Bitter companions of diabetes

Diabetes rarely ever comes alone. It brings with it a host of other ailments, which drastically lower your quality of life

elderly man undergoing eye check-upOf late, the incidence of diabetes is increasing by leaps and bounds. Type-2 diabetes is the most common form and is manifested in 90 per cent of all cases. Unlike type-1 diabetes, which occurs in children, type-2 diabetes occurs in adults and is usually triggered by lifestyle changes. In most patients, symptoms may not appear until middle age. On diagnosis, many people are surprised to know that they have actually had the disease for a prolonged time. This makes it more worrying, since complications strike even before the disease actually manifests.

As diabetes occurs, there are changes in insulin metabolism in the body. This causes patients to show symptoms like excessive urination, excessive thirst, excessive hunger, and rapid weight loss. These symptoms may be absent in a vast majority of patients on diagnosis [when diabetes is first detected]. Hence, it is critical to regularly screen patients at high risk—those with a family history of diabetes, those who are overweight and lead a sedentary lifestyle.

Once diabetes is diagnosed and you are on medications, it is important for you to know the warning signs of problems related to it like hypoglycaemia and hyperglycaemia. Other associated problems are to do with heart, brain, feet, eyes and kidneys. Read on to understand some of the problems that diabetes brings along.


Hypoglycaemia [lower-than-normal sugar levels] is a common occurrence in diabetics. Warning signs include giddiness, sweating, cold clammy skin, blackout, palpitations, and loss of consciousness. Any patient on diabetes medications should be warned about such symptoms, especially if s/he skips or delays regular meals.

Consumption of sugar or any sweetened food till the patient feels better is recommended as first aid. Prompt consultation with the treating doctor is required to determine the cause. This also helps rule out the possibility of kidney-related trouble as the contributing factor.


Hyperglycaemia or high blood sugar can be the result of many factors including stress, illness, infection, excessive carbohydrate intake, and inadequate treatment with medication or insulin. Over time, chronic hyperglycaemia can put you at risk for diabetic complications such as neuropathy [nerve damage], heart disease, and kidney failure.

In the short term, severe, untreated hyperglycaemia can cause diabetic ketoacidosis or DKA [total absence of insulin in the body] and other life-threatening problems. Warning signs include severe thirst, blurred vision, vomiting, and excessive urination. If you experience any of these symptoms, or if your blood glucose levels are running consistently higher than 180 mg/dl, call your healthcare provider immediately.

Cardiac complications

High glucose sugar levels lead to complications of the heart, eyes, brain, kidney, nerves and peripheral arteries. Hence, it is mandatory to follow the plan chalked out by the doctor to maintain normal sugar levels. Also keep a look out for early warning signs of trouble to avoid a crisis. Cardiac complication is a silent killer.

Any chest discomfort or pain while at rest or exertion, breathlessness and giddiness are indicators of heart problems. Yearly electrocardiogram [ECG] and tests like stress test, 2D echo and angiography can help detect heart problems at an early stage.

Stroke or paralysis

This is a result of blocked blood supply or bleeding in the brain. It occurs in uncontrolled diabetes and due to high blood pressure. Patients should maintain normal sugar levels and look for warning signs such as weakness in hands or feet, headache, and giddiness. It is best to approach your doctor immediately in case of any discomfort. Scanning of the brain helps to diagnose such problems and prevent major complications.

Feet trouble

Feet are commonly affected in diabetics with problems like infection, ulceration and gangrene, risk of sepsis or amputation. Changes in sensations like burning, pain, or loss of sense or pain in calves on walking should ring alarm bells. Any wound in the feet should not be ignored and should be treated completely. Further, measures should be taken to prevent recurrence such as specialised testing for nerve damage or loss of blood flow. Proper foot hygiene and use of clean socks, clean footwear and anti-fungal powder helps prevent foot infections.


High glucose level is an invitation for a variety of infections related to skin, nails, lungs, genital region, feet, and eyes. Boils on face or back are dangerous and can spread to other parts of the body. At the first sign of infection such as redness or pain, seek medical advice. Elderly patients are also at a risk of developing chest and abdominal infections like breathlessness or high fever with whooping cough or severe loose motions.

Kidney and eye problems

As symptoms related to kidney and eye disorder may not appear at an early stage, regular screening is needed for their early detection. Changes in visual acuity such as blurring of vision, double vision, watering in eyes are considered to be warning signs of eye disorders. Decreased urination or altered mental status and vomiting are signs of kidney damage at late stages.

The best approach that diabetics can adopt to avoid complications is to keep their sugar levels under control. Following a proper diet under the supervision of a dietician, regular exercise, intake of medications at appropriate doses and performing tests to assess sugar levels regularly goes a long way in managing diabetes. Controlling your lipid and blood pressure levels and maintaining an ideal weight is also an effective treatment.

Sudhindra Kulkarni
Dr Sudhindra Kulkarni, MD, DM, is a consulting endocrinologist at Fortis Hospitals, Mulund, Mumbai.



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