Complications and Special Situations

 

Questions & Answers 

Q: What are the early warning signs of a diabetic coma?
A: What you need to be attuned to are low blood sugar signs: dizziness, feeling light-headed, sudden fatigue, and sweats. This occurs with different people at different levels. For many who are used to having high blood sugars -- closer to 200 -- much of the time, they may experience these symptoms at levels over 100, especially if attempting to get into a more normal blood sugar range too quickly. As a guide, people without diabetes have a fasting blood sugar under 100, ideally between 80-90. Some people with diabetes who tend to keep their fasting sugars under 126, and never go over 180 daytime, may feel low at 60 or 70, then start to feel very low at 40-50. Under 40 for a blood sugar may bring on a coma. If you are not currently checking your blood sugars, start doing so. Ask your physician what levels your sugars should be before you eat breakfast in the morning. It is also good to check 2 hours after a meal, at least until you have an idea of how high the foods you are eating spike your sugars. And certainly, get some help with planning your meals if you haven’t already. And most importantly, be as active as you can possibly be.

Q: What is DKA? My son has type 1 and his doctor says that this is causing him to vomit and feel nauseous.
A: His doctor is referring to diabetic ketoacidodsis, or DKA. This is when ketones "take over" to the point where a person can become unconscious and even die if left unchecked. In this state, there is not enough insulin on board to get the glucose into the cells. The body perceives a form of starvation mode, and starts to break down fat at a rapid rate, resulting in the high levels of ketones, a byproduct of rapid fat breakdown. I'm assuming your physician has adjusted his insulin protocol to better cover his sugar levels. It's tough with teenagers as you well know, given the types of foods peers eat. Eating healthfully remains the goal and a challenge.

Q: Why are my feet and legs tingly? Like pins and needles and they hurt. But mostly in the evening and night time. I have a hard time trying to go to sleep. 
A: I’m assuming you have diabetes, and it does sound like neuropathy could be affecting your feet. I suggest you have your physician check this out, as it may mean the nerve endings are becoming damaged and you have reduced circulation to the feet. You may begin to see a similar sensation in your hands. The key to reversing this, or at least stopping it, is to keep your blood sugars in as close to normal range as possible, and to lead as healthy a lifestyle as you can. You may need some professional guidance with this if you aren’t clear about what constitutes good management and what range you diabetes should be in.

Q: How do I maintain my blood sugar when I cannot eat due to illness?
A: During the times when you can't eat, you can replace a meal by substituting about 60 grams of carbohydrates in the form of juice, ice cream, or Jell-O. For a snack, you will need approximately 15 grams of carbohydrate. For some people, this could mean 4 oz. of juice every hour. This will depend on how much you can tolerate at one time. Diluting your juice to 50/50 with water is a good idea for absorption. If you can't tolerate mealtime quantities, "snack" as you feel the need. The biggest concern is to stay hydrated.

Q: Is there an alternative treatment to cure neuropathy pain that I'm having every day?
A: I wish I had a magic pill for you.  I'm going to assume you are eating an alkaline diet; meaning lots of plant based foods and overall, doing what you can to maintain a healthy lifestyle. Supplementing with vitamin B6 can be very helpful, assuming you also have some basic nutritionals in place, such as a multivitamin and fish oil. There are other nutrition supplements/herbals/homeopathics that may help, but one would need to know what medications you are on and wheat other chronic conditions you may have.  You may already be using some form of capsacian for topical relief.  Acupuncture, massage therapy, and various forms of healing touch may also help.  Do some exploring in your area for integrative practitioners who may be able to arrive at a program that is compatible with your current medical management.

Q: What happens to a person with advanced neuropathy?
A: Advanced neuropathy can manifest in different areas of the body: hands, feet, eyes, stomach areas. It usually starts out with subtle changes, such as on/off tingling in the hands and feet, weakened eye sight, maldigestion, weaker bladder, etc. This is all a consequence of years of higher blood sugar levels. Advanced stages mean these symptoms are more severe. If left unchecked, the extreme results are such things as toe/foot/leg amputations, blindness, and kidney failure. If you are approaching this level, it is most important that you do what you can to eat healthfully, stay active, and take the best overall care of yourself that you can.

Q: What is DKA? My son has type 1 and his doctor says that this is causing him to vomit and feel nauseous.
A: His doctor is referring to diabetic ketoacidodsis, or DKA. This is when ketones "take over" to the point where a person can become unconscious and even die if left unchecked. In this state, there is not enough insulin on board to get the glucose into the cells. The body perceives a form of starvation mode, and starts to break down fat at a rapid rate, resulting in the high levels of ketones, a byproduct of rapid fat breakdown. I'm assuming your physician has adjusted his insulin protocol to better cover his sugar levels. It's tough with teenagers as you well know, given the types of foods peers eat. Eating healthfully remains the goal and a challenge.

