Diabetes refers to a group of diseases that affect how the body uses blood glucose. The main feature is increased blood glucose levels. Blood glucose levels are controlled by a hormone named insulin, inadequate production or resistance to insulin leads to Diabetes. Loss of regulation of blood glucose can lead to serious health problems which we see in Diabetes.People with Diabetes need hospital admission in case of the following conditions:Diabetic ketoacidosisIt usually occurs in people with Type 1 Diabetes with an underlying triggering factor such as infection. The condition develops when the body can't produce enough insulin. Without enough insulin, the body begins to break down fat as fuel. This causes a build-up of acids in the bloodstream called ketones. If it's left untreated, the build-up can lead to diabetic ketoacidosis.This condition is life threatening and requires Intensive Care Unit (ICU) admission with meticulous fluid resuscitation and insulin with electrolyte replacements. Children and adolescents who have been newly diagnosed with Diabetes can land up in this condition.Hyperglycaemic hyperosmolar stateHyperglycaemic hyperosmolar state happens when very high blood glucose leads to severe dehydration and highly concentrated blood (high osmolality), which are life-threatening. Hyperglycaemic hyperosmolar state also involves a lack of insulin, but the person usually still produces enough insulin to prevent the production of ketones.The person requires hospitalisation to manage severe dehydration causing electrolyte imbalance and impaired neuro-status. This is treated by close neuro-monitoring with fluid resuscitation and intensive care. Older people with Diabetes are more at risk and the underlying triggering factor such as an infection, that's also contributing to the high blood glucose level.The main difference between diabetic ketoacidosis and hyperglycaemic hyperosmolar state is that diabetic ketoacidosis involves ketones and blood acidity while hyperglycaemic hyperosmolar state doesn't.Hypoglycaemia with neuroglycopeniaHypoglycaemia or low blood glucose level can result in Neuroglycopenia (shortage of glucose in the brain). This affects the function of neurons, and alters brain function and behaviour. Prolonged or recurrent neuroglycopenia can result in loss of consciousness, damage to the brain, and eventual death.It is important to note that Hypoglycaemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGB) due to the changes in gut hormonal milieu. Prompt treatment is necessary as significant damage to brain parenchyma can occur leading to permanent damage.Hospitalisation due to complications of DiabetesLong-term complications of Diabetes develop gradually. The longer you have Diabetes and the less controlled your blood glucose is, the higher the risk of complications. Eventually, Diabetes complications may be disabling or even life-threatening. In fact, prediabetes can lead to Type 2 Diabetes. Possible complications include:Heart and blood vessel (cardiovascular) diseaseIf you have Diabetes, you are twice more likely to have heart disease or stroke than someone who does not have Diabetes.These can include coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). The most common type is coronary artery disease which affects the blood flow in coronary vessels supplying heart.Over time high blood glucose can damage blood vessels and the nerves that control your heart. High blood pressure along with raised cholesterol levels increases the chances of plaque formation on damaged arterial walls. High triglycerides and low HDL (good cholesterol) or high LDL (bad cholesterol) is thought to contribute to hardening of the arteries.The main goals in people with Diabetes needing hospitalisation are to minimise disruption of the metabolic state, prevent adverse glycemic events (especially hypoglycemia), return the patient to a stable glycemic balance as quickly as possible, and ensure a smooth transition to outpatient care. These goals are not always easy to achieve. On the one hand, the stress of the acute illness tends to raise blood glucose concentrations. On the other hand, the anorexia that often accompanies illness or the need for fasting before procedures tend to do the opposite.Because the net effect of these countervailing forces is not easily predictable in a given patient, the target blood glucose concentration should generally be higher than in the outpatient setting. The glycaemic control in patients admitted is achieved with insulin administration.Whatever the clinical presentation, tight glycemic control definitely decreases the mortality and morbidity in patients with Diabetes..Nerve damage (neuropathy)Too much sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhoea or constipation.For men, it may lead to erectile dysfunction. Nerve damage can cause health problems ranging from mild numbness to pain that makes it hard to do normal activities. Symptoms of nerve damage usually develop slowly, so it's important to notice your symptoms early so you can take action to prevent it from getting more seriousKidney damage (nephropathy)If you have Diabetes, get your kidneys checked regularly which is done by your doctor with simple blood and urine tests. Regular testing is your best chance for identifying DKD early if you do develop it. Early treatment is most effective and can help prevent additional health problems.Each kidney is made up of millions of tiny filters called nephrons. Over time, high blood glucose from Diabetes can damage blood vessels in the kidneys as well as nephrons so they don't work well. Many people with Diabetes also develop high blood pressure, which can damage kidneys too.Eye damage (retinopathy)Diabetes can damage the blood vessels of the eye (diabetic retinopathy). This could lead to blindness.Foot damageNerve damage in the feet or poor blood flow to the feet increases the risk of many foot complications.Skin and mouth conditionsDiabetes may leave you more prone to skin problems, including bacterial and fungal infections.Prevention is the keyType 1 Diabetes can't be prevented. But with healthy lifestyle choices that help treat prediabetes, Type 2 Diabetes and gestational Diabetes can be prevented. It is important to:Eat healthy foods - Choose foods lower in fat and calories and higher in fibre. Focus on fruits, vegetables and whole grains. Eat a variety to keep from feeling bored.Get more physical activity - Try to get about 30 minutes of moderate aerobic activity on most days of the week. Or aim to get at least 150 minutes of moderate aerobic activity a week. For example, take a brisk daily walk. If you can't fit in a long workout, break it up into smaller sessions throughout the day.Lose excess weight - If you're overweight, losing even 7 per cent of your body weight can lower the risk of Diabetes. For example, if you weigh 200 pounds (90.7 kilograms), losing 14 pounds (6.4 kilograms) can lower the risk of Diabetes. But don't try to lose weight during pregnancy. Talk to your doctor about how much weight is healthy for you to gain during pregnancy. To keep your weight in a healthy range, work on long-term changes to your eating and exercise habits. Remember the benefits of losing weight, such as a healthier heart, more energy and higher self-esteem.Dr Prashant Bhalekar is Consulting Intensivist
