Contributor: Toby Smithson, MS, RDN, LD, CDE, PWD

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When you were diagnosed with diabetes, you probably got the rundown of long-term diabetes complications. Long-term complications include eye problems, heart disease, kidney issues, nerve issues with burning, tingling, pain or loss of feeling to nerve endings in our legs or feet, a higher risk of osteoporosis, and some women may have trouble getting pregnant as well as irregular menstrual cycles. Long term complications from diabetes can be related to extended periods of elevated blood sugar levels – chronic high readings over many years. Reducing the risk for the long-term complications of diabetes is a steady, long-term strategy to keep average blood glucose levels as close to your target range as possible.

But, to complicate things even more, there are also short-term complications of diabetes, and short-term complications demand an immediate – sometimes emergency – response. Short term complications are episodes of low blood glucose levels (hypoglycemia) or high blood glucose levels (hyperglycemia) severe enough to affect the way we feel or function. These episodes of hypoglycemia or hyperglycemia are often unpredictable, so it’s important that we are prepared to respond with corrective action.

Hypoglycemia is defined as a blood glucose level lower than 70 mg/dl (3.9 mmol/l) and can be the result of diabetes treatment with insulin or a certain medication for type 2 diabetes that stimulate the release of natural insulin (sulfonylureas, meglitinides, d-phenylalanine derivatives). Hypoglycemia, whether you have symptoms or not, needs to be addressed immediately. Low blood glucose levels can impair judgment and balance, increasing the risks for poor decision making and accidents. A failure to treat low blood glucose can result in loss of consciousness, coma, and death.

• The symptoms of severe hypoglycemia include shakiness, dizziness, headache, sweating, irritability, moodiness, and heart palpitation.
• Strategies to prevent severe hypoglycemia include eating regular meals, checking blood glucose levels often, setting the alarm function on your continuous glucose monitor (CGM), always having fast-acting carbohydrate snacks on hand, avoiding excessive alcohol, and making sure friends and relatives are aware of the risks and symptoms.
• Treating hypoglycemia follows the “rule of 15” – consume 15 grams of a fast-acting carbohydrate, wait 15 minutes, check blood glucose level, repeat if necessary. Fast-acting carbohydrates include ½ cup juice, five lifesavers, or 3-4 glucose tabs. Severe hypoglycemia can also be treated with a glucagon injection. Always wear medical identification.
• Special note – excessive alcohol consumption is especially dangerous because the symptoms of hypoglycemia and alcohol intoxication are similar, alcohol affects the judgment of both you and your companions, and alcohol metabolism can interfere with the treatment for hypoglycemia.

Hyperglycemia is not as well defined with respect to serious risk, but short- term complications from episodes of high blood sugar readings can occur. Our bodies begin to excrete excess glucose through our kidneys at blood glucose levels around 200 mg/dl (11 mmol/l), making dehydration the primary risk even at those relatively low levels. Headache, trouble concentrating, fatigue, nausea, increased thirst, and increased urination are signs. While these symptoms will be short term until your blood sugar reading is back to target range, you probably will not feel your best. Severe, life-threatening hyperglycemia is a risk as well, both for type 1 and type 2 diabetes.

• Severe hyperglycemia in those with type 1 diabetes (and rare, but possible with type 2 diabetes) can lead to a life-threatening condition called diabetic ketoacidosis (DKA) in response to the buildup of ketones and acidification of the blood. A similar condition more common in those with type 2 diabetes is called hyperglycemic hyperosmolar nonketotic syndrome (HHNS). HHNS often occurs when a person with diabetes has an unrelated illness. Both conditions are life-threatening and should be treated in a hospital.
• Strategies to prevent hyperglycemia include checking blood glucose levels two hours after meals or with symptoms of hyperglycemia, staying hydrated, correcting rising blood glucose levels with rapid-acting insulin (if insulin is part of your treatment plan), mixing carbohydrates with foods containing protein and fat, and being especially cautious in monitoring blood glucose when you are sick. People with type 1 diabetes should carry ketone testing strips.
• Treating hyperglycemia with insulin is the most effective action, but many people with type 2 diabetes do not have access to insulin. Hydration is the next best solution, with water or a no-calorie beverage (NEVER with sugar-sweetened beverages). Exercise can help lower blood glucose levels but is not recommended if ketones are present. Keep your carbohydrate intake low. Call your doctor if symptoms are severe, or if treatment is not lowering your blood glucose levels. Always wear medical identification.

For the most part, we may manage our diabetes every day with our eyes farther down the road, looking to reduce the risk for long-term complications of diabetes. But, short-term complications – episodes of hypoglycemia and/or hyperglycemia – are almost certain to surprise us from time to time, even when we follow strategies to prevent them. If we know the signs, know how to respond and know when emergency intervention is required, short-term complications are just a bump in the road.

Toby Smithson, is a registered dietitian, certified diabetes educator and a PWD (person with diabetes). She is a speaker, writer, and consultant dietitian based in Hilton Head Island, SC. Toby is the Author of Diabetes Meal Planning and Nutrition For Dummies, a monthly contributor for Type2Diabetes.com, blogger for US News Health & Report and Columnist and Advisor for Diabetic Living Magazine. She can be found on DiabetesEveryDay.com.