What are the symptoms and causes of diabetic ketoacidosis. How does low blood sugar relate to shortness of breath in diabetes. What are the complications of diabetes and how can they be managed.

The Link Between Low Blood Sugar and Shortness of Breath

While low blood sugar (hypoglycemia) and shortness of breath may seem unrelated at first glance, they can be interconnected in the context of diabetes, particularly in a serious condition known as diabetic ketoacidosis (DKA). Understanding this relationship is crucial for managing diabetes effectively and recognizing potential emergencies.

How does low blood sugar lead to shortness of breath? In severe cases of hypoglycemia, the body’s stress response can trigger rapid, shallow breathing. Additionally, when blood sugar drops too low, the body may start breaking down fat for energy, producing ketones. The accumulation of ketones can lead to diabetic ketoacidosis, which often causes Kussmaul breathing – deep, rapid breaths that can be mistaken for shortness of breath.

Diabetic Ketoacidosis: A Serious Complication of Diabetes

Diabetic ketoacidosis is a life-threatening complication that can occur in people with diabetes, particularly type 1 diabetes. It develops when the body doesn’t have enough insulin to allow glucose to enter cells for energy. As a result, the body begins to break down fat for fuel, producing ketones in the process.

What are the primary causes of diabetic ketoacidosis?

• Insufficient insulin administration
• Illness or infection
• Severe dehydration
• Certain medications
• Physical or emotional stress

Recognizing the symptoms of DKA is crucial for prompt treatment. These may include:

1. Excessive thirst and frequent urination
2. Nausea and vomiting
3. Abdominal pain
4. Weakness or fatigue
5. Shortness of breath
6. Fruity-scented breath
7. Confusion

Long-Term Complications of Diabetes: A Comprehensive Overview

Diabetes is a chronic condition that, if not properly managed, can lead to various long-term complications affecting multiple organ systems. These complications typically develop over years of poorly controlled blood glucose levels. Understanding these potential issues is essential for motivating proper diabetes management and early intervention.

Eye Disease (Diabetic Retinopathy)

How does diabetes affect the eyes? High blood glucose levels can damage the blood vessels in the retina, leading to a condition called diabetic retinopathy. This can result in vision problems and, if left untreated, may cause blindness. Regular eye exams are crucial for early detection and treatment.

Cardiovascular Complications

Why are people with diabetes at higher risk for heart disease? Diabetes often coexists with other cardiovascular risk factors such as high blood pressure and high cholesterol. The combination of these factors significantly increases the risk of heart attacks, strokes, and peripheral artery disease.

Kidney Disease: A Silent Threat in Diabetes

Diabetic kidney disease, or nephropathy, is a serious complication that can lead to kidney failure if left unchecked. How does diabetes damage the kidneys? Consistently high blood glucose levels can harm the small blood vessels in the kidneys, impairing their ability to filter waste from the blood effectively.

What are the signs of diabetic kidney disease?

• Protein in the urine (albuminuria)
• High blood pressure
• Swelling in the feet and ankles
• Decreased need for insulin or diabetes medications
• Fatigue and weakness

Regular kidney function tests and maintaining good blood glucose control are essential in preventing or slowing the progression of diabetic kidney disease.

Neuropathy: When Diabetes Affects the Nervous System

Diabetic neuropathy refers to nerve damage caused by prolonged high blood glucose levels. It can affect various parts of the body, leading to a range of symptoms and complications.

Peripheral Neuropathy

What is peripheral neuropathy and how does it manifest? This is the most common form of diabetic neuropathy, primarily affecting the nerves in the feet and legs, and sometimes the hands and arms. Symptoms may include:

• Numbness or reduced sensation
• Tingling or burning sensations
• Sharp pains or cramps
• Increased sensitivity to touch
• Muscle weakness

Autonomic Neuropathy

How does autonomic neuropathy affect bodily functions? This form of neuropathy impacts the nerves that control involuntary body functions, potentially causing issues with:

• Digestive system (gastroparesis, diarrhea, constipation)
• Urinary tract (incontinence, urinary tract infections)
• Sexual response (erectile dysfunction, vaginal dryness)
• Heart rate and blood pressure regulation
• Sweat glands and temperature control

Diabetic Foot Complications: A Major Concern

Why are foot problems common in diabetes? The combination of nerve damage (neuropathy) and reduced blood flow to the feet makes people with diabetes particularly susceptible to foot complications. These can range from minor issues to severe problems that may lead to amputation if not properly managed.

What are the key aspects of diabetic foot care?

1. Daily foot inspections
2. Regular washing and careful drying of feet
3. Moisturizing to prevent dry, cracked skin
4. Proper nail care
5. Wearing well-fitting, comfortable shoes
6. Never walking barefoot
7. Regular check-ups with a podiatrist

Early detection and treatment of foot problems can significantly reduce the risk of serious complications, including ulcers and amputations.

Pregnancy and Diabetes: Managing Risks for Mother and Child

Women with diabetes face unique challenges during pregnancy. How does diabetes affect pregnancy outcomes? Poorly controlled blood glucose levels can lead to complications for both the mother and the developing fetus.

Risks for the Mother

What are the potential complications for pregnant women with diabetes?

• Worsening of diabetic retinopathy
• Increased risk of preeclampsia
• Higher likelihood of cesarean delivery
• Increased risk of infections

Risks for the Baby

How can maternal diabetes affect the developing fetus?

• Increased risk of birth defects
• Macrosomia (excessive birth weight)
• Neonatal hypoglycemia
• Jaundice
• Respiratory distress syndrome

Careful planning, close monitoring of blood glucose levels, and collaboration with healthcare providers are essential for managing diabetes during pregnancy and ensuring the best possible outcomes for both mother and child.

