), gastrointestinal tract (constipation, diarrhea, gastroparesis), genitourinary system (impotence, retrograde ejaculation, neurogenic bladder).Autonomic neuropathy leads to painless ischemia and myocardial infarction, malignant arrhythmias, sudden death, and three times increases the death rate in diabetes mellitus [40].

It should be noted the long-term relative asymptomaticity of the most common form of DPN – distal, mainly sensory, polyneuropathy. Since early initiation of therapy determines its effectiveness, the physician, when consulting a patient with diabetes mellitus, should keep in mind the possible damage to the peripheral nerves.Failure to diagnose DPN in a timely manner can lead to serious consequences, including disability and limb amputation as a result of the development of a diabetic foot.

Rare forms of damage to the peripheral nervous system in diabetes include acute cranial neuropathies (acute diabetic ophthalmoplegia), acute polyneuropathy of the extremities or trunk (painful thoracoabdominal neuropathy, diabetic radiculopathy), acute symmetric proximal motor diabetic polyneuropathies, asymmetric polyneuropathy.These types of neuropathy often occur acutely or subacutely, at the beginning of development are accompanied by severe pain syndrome. In the pathogenesis of these types of neuropathies, the leading mechanism is not so much a violation of glucose metabolism, as in chronic forms, but ischemic damage to nerves – nerve infarctions and autoimmune mechanisms.

The basis for early diagnosis of DPN is a thorough history taking and a detailed analysis of the patient’s complaints, since in the early stages of the disease there are no objective changes in the neurological status and abnormalities in the indices of routine electroneuromyography.DPN diagnostic criteria according to P.B. Dyck and P.J. Dyck, include diabetes mellitus, prolonged chronic hyperglycemia, distal symmetric sensorimotor polyneuropathy, exclusion of other causes of sensorimotor polyneuropathy. Diabetic retino- or nephropathy is similar in severity to polyneuropathy [41].

To verify the diagnosis of DPN in routine clinical practice, mainly electrophysiological methods are used, and pathomorphological research methods are used for scientific purposes.Electroneuromyography shows signs of predominantly axonopathy (decrease in the amplitude of the M-response), combined in some cases with myelinopathy (mild or moderate decrease in the rate of conduction of excitation along the nerves, an increase in distal latency, changes in F-wave indices) [41, 42]. The stages of DPN are shown in the table [41].

Treatment of DPN should include etiotropic, pathogenetic therapy and symptomatic therapy for neuropathic pain syndrome and autonomic dysfunction.Etiotropic therapy (tight and stable glycemic control) is the most important factor in slowing the progression of DPN [43]. Because rapid changes from hypoglycemia to hyperglycemia stimulate and worsen neuropathic pain, stability of glycemic control is as important as actual glucose levels. The DCCT study demonstrated that aggressive glycemic control in patients with type 1 diabetes reduced the risk of developing DPN by 60% over five years [44]. The effect of tight glycemic control on the risk of DPN in patients with type 2 diabetes or impaired glucose tolerance is not completely clear and requires further study [45].A 2012 Cochrane review indicates that tight glycemic control prevents the development of clinical manifestations of DPN and slows the progression of nerve conduction and vibration disturbances in patients with type 1 and 2 diabetes. However, at the same time, tight control of glucose levels increases the risk of serious hypoglycemic episodes, and this should be taken into account when assessing the balance of potential benefits and possible risks [46]. The results of clinical studies UKPDS and ADVANCE also did not demonstrate a significant effect of good glycemic control over a long period of time on the state of peripheral nerves in patients with type 2 diabetes [47, 48].

Given the importance of oxidative stress in the development of peripheral nerve damage in diabetes, drugs with an antioxidant effect are actively used in the treatment of DPN, with alpha-lipoic (thioctic) acid (ALA) playing the leading role. The ALA molecule contains two thiol groups that bind free radicals. ALA deactivates metal ions, which are part of enzymes that catalyze lipid peroxidation processes. ALA is readily soluble in both aqueous and fatty media and easily penetrates cell membranes.Due to its antioxidant effect, ALA has a neuroprotective effect, reduces endothelial dysfunction, normalizes the content of nitric oxide – a regulator of vascular wall relaxation, helping to improve microcirculation and reduce the risk of ischemic damage to peripheral nerves.

ALA also has other metabolic effects: it activates the processes of glucose utilization without increasing the need for it, increases the activity of the Krebs cycle, and reduces the insulin resistance of peripheral tissues.According to experimental data, ALA increases the synthesis and activity of the growth factor and regeneration of axons, which has a beneficial effect on neuroreparative processes and normalizes axonal transport [49, 50].

The clinical efficacy of ALA in chronic predominantly sensory distal DPN has been demonstrated in a number of large international studies. The ALADIN study showed that infusional administration of ALA promoted a gradual regression of subjective and objective neurological symptoms of DPN.The greatest therapeutic effect was observed with the use of ALA at a dose of 600 mg / day. An increase in the dose to 1200 mg / day was accompanied by an increase in the incidence of adverse events with a comparable therapeutic
efficiency [51].

The ALADIN II study examined the effects of long-term ALA therapy. 65 patients received ALA first intravenously for the first five days, then 600 mg (one group) and 1200 mg (another group) orally for two years.After 24 months of therapy, there was a statistically significant improvement in quantitative scales for assessing the severity of sensory and motor symptoms of neuropathy in both ALA groups compared to the placebo group. ALA intake had the greatest effect on sensory symptoms of DPN [52].

The SYDNEY study involved 120 patients with type 1 and type 2 diabetes, half of whom received placebo and half received ALA. The beneficial effect of ALA in sensory and autonomic disorders and its positive effect on electrophysiological parameters (electroneuromyography data) has been noted [53].In the SYDNEY II study, the therapeutic effect of ALA was found to be dose-dependent. With the appointment of 600 mg of the drug, the state of health improved after three weeks of treatment, and with the use of high doses (1200 and 1800 mg) – in a shorter time [53–55].

According to the results of the DEKAN study, ALA at a dose of 800 mg / day for four months improved the function of autonomic fibers in DPN [56].

The recommended scheme for the use of ALA for DPN includes intravenous drip administration at doses of 300-600 mg / day for two to four weeks, followed by oral administration at a dose of 600 mg / day for three to four months or more.In the Russian Federation, ALK is included in the federal standards for specialized medical care for diabetic and alcoholic polyneuropathies.

As noted above, microcirculation disturbance plays an important role in the pathogenesis of peripheral nerve damage in diabetes mellitus. Therefore, one of the areas of prevention and treatment of diabetic neuropathy is the correction of microcirculatory disorders. In this regard, dipyridamole is of great interest, since it affects both cerebral and peripheral microcirculation.It should be noted that one of the indications for the use of dipyridamole is the complex therapy of microcirculation disorders of any genesis. The use of drugs that simultaneously affect both cerebral and peripheral microcirculation avoids extremely undesirable polypharmacy. Domestic neurologists have a positive experience of using dipyridamole for DPN. For example, M.Kh. Al-Zamil (2008) found that the addition of dipyridamole to ALA promotes faster and more significant regression of pain and paresthesias.In patients with painful form of DPN, positive dynamics of pain and temperature sensitivity indicators was simultaneously observed [57].

Conclusion

Patients with type 2 diabetes mellitus have a high risk of developing cognitive impairment and DPN.