Diabetes Acute Complications: Recognizing Symptoms and Understanding Risks
Diabetes is a chronic condition that, when poorly managed, can lead to severe acute complications. These medical emergencies arise due to significant imbalances in blood glucose levels and metabolic dysfunction. Early recognition of symptoms is crucial for timely intervention and improved outcomes. The three primary acute complications associated with diabetes are diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and lactic acidosis. Each has distinct causes, clinical features, and risk factors.
1. Diabetic Ketoacidosis (DKA): A Life-Threatening Metabolic Crisis
Diabetic ketoacidosis typically occurs when insulin levels are critically low, leading to uncontrolled hyperglycemia—often triggered by missed medication, infection, or undiagnosed diabetes. Without sufficient insulin, the body begins breaking down fat for energy, producing acidic substances called ketones. As ketone levels rise, the blood becomes increasingly acidic, resulting in DKA.
Symptoms develop rapidly and may include nausea, vomiting, abdominal pain, excessive thirst, frequent urination, and a characteristic fruity or "acetone-like" odor on the breath—often described as smelling like rotten apples. Patients may also experience rapid breathing (Kussmaul respirations) as the body attempts to compensate for acidosis. In severe cases, confusion, lethargy, and progression to coma can occur if not treated promptly.
DKA is more common in individuals with type 1 diabetes but can also affect those with type 2 under extreme stress conditions. Immediate treatment involves intravenous fluids, insulin therapy, and electrolyte replacement in a hospital setting.
2. Hyperosmolar Hyperglycemic State (HHS): A Dangerous Condition in Older Adults
Hyperosmolar hyperglycemic state, formerly known as non-ketotic hyperosmolar coma, primarily affects older adults with type 2 diabetes. It usually develops gradually over days or weeks, often precipitated by illness, dehydration, or consuming large amounts of sugary foods during festive meals.
Why HHS Is Particularly Dangerous
This condition is characterized by extremely high blood glucose levels—often exceeding 600 mg/dL—without significant ketone production. The massive elevation in glucose increases serum osmolality, pulling fluid from cells and causing severe dehydration. Unlike DKA, HHS does not involve major ketone buildup, but the degree of dehydration and neurological impairment is often more profound.
Patients may present with dry mouth, sunken eyes, reduced skin elasticity, confusion, seizures, or even coma. Because HHS typically affects elderly patients who may already have underlying heart disease, kidney issues, or infections, the mortality rate is significantly higher than in DKA. Prompt diagnosis and careful rehydration with IV fluids, along with insulin administration, are essential for survival.
3. Lactic Acidosis: A Rare but Serious Complication Linked to Medication and Organ Dysfunction
Lactic acidosis in diabetes is relatively rare but potentially fatal. It occurs when there's an accumulation of lactate in the bloodstream, leading to a dangerous drop in blood pH. This condition is most commonly seen in patients with compromised organ function—particularly renal insufficiency—or those experiencing chronic tissue hypoxia due to heart failure, sepsis, or lung disease.
The Role of Metformin in Lactic Acidosis Risk
Metformin, a widely prescribed medication for type 2 diabetes, improves insulin sensitivity and lowers glucose production in the liver. However, in patients with poor kidney function, metformin can accumulate and impair lactate metabolism, increasing the risk of lactic acidosis—especially after prolonged use or overdose.
Clinical signs include gastrointestinal distress such as nausea, vomiting, abdominal pain, and diarrhea, along with generalized weakness and rapid breathing. If untreated, it can progress to circulatory collapse and death. Diagnosis requires blood tests showing elevated lactate levels and metabolic acidosis. Treatment involves discontinuing metformin, supporting vital functions, and addressing the underlying cause in an intensive care environment.
Prevention and Awareness Are Key
While these acute complications can be life-threatening, they are largely preventable through consistent glucose monitoring, adherence to medication regimens, regular medical check-ups, and prompt treatment of infections or illnesses. Education plays a vital role—patients and caregivers should recognize early warning signs and seek emergency care immediately when symptoms arise.
Understanding the differences between DKA, HHS, and lactic acidosis empowers individuals with diabetes to take proactive steps toward better health and reduces the risk of hospitalization and long-term complications.