Acute Complications of Diabetes: Recognizing and Responding to Emergencies

While long-term complications develop over time, acute complications of diabetes can occur suddenly and may be life-threatening if not addressed promptly. Understanding these acute complications is crucial for people with diabetes and their caregivers.

Hypoglycemia (Low Blood Sugar)

What causes hypoglycemia in people with diabetes? Hypoglycemia typically occurs when blood glucose levels fall below 70 mg/dL (3.9 mmol/L). Common causes include:

• Taking too much insulin or diabetes medication
• Skipping or delaying meals
• Excessive physical activity without proper fuel
• Alcohol consumption, especially on an empty stomach

What are the symptoms of hypoglycemia?

1. Shakiness
2. Sweating
3. Rapid heartbeat
4. Hunger
5. Irritability or mood changes
6. Headache
7. Blurred vision
8. Confusion

How should hypoglycemia be treated? The “15-15 rule” is a common approach:

1. Consume 15 grams of fast-acting carbohydrates (e.g., glucose tablets, fruit juice)
2. Wait 15 minutes and recheck blood glucose
3. If still low, repeat the process
4. Once blood glucose returns to normal, eat a small snack if the next meal is more than an hour away

Hyperglycemia (High Blood Sugar)

What leads to hyperglycemia in diabetes? High blood sugar can result from:

• Insufficient insulin or diabetes medication
• Overeating or consuming high-sugar foods
• Illness or infection
• Stress
• Certain medications (e.g., steroids)

What are the signs of hyperglycemia?

1. Increased thirst and frequent urination
2. Fatigue
3. Blurred vision
4. Headache
5. Dry mouth

How is hyperglycemia managed? Treatment typically involves:

• Adjusting insulin or medication doses (under medical guidance)
• Increasing water intake to prevent dehydration
• Exercising (if ketones are not present)
• Modifying diet as needed

Preventing Diabetes Complications: Strategies for Long-Term Health

While the potential complications of diabetes may seem daunting, many can be prevented or significantly delayed with proper management. What are the key strategies for preventing diabetes complications?

1. Blood Glucose Control: Maintaining blood glucose levels within target ranges is crucial. This often involves a combination of medication, diet, and exercise.
2. Regular Check-ups: Routine visits to healthcare providers, including endocrinologists, ophthalmologists, and podiatrists, can help catch and address potential issues early.
3. Blood Pressure Management: Keeping blood pressure under control is essential for preventing cardiovascular and kidney complications.
4. Cholesterol Management: Maintaining healthy cholesterol levels can reduce the risk of heart disease and stroke.
5. Smoking Cessation: Quitting smoking is particularly important for people with diabetes, as it significantly increases the risk of various complications.
6. Healthy Diet: Following a balanced, nutrient-rich diet can help manage blood glucose levels and reduce the risk of complications.
7. Regular Physical Activity: Exercise helps improve insulin sensitivity, manage weight, and reduce the risk of cardiovascular complications.
8. Stress Management: Chronic stress can affect blood glucose levels, so finding effective ways to manage stress is important.
9. Alcohol Moderation: Limiting alcohol intake can help prevent hypoglycemia and reduce the risk of other complications.
10. Medication Adherence: Taking prescribed medications as directed is crucial for managing diabetes and preventing complications.

By implementing these strategies and working closely with healthcare providers, people with diabetes can significantly improve their long-term health outcomes and quality of life.

Emerging Treatments and Technologies in Diabetes Management

The field of diabetes care is constantly evolving, with new treatments and technologies offering hope for better management and reduced complications. What are some of the emerging developments in diabetes care?

Artificial Pancreas Systems

How do artificial pancreas systems work? These systems combine continuous glucose monitors (CGMs) with insulin pumps and advanced algorithms to automatically adjust insulin delivery based on real-time glucose readings. This technology aims to mimic the function of a healthy pancreas, potentially reducing the risk of both hypo- and hyperglycemia.

Smart Insulin

What is smart insulin and how could it revolutionize diabetes treatment? Smart insulin is a type of insulin being developed that would automatically activate when blood glucose levels rise and deactivate when they fall. This could potentially reduce the risk of hypoglycemia and simplify diabetes management.

Gene Therapy

How might gene therapy impact diabetes treatment in the future? Researchers are exploring ways to use gene therapy to restore insulin production in people with type 1 diabetes or improve insulin sensitivity in those with type 2 diabetes. While still in early stages, this approach holds promise for more targeted and potentially curative treatments.

Immunotherapy

What role could immunotherapy play in diabetes management? For type 1 diabetes, immunotherapy approaches aim to prevent or reverse the autoimmune destruction of insulin-producing cells. This could potentially halt or even reverse the progression of the disease.

Advanced Glucose Monitoring

How are glucose monitoring technologies evolving? Next-generation continuous glucose monitors are becoming smaller, more accurate, and longer-lasting. Some are even exploring non-invasive methods of glucose monitoring, such as using tears or sweat to measure glucose levels.

While these emerging treatments and technologies offer exciting possibilities, it’s important to note that many are still in development or early stages of testing. Continued research and clinical trials will be necessary to determine their safety and efficacy in managing diabetes and reducing complications.

In conclusion, understanding the potential complications of diabetes, both acute and chronic, is crucial for effective management of the condition. By recognizing the signs of complications, implementing preventive strategies, and staying informed about emerging treatments, people with diabetes can take proactive steps to maintain their health and quality of life. Regular communication with healthcare providers and adherence to personalized treatment plans remain the cornerstones of successful diabetes management and complication prevention.

