HEALTH: Diabtes

Harriet Kaufman Adwoa,

 Registered Nurse, RN
 Masters in Science Nursing, MSN


The two main immediate complications of Type 1 and Type 2 diabetes are Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS).

In Type 1 diabetes what happens in the absence of insulin and starvation of the cells is that the body will start to digest fats to get its energy. People start losing weight and may think they’re doing something good for themselves without realizing they are starving their bodies. I mentioned that the end product of fat digestion is fatty acids. These fatty acids may be used for energy but they produce ketones which start to accumulate in the system causing acidosis – a toxic state of the body. The build-up of glucose in the blood makes people expel increased amounts of urine and with it many minerals needed to regulate the heart and other body muscles. We now have three major problems occurring in the body (increased sugar, dehydration and acidosis) and if this condition is not detected quickly the person can end up in a coma or dead. This complication progresses fast so do not delay in getting treatment.

This can occur because of extreme neglect or if the person happens to be ill (malaria, flu, or any other infection). Nausea, vomiting and diarrhea of course cause dehydration, as does fever. Ketones can be noted on the breath as a fruity smell not dissimilar to the smell of alcohol on the breath. Any diabetic who has this smell should be encouraged to check their blood sugar. Other things that may be noted include deep breathing, abdominal pain and signs of dehydration such as dry skin or chapped lips. At the later phase a person’s whole personality may change, showing anger, extreme emotions or disorientation. They may seem bizarre. This is a medical emergency so act fast. The most important thing is to get some hydration into the body. Then insulin can be considered. ORS or coconut water could be used and 120 grams (about ½ glass) should be given every 20 – 30 minutes. If the person is unconscious they must be taken to a hospital for drip therapy.

Knowing is the key to saving your own or someone else’s life.

This emergency rarely occurs in Type 2 diabetes since the body is able to make some insulin and never gets to the stage where it needs to be burning fat for energy. But we do have a condition of severe dehydration with hyperglycemia (hyper = too much and glycemia = sugar in the blood). The causes may be the same, neglect or any illness that would cause further dehydration. This does not occur quickly like DKA but is still something to watch out for. The signs are the same except that you may not see the abdominal pains and cramps that you see with DKA. The extent of dehydration will determine the behaviour and it’s good to keep in mind that brain cells get dehydrated too so you may see some behaviours that resemble a stroke (weakness on one side of the body, inability to speak). The other important thing to remember is that someone who is experiencing this type of dehydration may not have the feeling of being thirsty. People must be reminded to drink something every hour. Like DKA the most important thing is to get fluids into the body whether it’s by drip or orally. After that insulin could be given as an emergency measure. People who have diabetes have to follow strict guidelines if they are ill. Especially for those who have malaria where it’s difficult to eat at all even without nausea or vomiting.

Insulin shock or hypoglycaemia (hypo = low, glycemia = sugar in the blood) is another concern for those people who have to use insulin injections. Let’s say you are one of those people who have to take medication to control your blood sugar. You’ve been checking your sugar levels, eating well and taking your medication as you should. Then one day you are caught in traffic and can’t get to eat something at your normal time. The medication is working to lower your blood sugar but you are not balancing it with food. You start to feel shaky, sweaty and anxious. Then you notice that you are getting weak, a headache is coming on and your heart is beating fast. You are experiencing hypoglycaemia which in this case is probably because you weren’t able to eat at the right time. It could be brought on by taking too much medication, from doing more physical work then you usually do (exercise also lowers blood sugar) or from missing a meal. The worst case is that you would become unconscious and that is a medical emergency.

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