Diabetes mellitus is a chronic condition affecting how the body regulates blood sugar. There are two primary types. Type 1 diabetes (T1DM) is an autoimmune disease where the immune system mistakenly attacks the cells in the pancreas that produce insulin. This results in the inability to produce insulin, a hormone essential for regulating blood sugar. Type 2 diabetes (T2DM) occurs when the body becomes resistant to insulin or doesn’t produce enough insulin. This often develops due to factors like obesity, sedentary lifestyle and family history. While both types lead to high blood sugar levels, type 2 diabetes is often associated with lifestyle factors and can often be managed through diet, exercise and medication.

1. Shakiness, sweating and confusion

Hypoglycemia occurs when the blood sugar levels drop too low. Individual symptoms vary but usually develop when the levels are below 70. Severely low blood sugar levels can lead to seizures, neurologic derangements, and coma. Diabetic hypoglycemic events result from taking too much insulin, not eating after taking insulin, or following vigorous exercise. As glucose levels fall, confusion, dizziness, nausea, sweating, shakiness, and weakness appear. Treatment would include a high carbohydrate snack such as a glucose tablet, gel, or orange juice.

2. Excessive thirst and blurred vision

Hyperglycemia is a condition when the blood sugar levels are in excess, which varies by individual but is typically above 180-200 in a person with diabetes. This can follow eating a diet high in carbohydrates, lack of exercise, and not taking enough insulin or glucose-lowering agents. Secondary causes can occur by taking medications such as corticosteroids, beta-blockers, and diuretics. Gestational diabetes in pregnancy is another cause linked to insulin resistance. Early signs of hyperglycemia are frequent urination, increased thirst, fatigue, and blurry vision. Later signs, if the condition progresses, are fruity-smelling breath, dry mouth, dehydration, confusion, and nausea and vomiting. Treatment depends on the cause of hyperglycemia and usually includes administering insulin or a glucose-lowering agent and seeking medical assistance from a healthcare provider if symptoms persist.

3 Fruity-smelling breath and rapid breathing

A more ominous complication of elevated blood sugars and hyperglycemia is diabetic ketoacidosis (DKA). A life-threatening condition, DKA follows severely elevated glucose levels exceeding 500. The brain requires glucose for energy, and alternative pathways are utilized, sourcing fat and the production of ketones, which cause a fruity smell on the breath. Ketones are acidic and lead to toxicity, resulting in confusion and changes in mentation, difficulty in breathing, nausea, vomiting, and abdominal pain. Treatment warrants emergency management immediately by a healthcare provider to provide intravenous fluids, insulin, and electrolytes.

Warning signs of diabetic emergencies

Diabetes disrupts blood sugar regulation, an important energy source for the brain. Insulin is a hormone that helps the body manage blood glucose, but deficiencies in production or function can lead to severe complications and emergencies. Poorly controlled blood glucose levels can damage the eyes, kidneys, nerves, and heart. Warning signs are imperative as diabetic complications can be life-threatening. Early detection of hypoglycemia, hyperglycemia, and DKA can be the difference in preventing serious health risks and morbidity.