Complications of Diabetes | Starting Your Journey

Diabetes can lead to complications that affect many parts of the body, including the brain, eyes, heart, kidneys and nerves. Diabetes complications can be long-term (chronic) or short-term (acute).

Long-term complications happen when blood glucose is poorly managed and remains high over a long period of time. Keeping blood glucose levels as near-normal as possible, along with getting regular check-ups and blood tests, can help delay or prevent long-term diabetes complications, including the following:

Eye Disease

Many people with diabetes develop some degree of eye disease (retinopathy), caused by damage to the blood vessels that supply the retina from high blood glucose levels over a period. This can damage vision or cause blindness. Diabetic eye disease can be quite advanced before it affects vision, so it is important that people with diabetes have eye tests on a regular basis. If caught early, treatment can prevent blindness.

Oral Health

People with diabetes have a higher risk of developing inflammation of the gums (periodontitis) than people without diabetes. Periodontitis can cause tooth decay and loss and can lead to other complications, such as heart disease. Poorly controlled blood glucose can lead to mouth infections and problems. Good oral hygiene can help improve overall glucose control, prevent tooth decay and loss, as well as other diabetes complications.

Cardiovascular Disease

Cardiovascular disease is a major cause of death and disability among people with diabetes. This includes angina (chest pain or discomfort), heart attack, stroke, peripheral artery disease (reduced blood flow to limbs) and congestive heart failure (heart weakness that leads to a fluid build-up in the lungs and other body tissues). High blood pressure, high cholesterol, and high blood glucose (all common in diabetes) are some of the factors that increase the risk of cardiovascular disease.

Kidney Disease

Diabetes is one of the leading causes of chronic (long-lasting) kidney disease. This is caused by damage to small blood vessels in the kidneys (known as nephropathy) and results in the kidneys not working well or failing altogether. Controlling blood glucose levels and blood pressure greatly decrease the risk of diabetic kidney disease.

Pregnancy Complications

Women with any type of diabetes are at risk for several problems during pregnancy. High glucose levels can affect the development of the fetus and put both mother and baby at risk for complications during delivery. High blood glucose during pregnancy can lead to changes in the fetus that cause it to gain excess weight and become larger than usual size. This can lead to injuries to the child and mother during delivery; it can also lead to low blood glucose (hypoglycemia) in the baby after birth. Children who are exposed to high blood glucose in the womb are also at higher risk of developing type 2 diabetes later in life. Careful monitoring of blood glucose during pregnancy is very important. For women with known diabetes prior to pregnancy, monitoring and good glucose control should start before pregnancy.

Nerve Damage

Nerve damage (neuropathy) results from prolonged high blood glucose levels and can result in damage to any nerve in the body. The most common form is peripheral neuropathy, which mainly affects the sensory nerves in the feet. This can lead to pain, tingling and loss of sensation. Neuropathy can allow injuries to go unnoticed, leading to ulcers, serious infections and, in some cases, amputations. Nerve damage can also lead to erectile dysfunction (sexual problems in men), as well as problems with digestion, urination and several other functions.

Diabetic Foot

In addition to nerve damage, people with diabetes can experience problems with poor circulation in their feet because of damage to blood vessels. These problems increase the risk of ulcers, infection and amputation. People with diabetes face a risk of amputation that may be up to 20 times more than people without diabetes. With good blood glucose management, however, a large proportion of amputations can be avoided. Because of these risks, it is important that people with diabetes examine their feet regularly to identify problems early.

Short-term or acute complications can be related to low or high blood glucose levels. They include hypoglycemia and related crises such as seizures, as well as hyperglycemia related crises such as diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS). They often occur suddenly and can be life-threatening. Fortunately, they can be prevented or treated quickly if you and your loved ones know what to do to and how to do it.

Hypoglycemia: Low blood sugar

Hypoglycemia means low blood glucose. It is sometimes called a “hypo” and it can happen at any time during the day or night. When your body doesn’t have enough glucose to use as energy, usually when your blood glucose level is 70 mg/dL or lower, you suffer from hypoglycemia.

Signs and symptoms of low blood sugar include:

• Sudden, extreme hunger
• Headache
• Shaking/trembling
• Weakness/tiredness
• Cold sweat
• Fast heartbeat
• Anxiety/nervousness
• Irritability

What to do if you have low blood sugar:

• Check your blood sugar to confirm that it is 70 mg/dL or below.
• Apply the 15/15* rule:
  • Have 15 grams of a quick-acting carbohydrate that contains glucose, for example: a small glass of fruit juice, three to four teaspoons (1 tablespoon) of sugar in water, glucose gel or glucose tablets (see label for 15 grams amount).
  • Wait 15 minutes and check your blood sugar again.
  • If your blood sugar level is still low, continue to:
    • Alternate taking 15 grams of glucose with waiting 15 minutes and retesting your blood sugar until it reaches an acceptable target.
• Be sure to eat your next meal or a snack to prevent another low blood sugar reaction.
• If symptoms persist, call your doctor.

Untreated hypoglycemia can progress to changes in mental status, causing extreme confusion, loss of consciousness and seizures in some cases. It is a good idea to know your symptoms of hypoglycemia and be always prepared to treat them quickly, especially if you take insulin. It is also a good idea for your loved ones and friends to know your signs of low blood sugar and how to help you treat them in case of an emergency where you’re unable to treat yourself. Your healthcare professional can help teach your family and friends about diabetes emergencies and how to prepare for them.