Q: Ever since I developed diabetes, I am having problems remembering things. Can diabetes affect a person's memory?
A:  Being well hydrated and eating a diet of unrefined foods is the first step to mental clarity. When glucose levels are elevated, the sugar in the bloodstream requires lots of fluid to leave through the urine. If you are not drinking enough water, then your body cells pay the price by "donating" their water. Eating too many carbs, especially refined ones, can make one sleepy and certainly increase glucose levels more quickly. Be sure to start your day with protein - eggs work well for egg eaters - and include in small amounts throughout day. Some baseline supplements like a multivitamin, B-complex and fish oil caps may provide some nutrients you are not getting enough of. There are many more things one can do when working with a nutritionally oriented practitioner, but this is the first place to start.

Q: Take two people who have their blood sugar within a normal range. One is a type 2 diabetic controlled by diet, meds and exercise - the other does not have diabetes. Is the controlled type 2 diabetic at any greater risk of vision loss, circulation problems, kidney disease, etc than the person without diabetes?
A:  Perhaps. Much depends on how long the person has had diabetes and/or pre-diabetes before being diagnosed, and what other cardiovascular conditions he/she might have. Chronic conditions and disease states are never an isolated diagnosis; there are usually other conditions that need attention to keep the whole "machine" running smoothly.

Q: Can high blood sugars cause a rash? I have type 2 diabetes and take 6 - 500g tablets of metformin a day. I have a slightly itchy rash on my thighs.
A: High blood sugars can manifest differently in different folks. Eczema and rashes are possible. What I think you may want to question is your medication. It sounds like you are on 3000mg of metformin; 2000mg is generally the upper end before some other medication is introduced if still not in range. If you are consistently elevated and are following a healthy lifestyle/diet, you may want to discuss this with your physician. If you need a second opinion, find a good endocrinologist - a doctor who usually has a sub specialty in diabetes management.

Q: Am I more prone to infections if I have diabetes?
A: When diabetes is not well managed, your general resistance can be lower, making you more susceptible to infections, illnesses, and a longer recovery time. This is one more reason why it is so important to follow as healthy a lifestyle as you possibly can.

Q: Can diabetes affect my bladder control?
A: Yes, this could be a possible symptom of neuropathy. If this is the case, it means your diabetes has been progressing for a long time, probably several years before you were even diagnosed. You may have noticed reduced feelings in your feet and hands, meaning if you get pricked by a thorn or pin, it doesn't hurt you very much. Discuss all this with your physician, who is in the best position to advise you as to the next course of action. It would be to your benefit to lead as healthy a lifestyle as you possibly can, with the goal to keep your blood sugars as close to normal as possible. Your physician can work out these ranges with you if this hasn't already been done.

Q: How can I alleviate erectile dysfunction due to diabetes without the use of drugs or surgery? I am trying to exercise and lose weight as I know this will help.
A: Sexual functioning is an issue that is prevalent not just for those with diabetes, and not only for men. There are nutritional supplements that can support the physiological pathways involved in erections, and these are best done under the direction of a practitioner that is versed in complementary/alternative medicine. Losing fat mass is certainly a huge step, and should continue to be your target. A high quality multivitamin, 3 grams fish oil, B-complex at lunch, and magnesium capsule at night may be also helpful. In time, with body composition changes, you should see some improvement. You can also view a presentation on sexual dysfunction from our Diabetes University.

Q: How can diabetes affect the kidneys?
A: Diabetes can affect the action and health of the kidneys if not managed well over a longer term. Kidneys have a microvascular network where filtration occurs and nutrients are reabsorbed. The kidneys are a very sophisticated piece of equipment! Often patients with diabetes are put on blood pressure medications just to control the pressure on the kidneys to prevent damage. Those with diabetes should get measured yearly for microalbumin levels if there are currently no diagnosed kidney conditions/disease. If you are spilling protein in your urine, then we know you have already overtaxed this system, and must become most diligent about your diet, focusing on monitoring protein intake to levels not exceeding .8 grams protein for each kilo body weight. More plant protein and less animal protein creates less of a strain on kidney processing. If you are managing your diabetes with a healthy lifestyle and diet, you are much more on the road to being free of any long term complications.

Q: Are my feet and ankles swelling because I have diabetes?
A: Fluid build-up can cause swelling in the extremities when circulation has been impaired or weakened if some degree of peripheral neuropathy has started. This is evident with diabetes when it has been long-standing with variable blood sugars. I would suggest you revisit your lifestyle so that your food and activity levels are truly healthy, and bring this to your physician's attention. Drink plenty of water and eat lots of veggies, getting 30-40 grams of fiber per day. Do what you can to help re-balance your system so you are not dependent on a diuretic, which may be prescribed for you in the short run.

