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Could something as routine as high blood sugar turn into a life-threatening crisis? Unfortunately, the answer is yes. For people with diabetes, untreated blood sugar fluctuations may become critical, leading to emergencies such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) or severe hypoglycaemia – all of which require emergency care.
According to the IDF Diabetes Atlas (2024), 589 million adults worldwide have diabetes, with projections indicating a rise to 853 million by 2050. In 2024 alone, diabetes was responsible for 3.4 million deaths, and 43% of cases were undiagnosed.
This blog discusses the types of diabetic complications, diabetes symptoms, and the importance of a timely medical response.
Synopsis
What are Diabetic Complications?
Diabetic complications are the most serious and life-threatening consequences of uncontrolled blood sugar levels. These complications are categorised into acute (appearing suddenly as an emergency) and chronic (developing gradually).
Types of Diabetes and Risk of Emergencies
Each type of diabetes carries a risk for specific complications:
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Type 1 Diabetes: More prone to diabetic ketoacidosis (DKA)
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Type 2 Diabetes: Commonly linked to hyperosmolar hyperglycaemic state (HHS)
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Gestational Diabetes: May cause emergency complications during pregnancy or delivery
Diabetes Symptoms in Each Complication
Acute Complications:
1. Diabetic Ketoacidosis (DKA)
DKA is a medical emergency commonly found in individuals with uncontrolled diabetes. It results when the body metabolises fat too quickly without insulin, releasing ketones that make the blood acidic.
The symptoms are:
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Nausea and vomiting
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Deep, excessive breathing (Kussmaul breathing)
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Breath smelling like fruit
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Lethargy or confusion
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In extreme situations: coma or shock
2. Hypoglycaemia (Low Blood Sugar)
Hypoglycaemia is typically due to too much insulin, forgotten meals, or severe exercise.
Warning signs are:
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Shakiness, sweating, and irritability
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Dizziness, blurred vision, and confusion
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Loss of consciousness or seizures in extreme cases
3. Hyperglycaemia (High Blood Sugar)
Hyperglycaemia results when blood sugar is too high as a result of forgotten medication, infection, or poor control of diet. If it is not treated, hyperglycaemia can result in severe complications like DKA or HHS.
The symptoms can be:
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Too much thirst and passing of urine
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Tiredness
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Blurred vision
Chronic Complications:
1. Heart and Blood Vessel Disease (Macroangiopathy)
High risk of heart attack, stroke, hypertension, and poor circulation
Erectile dysfunction in men
2. Eye Damage (Diabetic Retinopathy)
One of the main causes of blindness due to blood vessel damage in the retina
3. Kidney Disease (Diabetic Nephropathy)
Decreased kidney function that can ultimately result in kidney failure
4. Nerve Damage (Diabetic Neuropathy)
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Tingling sensations, numbness, or burning pain in the hands and feet
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Problems with digestion, bladder function, and heart rate
5. Diabetic Foot
Poor blood flow and nerve damage may lead to ulcers and infections, and, in extreme cases, gangrene and amputation
6. Greater Risk of Infections
Individuals with a weakened immune system are at higher risk of infections
What to Expect During Emergency Care
At Manipal Hospitals, our experts adhere to strict protocols to stabilise patients with acute diabetic complications. Apart from clinical care, it's equally important that patients and families become active participants in care coordination and readiness. Here is the overview:
Initial Evaluation
A complete clinical assessment is conducted, including history and review of symptoms. Blood investigations are performed to evaluate:
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Blood glucose
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Ketone levels (in the case of suspected DKA)
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Electrolyte imbalance, particularly potassium and sodium
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Acid-base status (to rule out metabolic acidosis)
These are useful for determining the precise nature and severity of the complication.
Intravenous (IV) Fluid Therapy
Both DKA and HHS share dehydration as a common feature. IV fluids are given to:
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Restore fluid balance
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Improve blood flow
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Decrease blood glucose concentration by dilution
The fluid replacement type and rate are individualised according to the patient's status and electrolyte levels.
Insulin Therapy
In the event of critically high blood glucose, intravenous insulin treatment is started. This:
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Decrease high blood sugar
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Halts ketone production in DKA
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Restores the metabolic balance of the body
Insulin dose is very carefully titrated according to glucose and potassium levels.
Electrolyte Replacement
Electrolytes, specifically potassium, usually fall with insulin treatment. Deficiency may result in cardiac issues, so:
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Potassium, sodium, and bicarbonate are monitored constantly
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Electrolyte supplements are given as necessary to stabilize the heart and muscle activity
Continuous Monitoring
Diabetic emergency patients are watched closely in a high-dependency or ICU environment. Monitoring involves:
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Vital signs
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Blood glucose patterns
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Urine output and level of consciousness
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ECG monitoring if there is a cardiac risk
Conclusion
Diabetic Complications—whether acute or chronic—can significantly impact a patient’s quality of life and, in some cases, become life-threatening without timely intervention. Acute conditions like diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS), and severe hypoglycaemia require immediate emergency care to prevent irreversible organ damage or death. Chronic complications, on the other hand, gradually affect major organs such as the heart, kidneys, eyes, and nerves and require long-term monitoring and management.
Recognising the diabetes symptoms associated with these complications and acting promptly is key to avoiding serious outcomes. If you or a loved one experiences signs of a diabetic emergency—such as altered breathing, confusion, unconsciousness, or sudden vision changes—do not delay in seeking medical help. For any concerns related to diabetic complications, consult with our specialists at Manipal Hospitals, Mukundapur, for timely evaluation and personalised care.
FAQ's
Warning signs of a diabetic emergency may include severe fatigue, rapid or laboured breathing, dizziness, confusion, loss of consciousness, seizures, or extremely high or low blood sugar levels. If any of these symptoms occur, seek emergency care without delay.
Situations like diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS), and severe hypoglycaemia are medical emergencies requiring urgent care.
Yes. While complications often develop slowly, conditions like HHS can occur suddenly and may lead to coma or death if untreated.
Diabetic emergencies can be avoided by regular monitoring, proper medications, eating a balanced diet, and recognising early diabetes symptoms.
Yes. Manipal Hospitals, Mukundapur, has a dedicated emergency department with advanced care facilities to manage all types of diabetic complications.
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