Hyperglycemia: High blood glucose

High blood glucose can occur when your food, activity and medicine are not balanced: too much food, not enough activity and not enough medicine. It can also happen when you are unwell or under stress. If you have high blood glucose levels, you may be more prone to infection. And an infection can cause your blood glucose level to rise even more.

Signs of hyperglycemia:

Hyperglycemia or high blood glucose is a key sign of diabetes and, therefore, the symptoms are the same as the symptoms of diabetes. These include:

• Frequent urination
• Excessive thirst and/or hunger
• Dry mouth
• Unexplained weight loss
• Blurred vision
• Lack of energy and extreme tiredness

What to do if you have high blood sugar:

• Call the doctor to see if a change in medication is needed.
• Check your blood glucose regularly.
• Drink more water to help remove excess sugar from your blood through urine.
• Do moderate exercise.
• Reduce food portions in the meals that follow.

Diabetic ketoacidosis (DKA) happens when high levels of ketones, build up in your blood. Ketones are produced when there’s a shortage of insulin in the body and the body breaks down fat for energy. This happens because the body is unable to use glucose when there is little or no insulin and it is forced to burn fat.

Signs and symptoms of this condition include difficulty breathing, rapid breathing or shortness of breath with a fruity smelling breath; nausea, vomiting, urine or blood ketones; and a high blood glucose level.

Diabetic ketoacidosis is an emergency condition that needs immediate attention. It usually requires treatment in the hospital. You should call a medical emergency phone number or go to the nearest hospital when you suspect you have DKA.

You can detect this condition by taking a simple urine test that is available from pharmacies to check for ketones. Ask your healthcare provider for further blood glucose and ketone testing guidelines when you have detected ketones in your urine.

Hyperosmolar hyperglycemic state (HHS) is an emergency condition usually seen in older people with very high blood glucose. Typically, an underlying illness such as pneumonia, a urinary tract or other infection, or failure to follow a diabetes treatment plan triggers the problem.

HHS causes severe dehydration, and, if left untreated, can lead to seizures, coma and even death. Other signs and symptoms include increased urination, extreme thirst, fever and vision changes.

HHS is an emergency condition that needs immediate attention. You should call a medical emergency phone number for help or go to the nearest hospital.

To help prevent this condition, check your blood glucose regularly and more often when you’re sick. Talk with your healthcare provider about when and how often to test during illness.

How can you prevent diabetes complications?

When not well-managed, diabetes can lead to complications, both short-term (acute) and long-term (chronic).

A well-rounded diabetes management plan can help prevent diabetes-related health problems. This may include:

• keeping control of blood glucose levels
• keeping good control of blood pressure and cholesterol levels
• getting regular laboratory tests, eye, foot and other exams to detect and treat problems early
• learning everything you can to best manage your diabetes:
  • making healthy food choices
  • staying physically active
  • taking medication as prescribed by your doctor
  • testing your blood glucose regularly
  • knowing how to prevent and treat diabetes emergencies.

Sources:

*MedlinePlus. 15/15 Rule. National Institute of Health (NIH)/U.S. Library of Medicine. Bethesda, MD.

IDF Diabetes Atlas (8th Ed.) (2017). International Diabetes Federation: Brussels, Belgium. Last accessed online September 24, 2019

American Diabetes Association. (ADA) Standards of Medical Care in Diabetes–2019. Diabetes Care 2019; 42, Suppl. 1. Last accessed online September 24, 2019

American Diabetes Association. (ADA) – DKA and Ketones. Last accessed online September 24, 2019

Hypoglycaemia (low blood sugar) | NHS inform

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Introduction

Hypoglycaemia, or a “hypo”, is an abnormally low level of glucose in your blood (less than four millimoles per litre).

When your glucose (sugar) level is too low, your body doesn’t have enough energy to carry out its activities.

Hypoglycaemia is most commonly associated with diabetes, and mainly occurs if someone with diabetes takes too much insulin, misses a meal or exercises too hard.

In rare cases, it’s possible for a person who doesn’t have diabetes to experience hypoglycaemia. It can be triggered by malnutrition, binge drinking or certain conditions, such as Addison’s disease.

Read more about the causes of hypoglycaemia

Symptoms of hypoglycaemia

Most people will have some warning that their blood glucose levels are too low, which gives them time to correct them. Symptoms usually occur when blood sugar levels fall below four millimoles (mmol) per litre.

Typical early warning signs are feeling hungry, trembling or shakiness, and sweating. In more severe cases, you may also feel confused and have difficulty concentrating. In very severe cases, a person experiencing hypoglycaemia can lose consciousness.

It’s also possible for hypoglycaemia to occur during sleep, which can cause excess sweating, disturbed sleep, and feeling tired and confused upon waking.

Read more about the symptoms of hypoglycaemia

Correcting hypoglycaemia

The immediate treatment for hypoglycaemia is to have some food or drink that contains sugar, such as dextrose tablets or fruit juice, to correct your blood glucose levels.

After having something sugary, you may need to have a longer-acting “starchy” carbohydrate food, such as a sandwich or a few biscuits.

If hypoglycaemia causes a loss of consciousness, an injection of the hormone glucagon can be given to raise blood glucose levels and restore consciousness. This is only if an injection is available and the person giving the injection knows how to use it.

You should dial 999 to request an ambulance if:

• a glucagon injection kit isn’t available
• there’s nobody trained to give the injection
• the injection is ineffective after 10 minutes

Never try to put food or drink into the mouth of someone who’s drowsy or unconscious as they could choke.  This includes some of the high-sugar preparations specifically designed for smearing inside the cheek.

Read more about treating hypoglycaemia

Preventing hypoglycaemia

If you have diabetes that requires treatment with insulin, the safest way to avoid hypoglycaemia is to regularly check your blood sugar and learn to recognise the early symptoms.

