Danger signals

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I. Diabetic ketoacidosis and coma

Ketones are waste products that are made when your body is forced to burn body fat, instead of glucose, for energy (as happens in diabetes). Ketones build up in the blood and are excreted in the urine. This condition is known as ketoacidosis. Diabetic ketoacidosis may be the first symptom of a person with Type I diabetes; or it may be the result of increased insulin needs in Type I diabetes. People with Type II diabetes usually develop ketoacidosis only under conditions of severe stress.  Signs and symptoms of ketoacidosis are :

  • Frequent urination and thirst.
  • Nausea and vomiting.
  • Muscular stiffness.
  • Rapid and deep breathing.
  • Fruity (a pleasant odor like that of a nail polish remover) breath.
  • Mental stupor (decreased consciousness or alertness).
  • Other symptoms that may be associated include- headache, pain in abdomen, loss of appetite and low blood pressure.
  • Blood glucose level is above 300 mg/dl.
  • Urine test : shows presence of glucose and ketone in urine.

If timely management of ketoacidosis is not done it may progress on to coma (diabetic coma).

II. Hypoglycemia (low blood sugar)

It usually occurs most often in people who use insulin to lower their blood sugar. Hypoglycemia results when the blood glucose level becomes extremely low (below 60 mg/dl). Other conditions that can lead to hypoglycemia in people with diabetes include :

  • Taking too much medication
  • Missing or delaying a meal
  • Eating too little food for the amount of insulin taken
  • Exercising too strenuously
  • Drinking too much alcohol

Symptoms include :

  • In mild hypoglycemia (41-60mg/dl) patient is
    • irritable
    • weak
    • shaky
    • hungry
  • In moderate hypoglycemia (21-40 mg/dl) patient
    • feels drowsy
    • has a pale face
    • breathes with difficulty
    • skin is cold and clammy to touch
  • In severe hypoglycemia (less than 20 mg/dl) patient may
    • have convulsions
    • become unconscious

Frequent hypoglycemic spells can lead to a condition in which the brain gets adapted to low blood glucose levels making the person unaware of hypoglycemia. Such a state is therefore called Hypoglycemic Unawareness and the only identifiable features are excessive yawning and mental clouding.

Hypoglycemia is an emergency which can be reversed easily. But if allowed to progress unchecked it can lead to convulsions or coma.