Over time, high blood glucose levels cause damage to nerves and blood vessels (large and small), leading to damage to the various organs.
1. ACUTE COMPLICATIONS: related to acutely high or low blood glucose levels.
* Diabetic Ketoacidosis – (glucose levels are very high) this occurs when there is insufficient insulin to convert glucose into energy. The result is that the body then uses fat as an energy source. This produces ketones, a substance which is harmful to the body. Symptoms include severe thirst, passing large volumes of urine, fatigue, nausea and vomiting, often together with abdominal pain. This condition requires immediate medical attention.
* Hypoglycaemia – (glucose levels fall below 4.0 mmol / L) This usually occurs either when diabetic medication dose is too high, or if there is insufficient caloric intake or sudden excessive physical exertion. Symptoms of hypoglycaemia include dizziness, confusion, weakness, tremors, sweating and anxiety. Severe hypoglycaemia can lead to coma, seizures and irreversible brain death.
2. CHRONIC COMPLICATIONS: related to damaged nerves and blood vessels.
* Eye complications – diabetic retinopathy. Diseased small blood vessels cause leakage of protein and blood in the retina. Small aneurysms and new but brittle blood vessels (neovascularization) can also occur. Spontaneous bleeding from these abnormal blood vessels can compromise vision. Cataracts and glaucoma are also more common in diabetics. A person with diabetes is 25 times more likely to become blind compared to a non-diabetic.
* Kidney complications – diabetic nephropathy. Initially there is leakage of protein in the urine. Later on, there may be progress to renal failure, in which the kidneys can no longer cleanse and filter the blood. When this happens, dialysis will be required.
* Nerve damage – diabetic neuropathy. Symptoms of nerve damage include numbness, burning and aching of the feet and lower limbs. This can eventually lead to the so called "diabetic foot." The loss of sensation leads to the failure of recognizing and protecting the foot from injury. Because of poor blood circulation, minor injuries may not heal and serious infections can occur. Diabetes is the top cause of lower limb amputations. Nerve damage can also cause erectile dysfunction and gastroparesis (delayed emptying of the stomach).
* Accelerated atherosclerosis – this hardening and narrowing of large blood vessels can lead to coronary heart disease (angina and heart attacks), strokes and claudication (pain in the legs on walking due to reduced blood supply to the legs).
DIAGNOSIS OF DIABETES
Your doctor will make the diagnosis of diabetes if either one of the following criteria are met:
* In the presence of clearly elevated glucose levels with acute hyperglycaemic complications (ie. Diabetic ketoacidosis, hyperosmolar non-ketotic hyperglycaemic coma), no further tests are needed for diagnosis.
* If you have typical symptoms of diabetes, then a single blood test confirming either one of the following will suffice:
– Random blood glucose levels> 11.1 mmol / L,
– Fasting blood glucose levels> 7.0 mmol / L or
– 2 hour post-challenge (the Oral Glucose Tolerance Test) glucose of> 11.1 mmol / L
* If you do not have the typical symptoms of diabetes, then you will need 2 blood tests on separate occasions both showing glucose levels beyond the ranges stated above.