Missing meals or snacks or eating less carbohydrate than planned can increase your risk of hypoglycaemia. You should be careful when drinking alcohol as it can also cause hypoglycaemia, sometimes many hours after drinking.

Exercise or activity is another potential cause, and you should have a plan for dealing with this, such as eating carbohydrate before, during or after exercise, or adjusting your insulin dose.

You should also make sure you regularly change where you inject insulin as the amount of insulin your body absorbs can differ depending on where it’s injected.

Always carry rapid-acting carbohydrate with you, such as glucose tablets, a carton of fruit juice (one that contains sugar), or some sweets in case you feel symptoms coming on or your blood glucose level is low.

Make sure your friends and family know about your diabetes and the risk of hypoglycaemia. It may also help to carry some form of identification that lets people know about your condition in an emergency.

When hypoglycaemia occurs as the result of an underlying condition other than diabetes, the condition will need to be treated to prevent a further hypo.

Read more about preventing hypoglycaemia

Symptoms of hypoglycaemia

The symptoms of hypoglycaemia usually begin when your blood glucose level drops below four millimoles (mmol) per litre.

If you have diabetes, particularly if it’s treated with insulin, you may be advised to use a small device called a blood glucose meter to regularly check your blood glucose levels.

Symptoms can vary from person to person, and it’s important to be aware of the early warning signs so you can treat them.

Signs and symptoms of hypoglycaemia can include:

• feeling hungry
• sweating
• dizziness
• tiredness (fatigue)
• blurred vision
• trembling or shakiness
• going pale
• fast pulse or palpitations
• tingling lips
• irritability
• difficulty concentrating
• confusion
• disorderly or irrational behaviour, which may be mistaken for drunkenness

If hypoglycaemia isn’t treated promptly and your blood glucose levels drop low enough, you may become drowsy or even lose consciousness.

Most people with insulin-treated diabetes notice that the symptoms of hypoglycaemia change and become less obvious the longer they live with the condition.

For some people, the warning symptoms become greatly reduced, putting them at significant risk of having severe episodes where they’re dependent on others for help.

Let your diabetes care team know if you develop this problem as your treatment may need to be changed to reduce the risk.

Read more about how hypoglycaemia is treated

Hypoglycaemia while sleeping

Having a hypo while you’re asleep is known as nocturnal hypoglycaemia. It’s more common in people who treat diabetes with insulin.

Although some people find their sleep is disturbed when they experience nocturnal hypoglycaemia, you may only notice the symptoms when you wake up in the morning.

The symptoms of nocturnal hypoglycaemia can include:

• headache – often likened to having a hangover
• feeling unusually tired in the morning
• damp sheets or clothing from sweating

Causes of hypoglycaemia

In most cases, hypoglycaemia affects people with diabetes, although more rarely it can also occur as a result of other underlying conditions.

Hypoglycaemia in people with diabetes

Overdose of diabetes medication

A common cause of hypoglycaemia is taking too much insulin for your current needs. Insulin is a medication that helps control your blood glucose levels. It’s commonly used to treat type 1 diabetes and is also recommended for some people with type 2 diabetes.

A fall in blood glucose levels can also occur after taking too much oral hypoglycaemia medication, such as sulphonylurea, which causes a release of insulin. This medication is often used to lower blood glucose levels in people with type 2 diabetes.

Exercise, food and alcohol

For people with type 1 diabetes, maintaining the correct blood glucose level involves balancing how much insulin you inject, the amount of food you eat, and how much energy you burn during exercise.

Hypoglycaemia may occur if you’ve taken your dose of insulin as usual, but your carbohydrate intake is lower than normal or has been used up more quickly. This may happen if you delay or miss a meal or snack, don’t eat enough carbohydrate, or exercise more than usual.

People with diabetes who’ve drunk too much alcohol, or drank alcohol on an empty stomach, can also get hypoglycaemia.

However, it’s not always possible to identify why a particular episode of hypoglycaemia has occurred, and sometimes it happens for no obvious reason.

Hypoglycaemia in people without diabetes

Hypoglycaemia – even mild cases – is very rare in people who don’t have diabetes. The possible causes are outlined below.

Reactive hypoglycaemia

People without diabetes can sometimes experience hypoglycaemia if their pancreas produces too much insulin after a large carbohydrate-based meal. This is known as reactive hypoglycaemia.

It’s not clear why this happens, although it’s thought to be more common in people who are overweight or have had gastric bypass surgery.

In rare cases, a benign (non-cancerous) tumour in the pancreas may cause an overproduction of insulin, or the tumour itself may use up too much glucose.

Other possible causes

Other possible causes of hypoglycaemia in people without diabetes are:

• fasting or malnutrition – where not enough nutrients are consumed for your body to function properly
• binge drinking or heavy drinking of alcohol
• Addison’s disease – a disorder of the adrenal glands (two small glands that sit on top of the kidneys) 
• certain medication – hypoglycaemia has been known to occur in people taking quinine (for malaria), salicylates (for rheumatic disease) and propranolol (for high blood pressure)
• severe illnesses affecting the liver, kidneys or thyroid gland

Treating hypoglycaemia

In most cases, you can treat hypoglycaemia yourself when you recognise the symptoms.

Treating an episode of hypoglycaemia

The immediate treatment for hypoglycaemia is to have some sugary food or drink (about 15 to 20g of rapidly acting carbohydrate) to end the attack.