Q: Is there any risk to having type 2 diabetes while being pregnant?
A: With pregnancy, the focus is to keep the mother in a bit tighter control, and this has to be done w/insulin, as oral medications would cross the placenta into the fetus. The risk to the unborn child would arise as a result of uncontrolled high blood sugars. When you already have diabetes - as opposed to gestational diabetes diagnosed at 28 weeks - you may be put on a more controlled diet pattern from the beginning, meaning morning carbs are monitored more closely, with the morning often smaller intake, especially in the last trimester. This often depends on your blood sugar levels and the goals set. As the fetus develops, 25-28 weeks, the goals may be as “tight” as 110 mg/dl 1 hr post meal, or 120 2hr post meal, and around 90 fasting every am. In my experience, women become very motivated to be disciplined, follow patterns that control carbs, and accept insulin as the assist to be changed as needed to stay in range. Your physician should give you clear guidelines for management. There’s much published literature as well on diabetes and pregnancy. There are many healthy, normal weight babies born to mothers with diabetes. It is not a given that your child will develop diabetes; it is most important you instill good lifestyle habits from the beginning.

Q: Is it possible that diabetes can make someone smell like they have been drinking alcohol?
A: When people are ketotic, they can smell like alcohol. This means fat is breaking down at an undesirable rate to supply fuel for the body. This is more often seen in people with very elevated blood sugars. There could be other digestive malfunctions going on.

Q: How does protein get into the urine?
A: Protein in the urine is a result of kidney malfunctioning, and can cause the pressure of blood vessels in the kidneys to rise. In the earlier stages, eating smaller servings of high protein foods and generally eating whole and unrefined foods can greatly help to get things under control. I'm assuming your physician is working on this with you? It is certainly time for you now, if you haven't already done so, to follow as healthful a lifestyle as you possibly can.

Q: Can low blood sugar be causing my mother to have hallucinations? Once she gets her sugar stabilized the hallucinations decrease rapidly.
A: Yes, if her blood sugars are very low, hallucinations are possible. Is she on medication for diabetes? If so, it needs to be lowered/adjusted! Get assistance with both this and her food intake by seeing a specialist such as an endocrinologist soon. Don't invite other potential health risks from low blood sugar.

Q: When I eat or drink something sweet, why do I get a headache and start to feel nauseous.?
A: It sounds as if you are carbohydrate sensitive, meaning the refined, simple carbohydrates such as sweets, are rapidly digested, lifting your blood sugar quickly but then rapidly "dropping" you back down. This is especially likely to happen if no other foods are eaten along with the simple carb foods. It would be very wise for you to avoid these foods as much as possible. Have you had your blood sugar tested? Now would be a good time to follow a healthy lifestyle, eating whole, unrefined foods and staying active. Balancing our metabolisms is an ongoing and fine tuning process, challenged by the environment we live in and the daily stresses of life. It is doubly important to nourish ourselves well in order to combat the elements we can't control.

Q: What would you suggest for a type 2 diabetic with shingles?
A: I am not familiar with all the medications used for shingles and their impact on blood sugar. This would certainly be a time to eat as healthfully as possible, and take some nutritional supplements - even a potent multivitamin regimen. Fortifying your immune system will speed healing. Lots of veggies, fish, and legumes as food focuses are helpful. Your blood sugars may be elevated now due to the stress of the condition. Stay well hydrated. If you can tolerate dairy, try some Kefir - a milk with live cultures that is a good immune booster for the GI tract. Aloe Vera juice, found in many stores, can help soothe the GI tract if you are experiencing any signs of maldigestion.

Q: My husband with type 1 diabetes suffers from severe nerve twitching at night in both arms and legs. It seems as if he is being shocked repeatedly. Is there any relief for this condition?
A: It sounds like neuropathy, and I would hope by now you are in touch with his physician on this. The first step is getting the blood sugars in the best control he can. I would suspect this is not the case. Eating nutrient dense foods, being active, and receiving guidance on appropriate supplementation with vitamins/minerals are all part of the corrective path. B vitamins in particular may help once other lifestyle changes are taking place. There are tests that can be done to assess nerve damage. The most important consideration is that your husband wants to get better and is willing to do what is necessary to get there.

Q: Could a sweetish body odor be related to diabetes? My 74-year-old mother says that her diabetes is under control and she does not smell this odor herself. The problem is that she seems to have a distinctive and, unfortunately for me, disgustingly sweet and cloying body odor.
A: Ketosis can cause this unappetizing fruity odor. Have you actually seen her numbers to know if she is in good control of her diabetes? In your observation, is she eating reasonable sized meals, not severely restricting her intake? If her sugars are continuously high, her body can produce this odor if the cells are not getting what they need in the way of fuel. Fat then becomes the primary fuel source, breaking down in an unhealthy manner, causing the odor. See if you can persuade her to see an endocrinologist to address this problem.

