Diabetic emergencies : nine lifesaving tips

Diabetes is a multisystem disorder which affects almost all the organs of the body. While there are many long term complications of diabetes , the acute complications are the more life threatning ones when not managed appropriately. In the short term hypoglycemia(decreased glucose levels in the blood) ketoacidosis (increased ketone bodies in the blood leading to acidosis) and hyperosmolar non ketotic  diabetic coma  are the main life threatning conditions. Here are some tips to avoid having the acute life threatening complications

1. Recheck blood sugar levels after first diagnosis and after following the proper management options-diet control or drugs or insulin. This is confirm your level of control of blood sugar. Too light control is bad for  health generally on the long term  and too strict control has the risks of hypoglycemic episodes. Then after do periodic checking and  get your treatment readjusted.
2. If after recent adjustments of your treatment you suffer from  poor quality of sleep, morning headaches, hangover, chronic fatigue vivid dreams or nightmares  it might be due to hypoglycemia during the sleep.  Some of you have your partners noticing you sweating or being restless or twitching during your sleep. This might need a further investigation and dose adjustment of the medications if there is hypoglycemia.
3.  Avoid missing your drugs and meals. As much as possible try to keep them regular.
4. Keep some form of fast acting carbohydrates with you always if possible or at least during travel. Take  them at the first symptoms of hypoglycemia you notice.

5.   Be careful especially during infections, any form of stressful conditions, fever, heavy exercise and hectic conditions where you might miss meals. These conditions might provoke ketoacidosis and hypo or hyper glycemia.

6.  Never decrease or omit the dosage by yourself before discussing it with your doctor. When people are down with fever or any other cause they miss meals or eat less than usual due to decreased appetite. In such conditions patients often omit or decrease the dose mistakenly thinking that the insulin is not needed such conditions. Such patients frequently land up with ketoacidotic coma in emergency.

So the moral is insulin is also required when you are fasting to avoid ketoacidosis

7. Non ketotic hyperosmolar coma it sounds hifi but it just means there are no excessive  ketone in your blood but due to  increased  blood glucose there is dehydration (symptoms of hypoglycemia and dehydration) and altered mental status. Causes of this might be withdrawal of antidiabetic drugs, consumption of glucose rich food  inadequate fluid intake and other illnesses.

8. Avoid binge drinking. Since alcohol also causes hypoglycemia esp in patients taking insulin or sulphonylureasegroup of antidiabetic drugs(chlorpropamide,glipizide,gliclazide,glibenclamide ). In UK recommendation for weekly limits is a maximum of 14 units for women, 21 for men.1 unit  is equivalent to half pint of lager/beer, or a small glass of wine.

9.If you notice following symptoms it is better if the person is rushed to the nearest medical facility.   

• Confusion
• Dizziness, drowsiness
• Fruity odor in the breath
• Excessive thirst or urination
• Nausea,vomiting,abdominal pain
• Decreased or no urine

Hypo/hyper glycemia and ketoacidosis are the acute complications of the diabetes and antidiabetic medications. Diabetes affects almost all the organ of the body including kidney , eyes and blood vessels.

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