For example, this could be:

• a glass of fruit juice or non-diet soft drink
• between three and five dextrose tablets
• a handful of sweets

At first you should avoid fatty foods and drinks, such as chocolate and milk, because they don’t usually contain as much sugar and the sugar they do contain may be absorbed more slowly.

After having something sugary, you should have a longer-acting carbohydrate food, such as a few biscuits, a cereal bar, a piece of fruit or a sandwich.

It will usually take around 15 minutes to recover from a mild episode of hypoglycaemia. If you have a blood glucose meter, measure your blood sugar again after 15 to 20 minutes. If it’s still too low (below 4mmol), you should have some more sugary food or a drink before testing your levels again in another 15 to 20 minutes.

When treating someone else with hypoglycaemia, if the above treatment isn’t effective, you may be able to help them by applying glucose gel (or honey, treacle or jam if glucose gel isn’t available) to the inside of their cheeks, and gently massaging the outside of their cheeks.

It may take 10 to 15 minutes before they feel better. This shouldn’t be done if the person is drowsy or unconscious because of the risk of choking.

If you have several episodes of hypoglycaemia a week, you should contact your diabetes care team to find out the underlying cause. Your medication may need to be adjusted, or there may be another condition causing hypoglycaemia that needs to be treated.

If a person is unconscious

If a person loses consciousness because of severe hypoglycaemia, they need to be put into the recovery position and given an injection of the hormone glucagon (if they have an injection kit). The injection will raise their blood glucose level.

The injection should be carried out by a friend or family member who knows what they’re doing, or by a trained healthcare professional.

You should dial 999 to request an ambulance if:

• a glucagon injection kit isn’t available
• there’s nobody available who’s trained to give the injection
• the injection is ineffective after 10 minutes

Never try to put food or drink into the mouth of someone who’s unconscious as they could choke.

If you’re able to give a glucagon injection and the person regains consciousness, they should eat some longer-acting carbohydrate food, such as a few biscuits, a cereal bar or a sandwich.

You should continue to monitor the person for signs of recurring symptoms in case they need to be treated again.

Preventing hypoglycaemia

If you have diabetes, sticking to your medication plan and eating regular meals can help prevent hypoglycaemia.

It’s also important to monitor your blood glucose levels.

Monitoring blood glucose

Regularly monitoring your blood glucose levels can help you keep your blood glucose as normal and stable as possible, and will help you spot the signs and symptoms of hypoglycaemia quickly.

Your blood glucose level can vary throughout the day, so you may need to check it several times a day, depending on the treatment you’re taking.

You can monitor your blood glucose levels using a blood glucose meter, a small device that measures the concentration of glucose in your blood.

Read more about living with type 1 diabetes and living with type 2 diabetes

Food and alcohol

If you have diabetes, strenuous physical activity can lead to hypoglycaemia. Eating extra carbohydrate-based foods before and during exercise can help reduce the chances of this happening.

If you’re taking insulin, your doctor may advise you to lower your dose before you do strenuous physical activity.

Alcohol can also affect your body’s ability to release glucose. If you have type 1 diabetes, it’s recommended that you drink no more than 2 to 3 units of alcohol a day and eat a snack after drinking alcohol.

Spotting the signs

As hypoglycaemia can develop suddenly, it’s important to be aware of the symptoms of hypoglycaemia so you can treat it quickly. Tell your family and friends about the signs to look out for and let them know how to treat it.

People with diabetes are advised to carry a form of identification with them that states their condition so they can be helped quickly and efficiently.

Keep treatment with you

If you’re at risk of hypoglycaemia, you should carry sugary food and drink with you at all times to treat mild cases as soon as possible.

If you have diabetes, particularly type 1 diabetes, your doctor may recommend medications such as glucose gel to carry with you. This can be used to treat hypoglycaemia that doesn’t respond to normal treatment.

If you’re being treated with insulin, you’ll usually be given a kit that contains an injection of a medication called glucagon. Family members or your carer can be trained to carry out the injection, which should be used if you lose consciousness because of severe hypoglycaemia.

Preventing hypoglycaemia at night

It’s important to avoid recurrent hypoglycaemia during the night (nocturnal hypoglycaemia) as it can reduce the early symptoms of daytime episodes.

If you experience nocturnal hypoglycaemia, you can try:

• keeping something sugary by your bedside
• having a snack before bedtime, such as biscuits and milk
• checking your blood glucose levels between 3am and 4am, when hypoglycaemia is most likely to occur

Hypoglycaemia and driving

As hypoglycaemia can cause confusion, drowsiness, or even unconsciousness, this can present a significant risk to you or other road users.

If you have diabetes that requires treatment with insulin, you must:

• inform the DVLA and your insurance company
• test your blood sugar before driving and at regular intervals (at least every two hours) while driving
• avoid driving if your blood glucose is low
• avoid driving for 45 minutes after treating hypoglycaemia
• carry rapid-acting carbohydrates with you in the vehicle at all times

If you experience hypoglycaemia while driving, pull over and stop as soon as it’s safe to do so. Remove the keys from the ignition and get out of the driver’s seat before treating hypoglycaemia in the normal way.

If you have two or more episodes of hypoglycaemia that require assistance in a 12-month period, it’s a legal requirement to stop driving and inform the DVLA.

If you’re a group two driver (you hold a licence to drive buses, coaches or lorries), you’re legally required to stop driving group two vehicles immediately and inform the DVLA if you have a single episode of hypoglycaemia that requires assistance.

Inform your diabetes care team if you start having problems recognising hypoglycaemia or you start to have more regular episodes, even if there were warning symptoms and you were able to treat them without assistance.

See the GOV.UK website for more information about hypoglycaemia and driving

Complications of diabetes | OneTouch®

What are the complications of diabetes?