Q: I seem to suffer many complications of diabetes including bouts of neuropathy, gum and tooth problems, and frequent yeast related problems. How likely is it that these problems are actually early complications of diabetes? For several years now I have been told I'm pre-diabetic and have been doing everything I can to prevent becoming a diabetic.
A: Yes, these conditions certainly can be related to diabetic complications after years of elevated blood sugars. I strongly urge you to see an endocrinologist, who may then refer you to other specialists as needed. It is from the largest and most comprehensive nationwide study (The Diabetes Control and Complications Trial or DCCT) that we learned of the impact of pre-diabetes on the progression of complications. This is why the criteria for pre-diabetes diagnosis is now at 100-125 for fasting blood sugars.

Q: How common is blindness caused by diabetes? My eye sight has always been a perfect 20/20 however my vision is now blurry and my blood levels go up and down like a yo-yo.
A: Frequent high blood sugars can cause immediate blurriness, but that does not necessarily indicate permanent damage. If you maintain a pattern of high blood sugars for many years, damage to the eyes can set in. This is known as retinopathy. Get all the assistance you can now to maintain stable blood sugar control, taking charge of your eating and being as active as you can be. A healthy lifestyle is the first best defense for keeping away complications such as retinopathy.

Q: Could diabetes be causing the bottoms of my feet to itch at night?
A: Diabetic neuropathy - damage to the nerve endings - can manifest as itching. I suggest you have your practitioner check for this to determine if you may be losing sensation/feeling in the feet and perhaps other areas. Meanwhile, do everything in your power to keep your blood sugars in good control.

Q: I have had really severe neuropathy for several years, and no other test results (like MRI's) show any problems.
A: I would consult an endocrinologist, especially if you already have undefined neuropathy. More emphasis is now being placed on 2 hour blood sugar levels than on fasting levels. Severe neuropathy reflects years of hyperglycemia, and would generally manifest first as peripheral neuropathy. "Severe" implies that you already have loss of sensation, compromised sight, etc. If this describes you, and you have not been referred to specialists before now, referral is long overdue. Have you been taking any nutritional supplements, or working a practitioner who understands this application? B vitamins and magnesium are compromised with neuropathy, and should be taken together with a nutrient dense diet. All diabetic diets are not equal in terms of balance and nutrient quality. Choose your practitioners now carefully; seek second opinions as necessary.

Q: Why do I get panic attack symptoms when my blood sugar falls below 90?
A: Blood sugar fluctuations can cause panic attack-like symptoms. What you need assistance with right now is thorough nutritional counseling to get a good foundation for blood sugar stability. This would be preferable from a nutritionist who also understands appropriate vitamin/mineral supplementation and other integrative therapies.

Q: Someone I know died of a "diabetic heart attack" very suddenly a few weeks ago. Can you explain to me what this means?
A: He died of a heart attack and had diabetes. Diabetes is a cardiovascular disease but it is not a “given” that everyone with diabetes will die of a heart attack. When the cause of death with diabetes is due to complications, this often translates into a cardiac event such as “heart attack”. When blood sugars remain high over many years, damage can occur to the nerves and blood vessels, causing constriction among other things. Reduced blood flow may then be the results, the setup for a number of possible events. People with diabetes need to be diligent about good lifestyle habits, as we all should.

Q: My brother has said his feet hurt, both of his big toes are turning black, and one of the toenails has already came off. Is this happening because he has diabetes?
A: Encourage him to see his physician ASAP! He could very well be at the point of amputation, and if he is not attempting to manage his diabetes, this blackening of the toes — which is most likely dying tissue — could begin a path up his feet and legs over time. Don’t delay!

Q: My wife recently suffered from nerve damage in her arms and legs because of type 1 diabetes. What is the best way help her through the pain?
A: There are capsaicin creams that sometimes help. Of course, I am assuming she is truly focusing on a whole foods eating plan and trying to keep her blood sugars in a reasonable range. B vitamins are very helpful here as are other nutritional supplements. I would also suggest if you are open to it, and have access in your area, to seek out acupuncture. Depending on the degree of her nerve damage, this may be helpful, as can regular therapeutic massage. Have her be as active as she can manage; swimming/water walking are good forms of exercise.

 

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Information on the "Ask The Diabetes Educator" pages should not be relied on for medical or technical advice. Always consult your healthcare team. Diabetes Action and Jane DeVane cannot be responsible for errors or wrongful use of the information available on this website. The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician/medical team.

 

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