DIABETES SHORT TERM COMPLICATIONS
One of the problems with
diabetes is that the person with the disease usually feels fine and there are no symptoms even when the glucose
levels are in the 100 to 200 mg/dl range. Therefore, it is easy to ignore the diabetes. Eventually, there are
symptoms, but often, they are due to diabetes-related complications. It is therefore important for people with
diabetes to understand the consequences of poor glucose control and to make the effort to control the diabetes
even when they feel well. Short-term
complications are due to high glucose levels for a period of hours, days, or weeks.
The short-term complications that occur in people with diabetes include
The degree of insulin deficiency and the level of blood glucose elevation
will determine which of these short-term complications are present. If glucose levels are only slightly
elevated, there may not be any symptoms, and diabetes is diagnosed only if the glucose is measured as part of a
Glucose does not appear in the urine until the blood glucose level is
above 200 mg/dl. When this happens, glucose in the urine can cause bladder or kidney infections (especially in
women), vaginal yeast infections, and an infection of the skin of the penis (balanoposthitis). High levels of
glucose impair the kidneys’ ability to concentrate the urine, and so there is increased urine production and
symptoms of frequent urination, thirst, and dehydration. The loss of calories in the urine can cause weight
loss, especially if blood glucose levels are very high.
Short-term elevations in glucose can also affect the lens of the eye,
causing blurred vision. This is reversible, and the vision returns to normal once the diabetes is treated.
Sometimes the blurred vision causes a person to see an ophthalmologist or an optometrist, who then makes the
diagnosis of diabetes.
In people who have a severe insulin deﬁciency, a very serious condition
called diabetic ketoacidosis (DKA) can develop.
Following are the symptoms of diabetic
• A signiﬁcant amount of weight loss
• Thirst and frequent urination
• Rapid heart rate
• Nausea and vomiting
• Stomach pain
• Severe fatigue
• Blurred vision
• Confusion or coma (if left untreated)
A person who is in DKA has a characteristic
appearance: the eyes are sunken, the skin ﬂushed but dry and cool, the tongue is dry, and the breath smells
of acetone (like nail polish remover or a room in which apples are kept). The heart rate is fast, and as the
illness gets worse, the pulse becomes feeble. Most people are awake, but confusion or coma can occur if the
DKA is severe. The urine of a person with DKA has large amounts of glucose and ketones, and there are
characteristic abnormalities in the blood tests.
If left untreated, DKA can be life threatening, and people with this
condition are usually admitted to the hospital for treatment with intravenous ﬂuids and
A signiﬁcant proportion of people who develop type 1 diabetes ﬁrst
discover their illness when they are in DKA and they get admitted to hospital. Many of these people never get
DKA again. Some individuals, however, have another or many episodes of DKA. Infections are an important cause of
these repeat DKA episodes. Failure to take insulin, lack of health-care insurance, and psychological trauma are
also risk factors for recurrent DKA.
Sometimes, the insulin deﬁciency is not severe enough to cause DKA but is
still of a sufﬁcient degree to cause very high glucose levels, often 800 mg/dl or more. These very high glucose
levels can lead to coma (called a hyperosmolar coma). A person in hyperosmolar coma has severe dehydration—the
eyes are sunken, the mouth is dry, and the blood pressure is very low. Hyperosmolar coma typically occurs in
older individuals, for example, someone living in a nursing home that may not drink enough ﬂuids, but it can
also happen in younger individuals who quench their thirst by drinking large amounts of ﬂuids with high sugar
content such as juices or regular sodas. Hyperosmolar coma is a very serious medical condition requiring