Complications and treatments

The acute complications of diabetes are hypoglycaemia and hyperglycaemia.

• Hypoglycaemia occurs rapidly when blood glucose levels are too low. Symptoms vary, but include confusion, dizziness, hunger, mood changes and sweating. It can be caused by taking too much insulin, excess alcohol consumption, physical exertion and missing meals. Severe episodes of hypoglycaemia can lead to unconsciousness. 

• Hyperglycaemia occurs when blood glucose levels are too high. It can be caused by physical and psychological stress as stress hormones cause the level of glucose in the blood to rise. It can also be a result of missing medication, having an infection or from having eaten food containing more carbohydrate than your body can cope with. It is important to be able to recognise the symptoms of hyperglycaemia and be aware of the treatments as if left untreated it can lead to ketoacidosis which is potentially life-threatening and occurs mainly in people with type 1 diabetes, with children and young adults most at risk. 

Diabetes UK provides detailed information on the symptoms of hypoglycaemia and hyperglycaemia, and how to prevent and treat them.

There are numerous long-term complications of diabetes, but they are largely preventable through self-care, maintaining a healthy lifestyle and regular contact with health care professionals. Nurses have a responsibility to promote good nutrition and lifestyle choices including appropriate levels of physical activity and providing support for people with diabetes to give up smoking. The responsibility for screening for diabetic complications will also often be the responsibility of the nurse which will include taking blood and urine samples, as well as checking for vision problems and signs of neuropathy.

The long term complications of diabetes include:

• Cardiovascular disease
• Nephropathy
• Neuropathy
• Retinopathy
• Vascular disease

These can result in people with diabetes being an increased risk of heart attacks, kidney failure, strokes and visual impairment. People with diabetes are also at risk of developing problems with their feet which may lead to ulcers and potentially require an amputation. 

Diabetes is the most common cause of lower limb amputations and people with diabetes are at an increased risk of needing to have an amputation compared to the general population. Raised blood sugars can cause damage to the nerves in the feet and hands and lead to a loss of circulation and sensation. It is important that people with diabetes have regular foot checks and work to control blood glucose, blood fats and blood pressure levels to prevent complications related to the feet. Regular foot care should be undertaken by the patient and a health care professional to prevent ulceration of the feet and ultimately amputation of the toes, feet or legs.

NICE has produced guidance: Diabetic foot problems: prevention and management, which provides an overview of foot care for people with diabetes. Diabetes UK has launched the Putting Feet First campaign which aims to reduce the number of preventable leg, foot and toe amputations being carried out owing to diabetes. An integrated foot care pathway has been developed to help health care professionals provide the best standard of care. 

Research published in Diabetes Care suggests that people from black and South Asian communities are at an increased risk of developing type 2 diabetes. NICE recommends risk assessments and screening should happen from the age of 25 for people from these communities that will enable those with the condition to be diagnosed and those at risk to make lifestyle changes to prevent diabetes. 

Men with diabetes are at an increased risk of experiencing erectile dysfunction. It is important to be aware of the causes and symptoms of this and there are now a wide range of treatment options available for men with erectile dysfunction. Further information on sexual dysfunction associated with diabetes can be found here.

Treatment