Diabetes is a disorder of glucose metabolism in the body. Frequency of urination, increased appetite and increased thirst are the common problems which occur due to diabetes. Apart from these, there can be many other problems needing urgent medical attention. Diabetic individuals mostly know about chronic complications of diabetes like neuropathy, but are unaware of acute metabolic complications. If mild symptoms occur, they are passed off as minor sickness but when they become severe, a patient becomes critically sick and may die.

The acute medical complications of diabetes, may arise due to uncontrolled diabetes, while some occur as a result of treatment, whether insulin or drugs.

Every diabetic patient and his family members should be aware of these complications so that they can recognise the problem at the earliest point and seek urgent medical treatment. Even some simple first aid given at home can help the patient.

Hypoglycemia, or low blood sugar, is the most common complication. This happens if the person has skipped a meal or taken anti diabetic treatment without taking food or due to stress or over exertion. In the early stages, there is a vague feeling of sudden weakness. This is associated with sweating, palpitations, laboured breathing and dryness of mouth. At this stage, if the patient eats or drinks something sweet, he improves immediately. If no remedial measures are taken, he may become confused, disoriented and may slip into coma. Still untreated, he may die.

Diabetic ketoacidosis is a metabolic complication which develops due to very high blood sugar levels. It is more common in young individuals who have type 1 insulin dependent diabetes but can occur in older persons also. This happens when somebody has been non-compliant with his daily dose of insulin and sugar levels rise in blood. Exertion, inter current infections and heart attacks can also precipitate this condition.

Diabetic ketoacidosis presents with severe abdominal pain, which can be confused with other conditions like acute pancreatitis, acute cholecystitis, and etcetera, thus delaying the diagnosis at times. Also, one has severe vomiting and laboured breathing. Due to the very high blood sugar, there is marked diuresis leading to loss of fluid and electrolytes from the body. This, coupled with loss of water and electrolytes due to vomiting, causes severe dehydration and weakness. Untreated, the person may slip into coma and die.

Another type of complication can occur in elderly diabetics which is not so dramatic in its presentation. It usually occurs in people who are not eating properly due to some sickness or some other problem. There is gradually increasing weakness which passes to unconsciousness and a coma.

Once a person with diabetes becomes unconscious, it becomes difficult to decide the possible cause, whether high or low sugar. If there is a family member who has been with the patient and knows all that happened before the patient passed out, it becomes easy to assess the situation. But otherwise it remains a dilemma.

The condition can be diagnosed by means of blood and urine tests. Estimation of blood sugar levels shows whether there is high or low blood sugar. Presence of ketones in the urine indicates diabetic ketoacidosis to be the cause of the coma.

Whether it is low or high blood sugar levels, causing the metabolic complications, they are all potentially fatal conditions and are entirely preventable.

Those suffering from diabetes should adhere very well to the prescribed diet and anti-diabetic medication. It is equally important to take adequate meals with the medicines, otherwise the blood glucose levels go down. Taking small frequent meals prevents the derangement of glucose metabolism.

With these small precautions, one can avoid the metabolic complications. If one feels undue weak or sick, he or she should get blood sugar tested immediately. If he or she has missed a dose of insulin it should be given immediately, if the individual has missed food, he should be given something sweet or some food immediately as a remedy for the hypoglycemia.

Dr Rachna Pande, Specialist, internal medicine rachna212002@yahoo.co.uk