Just in case having to deal with Diabetes isn’t bad enough, several other complications can occur because of it! And I’m sure you’ll agree with me that nearly all of them look crazy! So I like to split the complications into two:
Acute (complications that occur quickly, and can be rapidly solved)
vs
Chronic (complications that take time to happen, and need an even longer time to heal)
Acute Diabetic Complications
1. Hypoglycaemia
I can honestly say that when this happens, especially in a ward setting your heart will be racing.
Hypoglycaemia means low blood glucose, and patients with low blood glucose often experience confusion, sweats and weakness in their body. However, in extreme circumstances, the patient will become unconscious and unresponsive. If this is not treated, it may also lead to death.
The blood glucose level is most commonly checked with a blood glucose monitor which looks like this:
The International Hypoglycaemia Study Group has identified the following values to classify the severity of hypoglycaemia:
Level 1: 3.1- 3.9mmol/L (aka. don’t panic, it’s not terribly bad)
Level 2: 2.9- 3mmol/L (this is pretty bad, so you should be worried)
Level 3: Anything less than 2.8mmol/L (OMG!! This is extremely bad, screaaaaaam!)
Lol, I’m joking chill. But seriously these values do represent the severity of the situation. So, if you get these values, you should encourage your patient to eat or drink (if the patient is conscious and can swallow)
If your patient is not conscious, then in most cases, the medical team will order a glucose infusion, or a bolus glucose injection. In severe cases, they might also request a glucagon injection, but this can not be used in patients with liver failure. (Ps. The glucagon injection is usually found in the fridge)
2. Diabetic Ketoacidosis
As we explained before, when the body does not have glucose in the cells, it starts to break down fat for energy. If you don’t know what I’m talking about, then you should read: Diabetes Mellitus Nursing Care: Overview & Pathophysiology
Now DKA happens when the body starts breaking down fat at a very fast rate. The liver then processes the fat into fuel called ketones. These ketones will cause the blood to become acidic. And just if you are wondering, no acidic blood is not good either! But we’ll talk about that another time.
Most hospitals have protocols in place on how to treat patients with DKA. It often involves the administration of IV fluids and insulin therapy.
3. Hyperglycaemic Hyperosmolar State
This complication occurs when a patient has had a very high blood glucose level for a long time. Because glucose is osmotically active (it attracts water), the patient will urinate frequently. This means that a lot of fluid is lost from the body, leading to severe dehydration.
Chronic Diabetic Complications
Now with chronic complications, all of the problems come circling down to the same issue: Diabetes damages blood vessels.bAnd to make it worse, this damage has no limit, it can affect any blood vessel in the body.
Microvascular Complications of Diabetes
(Damage to Small Blood Vessels)
Diabetic Retinopathy: Diabetes can impair the blood vessels attached to the retina (part of the eye), and as a result, it decreases the blood flow to it. This decrease in blood flow can cause blurred vision, and if left untreated, it leads to blindness.
Diabetic Nephropathy: This is sometimes called Diabetic Kidney Disease, and it refers to the chronic loss of kidney function. It develops because uncontrolled Diabetes damages the filtration system of the kidneys (aka. nephrons). Nephropathy can be investigated by doing a simple urine test to look for proteins or a blood test to check the kidney function. If the condition is not monitored, it can easily lead to kidney failure, which requires dialysis or a kidney transplant.
Diabetic Neuropathy: The nerves are responsible for sensation, including touch, heat, pain etc. Because Diabetes affects the blood vessels, the nerves are also affected, and they get a decrease in blood flow. This lack of blood to the nerves inhibits the sensation of extremities (ex: hands and feet), and it also impacts the cranial nerves.
Macrovascular Diabetic Complications
(Damage to large blood vessels)
Cardiovascular Problems: Similar to the previous explanation, diabetes damages blood vessels and nerves that regulate the heart. This means that people with uncontrolled Diabetes are at a higher risk of having a cardiac arrest (heart attack) or a stroke (no blood flow to the brain). Furthermore, many studies show that people with Diabetes are likely to have high cholesterol levels, high blood pressure, and obesity. All of these factors contribute to increasing the chances of developing heart disease.
Diabetic Foot Complications: Having feet ulcers, and wounds are highly familiar in people with Diabetes, and unfortunately, they are challenging to heal. Such wounds occur for the same reasons discussed in the beginning, Neuropathy and Neuroischaemia. In other words: Diabetes damages the blood vessels -> so blood flow is limited meaning that -> circulation in extremities (hands/feet) is not good, which in turn -> also affects the nerves -> leading to loss of sensation.
This loss of sensation paired up with lousy circulation make up the perfect recipe for disaster because often diabetic people will hit or cut their feet without noticing (because they don’t feel the pain). So, a wound is created, but for the wound to heal it requires good blood flow to receive oxygen and nutrients. As you might begin to notice, healing foot ulcers or wounds on diabetic people is complicated, and it will take longer than average. To top it all off, because the wound is open for longer, it becomes more susceptible to getting infected.