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Diabetes can lead to complications that affect many organs and systems in the body, including the brain, eyes, heart, kidneys, and nerves. Diabetic complications can be long term (chronic) or short term (acute).

Long-term complications occur when blood glucose levels are poorly controlled and remain high for a long period of time. Keeping your blood glucose levels as close to normal as possible, as well as regular checks and blood tests, can help slow or prevent long-term complications of diabetes. They include the following:

Eye diseases

Many people with diabetes develop some degree of eye disease (retinopathy) caused by damage to the blood vessels supplying the retina as a result of having high blood glucose levels over a period of time. This may result in impaired vision or cause blindness. The development of diabetic eye disease can go far enough before it affects vision, so it is important that people with diabetes have their eyes checked regularly. Early diagnosis and treatment can prevent blindness.

Oral health

People with diabetes have a higher risk of developing gum disease (periodontitis) than people without diabetes. Periodontitis can cause tooth decay and loss and can lead to other complications such as heart disease. Poorly controlled blood glucose levels can lead to infections and diseases of the mouth. Good oral hygiene can help improve overall glucose control, prevent tooth decay and loss, and other diabetic complications.

Cardiovascular disease

Cardiovascular disease is the leading cause of disability and death in people with diabetes. These include angina pectoris (chest pain or discomfort), myocardial infarction (heart attack), stroke, peripheral arterial disease (reduced blood flow to the extremities), and congestive heart failure (heart weakness leading to fluid buildup in the lungs and other tissues). organism). Factors that increase the risk of developing cardiovascular disease are high blood pressure, high cholesterol and blood glucose levels (typical in diabetes).

Kidney disease

Diabetes is one of the leading causes of chronic (long-term) kidney disease. It is caused by damage to the small blood vessels in the kidneys (a disease called nephropathy), which causes the kidneys to work less efficiently or fail completely. Controlling blood glucose and blood pressure significantly reduces the risk of diabetic kidney disease.

Pregnancy complications

Women with any type of diabetes are at risk of several problems during pregnancy: High glucose levels can affect fetal development and put mother and baby at risk of complications during childbirth. High blood glucose levels during pregnancy can lead to changes in the development of the fetus – it can grow larger than usual and gain excess weight. This can cause injury to the baby and mother during childbirth, as well as low blood glucose levels (hypoglycemia) in the baby after birth. Children who are exposed to high blood glucose levels in utero also have a greater risk of developing type 2 diabetes later in life. Careful monitoring of blood glucose levels during pregnancy is very important. For women diagnosed with diabetes before pregnancy, glucose monitoring and proper control should begin before pregnancy.

Nerve damage

Nerve damage (neuropathy) is the result of prolonged exposure to high blood glucose and can damage any nerve in the body. The most common form is peripheral neuropathy, which mainly affects the sensory nerves in the legs. This disease can lead to pain, tingling, and loss of sensation. As a result of neuropathy, injuries can go unnoticed, leading to ulcers, serious infections, and, in some cases, amputations. Nerve damage can also lead to erectile dysfunction (sexual problems in men), as well as problems with digestion, urination, and a number of other bodily functions.

Legs affected

In addition to nerve damage, people with diabetes may have problems with poor circulation in the legs, which results from damaged blood vessels. These problems increase the risk of ulcers, infections, and can lead to amputations. The risk of amputation in people with diabetes can be up to 20 times higher than in those who do not have the disease. However, proper glucose control can prevent a significant proportion of amputations. Because of these risks, it is important that people with diabetes have their feet checked regularly to detect problems early.

Short-term or acute complications may be associated with low or high blood glucose levels. Complications include hypoglycemia and related crises such as seizures, as well as hyperglycemic crises such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). They often come on suddenly and can be life-threatening. Fortunately, they can be prevented or treated quickly if you and your loved ones know how to act in these cases.

Hypoglycemia: low blood sugar

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Hypoglycemia means low blood glucose. It is sometimes called “hypo” and can occur at any time of the day or night. Hypoglycemia occurs when your body doesn’t have enough glucose to use for energy. This usually occurs when the blood glucose level is 3.9 mmol/L or lower.

Signs and symptoms of low blood sugar include:

• Sudden, extreme hunger
• Headache
• Trembling
• Weakness or fatigue
• Cold sweat
• Palpitations
• Anxiety or nervousness
• Irritability

What to do if you have low blood sugar:

• Check your blood sugar to make sure it is 3.9 mmol/L or lower.
• Apply rule 15/155:
  • Take 15 g of a fast-acting carbohydrate that contains glucose, such as: a small glass of fruit juice, 3-4 teaspoons (1 tablespoon) of sugar dissolved in water, glucose gel or glucose tablets (see label to determine how much is 15 G).
  • Wait 15 minutes and check your blood sugar again.
  • If blood sugar remains low:
    • Continue alternating 15 g glucose with waiting 15 minutes before testing your blood sugar again. Do this until it reaches acceptable levels.
• Do not skip the next meal, so as not to provoke a decrease in blood sugar levels again.
• If symptoms persist, contact your doctor.

If left untreated, hypoglycemia can progress to a change in mental status, causing extreme confusion or loss of consciousness and, in some cases, seizures. It’s good to know your symptoms of hypoglycemia and be ready to take action quickly, especially if you’re on insulin. Your family and friends are encouraged to know your signs of low blood sugar and how to help you in an emergency if you cannot take action yourself. Your doctor can help teach your family and friends how to manage diabetes emergencies and how to prepare for them.

