Type 1 diabetes increases the risk for many serious health complications. However, during the past several decades, the rate of serious complications among people with diabetes has been decreasing, and more patients are living longer and healthier lives. There are two important approaches to preventing complications from type 1 diabetes:
- Good control of blood glucose and keeping glycosylated hemoglobin (A1C) levels below or around 7%. This approach can help prevent complications due to vascular (blood vessel) abnormalities and nerve damage (neuropathy) that can cause major damage to organs, including the eyes, kidneys, and heart.
- Managing risk factors for heart disease. Blood glucose control helps the heart, but it is also very important that people with diabetes control blood pressure, cholesterol levels, and other factors associated with heart disease.
Diabetic ketoacidosis (DKA) is a life-threatening complication caused by a complete (or almost complete) lack of insulin. In DKA, the body produces abnormally high levels of blood acids called ketones. Ketones are byproducts of fat breakdown that build up in the blood and appear in the urine. They are produced when the body burns fat instead of glucose for energy. The buildup of ketones in the body is called ketoacidosis. Extreme stages of diabetic ketoacidosis can lead to coma and death.
For some people, DKA may be the first sign that someone has diabetes. In type 1 diabetes, it usually occurs when a patient is not compliant with insulin therapy or intentionally reduces insulin doses in order to lose weight. It can also be triggered by a severe illness or infection.
Symptoms and complications include:
- Thirst and dry mouth
- Frequent urination
- Dry warm skin
- Nausea and vomiting and stomach pain
- Deep and rapid breathing sometimes with frequent sighing
- Fruity breath odor
- Confusion and decreased consciousness
- Cerebral edema, or brain swelling, is a rare but very dangerous complication that can result in coma, brain damage, or death.
- Other serious complications from DKA include aspiration pneumonia and adult respiratory distress syndrome.
Life-saving treatment uses rapid replacement of fluids with a salt (saline) solution followed by low-dose insulin and potassium replacement.
Hyperglycemic Hyperosmolar Nonketonic Syndrome (HHNS)
Hyperglycemic hyperosmolar nonketonic syndrome (HHNS) is a serious complication of diabetes that involves a cycle of increasing blood sugar levels and dehydration, without ketones. HHNS usually occurs with type 2 diabetes, but it can also occur with type 1 diabetes. It is often triggered by a serious infection or another severe illness, or by medications that lower glucose tolerance or increase fluid loss (especially in people who are not drinking enough fluids).
Symptoms of HHNS include high blood sugar levels, dry mouth, extreme thirst, dry skin, and high fever. HHNS can lead to loss of consciousness, seizures, coma, and death.
Review Date: 05/05/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.