Hyperglycemia: high blood glucose

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Blood glucose levels rise when diet, activity level and therapy are poorly balanced: too much food, insufficient physical activity or drug dose. It can also happen when you are feeling unwell or stressed. High blood glucose levels increase the risk of infection. And infection can lead to even higher blood glucose levels.

Signs of hyperglycemia

Hyperglycemia, or elevated blood glucose, is the main symptom of diabetes, so the symptoms of hyperglycemia and diabetes overlap. They include signs such as:

• Frequent urination
• Excessive thirst and/or hunger
• Dry mouth
• Sudden weight loss
• Blurred vision
• Lack of energy and extreme fatigue

What to do if you have high blood sugar:

• Contact your doctor to see if a change in therapy is needed.
• Check your blood glucose regularly.
• Drink more water to remove excess sugar from the blood in the urine.
• Practice moderate physical activity.
• Reduce portions of food at the following meals.

Diabetic ketoacidosis ⁴ (DKA) occurs when high levels of ketones accumulate in the blood. Ketones are chemicals that are produced when there is a lack of insulin, when the body breaks down fat for energy. This is because the body cannot use glucose in the absence or low amount of insulin, and it is forced to burn fat. High levels of ketones in the blood act like a poison.

Signs and symptoms of this condition include difficulty breathing, rapid breathing or shortness of breath with fruity breath, nausea, vomiting, ketones in the urine or blood, and high blood glucose.

Diabetic ketoacidosis is a life-threatening condition requiring immediate treatment. Its treatment is usually carried out in a hospital. If you suspect that you have DKA, you should call an ambulance or go to the nearest hospital.

You can prevent this condition by doing a simple urine test for ketones using a test kit available from pharmacies. Refrain from strenuous exercise if blood glucose is above 240 mg/dl and ketone bodies are present in the urine. Talk to your doctor about further monitoring of your blood glucose and ketones if you find ketones in your urine.

Hyperosmolar hyperglycemic state (HGS) ³ is an emergency condition commonly seen in older people with very high blood glucose levels. It usually develops as a result of an underlying disease such as pneumonia, a urinary tract infection, or another infection, or when your diabetes care plan goes wrong.

HCV causes severe dehydration and, if left untreated, can lead to convulsions, coma and even death. Other signs and symptoms include increased urination, extreme thirst, fever, and vision changes.

HHS is a life-threatening condition requiring immediate treatment. You should call an ambulance or go to the nearest hospital.

To prevent this condition, check your blood glucose regularly and do it more often when you are sick. Talk to your doctor about when and how often you should check your glucose levels while you are sick.

How can you prevent diabetes complications?

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If poorly managed, diabetes can lead to complications, both short-term (acute) and long-term (chronic). Well-planned diabetes management can help prevent diabetes-related health problems. This may include

• Blood glucose monitoring
• Proper control of blood pressure and cholesterol
• Regular lab tests, eye exams, and foot exams for early detection of problems
• Learn all you can about how best to manage your diabetes, including the following:
  • Healthy food choices
  • Active lifestyle
  • Taking medication as prescribed by a physician
  • Regular blood glucose monitoring
  • Knowing how to prevent diabetes emergencies or get help quickly.

References:

² IDF Diabetes Atlas (Version 8) (2017). International Diabetes Federation: Brussels, Belgium. Online version dated 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

⁴ American Diabetes association. (ADA) – DKA and Ketones. Online version May 7, 2018 at http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html

⁵ Medline Plus. 15/15 Rule. National Institute of Health (NIH)/U.S. Library of Medicine. Bethesda, M.D. Online version May 23, 2018 at https://medlineplus.gov/ency/imagepages/19815.htm

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Why is shortness of breath dangerous in diabetes?

Organs that are more susceptible to the effects of diabetes are the kidneys and the cardiovascular system. One of the symptoms that is important to quickly bring to the attention of a doctor is shortness of breath that has appeared or worsens.

What can diabetic shortness of breath mean?

New or worsening dyspnea in a diabetic may be a sign of the potentially serious disease diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) occurs when the body does not produce enough insulin to convert carbohydrates into glucose for energy. In this case, the body begins to break down fats for energy. When this happens, a waste by-product called ketones is created. Ketones are excreted from the body by the kidneys in the urine.

In diabetic ketoacidosis, ketones accumulate faster than the kidneys can remove them from the body. This leads to the accumulation of ketones, which are toxic. The body may try to use the lungs to remove excess ketones, which causes shortness of breath. Meanwhile, due to lack of insulin, blood glucose levels rise.

In addition to shortness of breath, a person with diabetic ketoacidosis often has nausea and vomiting, severe dry mouth, and sometimes fruity breath. People can pass out quickly as ketone levels rise in the body, so it is often necessary to seek emergency medical attention.

Heart attack and stroke

If you have diabetes, shortness of breath can be a sign of heart disease. Cardiovascular disease is the number one cause of death for people with diabetes: diabetics are twice as likely to have a heart attack or stroke.

In diabetic patients, even with careful monitoring, there may be times when blood glucose levels are elevated. Over time, this condition can damage the network of blood vessels and nerves throughout the body, especially the delicate blood vessels and nerves around the heart. Shortness of breath can be one of the first signs of a heart attack or stroke.

Other symptoms include sweating, upset stomach or nausea, pain or discomfort in the arms, jaw, chest, upper abdomen or back, a drooping eyelid or smiling on one side of the face, or slurred speech. Any of these symptoms should be evaluated urgently.

Diabetic coma

People with diabetes may have high blood glucose, called hyperglycemia, or too low blood glucose, called hypoglycemia.

Similar to ketoacidosis, an abnormal amount of glucose can affect lung function and cause shortness of breath.