Diabetes refers to a group of diseases that affect how the body uses blood glucose. The main feature is increased blood glucose levels. Blood glucose levels are controlled by a hormone named insulin, inadequate production or resistance to insulin leads to Diabetes. Loss of regulation of blood glucose can lead to serious health problems which we see in Diabetes.People with Diabetes need hospital admission in case of the following conditions:Diabetic ketoacidosisIt usually occurs in people with Type 1 Diabetes with an underlying triggering factor such as infection. The condition develops when the body can't produce enough insulin. Without enough insulin, the body begins to break down fat as fuel. This causes a build-up of acids in the bloodstream called ketones. If it's left untreated, the build-up can lead to diabetic ketoacidosis.This condition is life threatening and requires Intensive Care Unit (ICU) admission with meticulous fluid resuscitation and insulin with electrolyte replacements. Children and adolescents who have been newly diagnosed with Diabetes can land up in this condition.Hyperglycaemic hyperosmolar stateHyperglycaemic hyperosmolar state happens when very high blood glucose leads to severe dehydration and highly concentrated blood (high osmolality), which are life-threatening. Hyperglycaemic hyperosmolar state also involves a lack of insulin, but the person usually still produces enough insulin to prevent the production of ketones.The person requires hospitalisation to manage severe dehydration causing electrolyte imbalance and impaired neuro-status. This is treated by close neuro-monitoring with fluid resuscitation and intensive care. Older people with Diabetes are more at risk and the underlying triggering factor such as an infection, that's also contributing to the high blood glucose level.The main difference between diabetic ketoacidosis and hyperglycaemic hyperosmolar state is that diabetic ketoacidosis involves ketones and blood acidity while hyperglycaemic hyperosmolar state doesn't.Hypoglycaemia with neuroglycopeniaHypoglycaemia or low blood glucose level can result in Neuroglycopenia (shortage of glucose in the brain). This affects the function of neurons, and alters brain function and behaviour. Prolonged or recurrent neuroglycopenia can result in loss of consciousness, damage to the brain, and eventual death.It is important to note that Hypoglycaemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGB) due to the changes in gut hormonal milieu. Prompt treatment is necessary as significant damage to brain parenchyma can occur leading to permanent damage.Hospitalisation due to complications of DiabetesLong-term complications of Diabetes develop gradually. The longer you have Diabetes and the less controlled your blood glucose is, the higher the risk of complications. Eventually, Diabetes complications may be disabling or even life-threatening. In fact, prediabetes can lead to Type 2 Diabetes. Possible complications include:Heart and blood vessel (cardiovascular) diseaseIf you have Diabetes, you are twice more likely to have heart disease or stroke than someone who does not have Diabetes.These can include coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). The most common type is coronary artery disease which affects the blood flow in coronary vessels supplying heart.Over time high blood glucose can damage blood vessels and the nerves that control your heart. High blood pressure along with raised cholesterol levels increases the chances of plaque formation on damaged arterial walls. High triglycerides and low HDL (good cholesterol) or high LDL (bad cholesterol) is thought to contribute to hardening of the arteries.The main goals in people with Diabetes needing hospitalisation are to minimise disruption of the metabolic state, prevent adverse glycemic events (especially hypoglycemia), return the patient to a stable glycemic balance as quickly as possible, and ensure a smooth transition to outpatient care. These goals are not always easy to achieve. On the one hand, the stress of the acute illness tends to raise blood glucose concentrations. On the other hand, the anorexia that often accompanies illness or the need for fasting before procedures tend to do the opposite.Because the net effect of these countervailing forces is not easily predictable in a given patient, the target blood glucose concentration should generally be higher than in the outpatient setting. The glycaemic control in patients admitted is achieved with insulin administration.Whatever the clinical presentation, tight glycemic control definitely decreases the mortality and morbidity in patients with Diabetes..Nerve damage (neuropathy)Too much sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhoea or constipation.For men, it may lead to erectile dysfunction. Nerve damage can cause health problems ranging from mild numbness to pain that makes it hard to do normal activities. Symptoms of nerve damage usually develop slowly, so it's important to notice your symptoms early so you can take action to prevent it from getting more seriousKidney damage (nephropathy)If you have Diabetes, get your kidneys checked regularly which is done by your doctor with simple blood and urine tests. Regular testing is your best chance for identifying DKD early if you do develop it. Early treatment is most effective and can help prevent additional health problems.Each kidney is made up of millions of tiny filters called nephrons. Over time, high blood glucose from Diabetes can damage blood vessels in the kidneys as well as nephrons so they don't work well. Many people with Diabetes also develop high blood pressure, which can damage kidneys too.Eye damage (retinopathy)Diabetes can damage the blood vessels of the eye (diabetic retinopathy). This could lead to blindness.Foot damageNerve damage in the feet or poor blood flow to the feet increases the risk of many foot complications.Skin and mouth conditionsDiabetes may leave you more prone to skin problems, including bacterial and fungal infections.Prevention is the keyType 1 Diabetes can't be prevented. But with healthy lifestyle choices that help treat prediabetes, Type 2 Diabetes and gestational Diabetes can be prevented. It is important to:Eat healthy foods - Choose foods lower in fat and calories and higher in fibre. Focus on fruits, vegetables and whole grains. Eat a variety to keep from feeling bored.Get more physical activity - Try to get about 30 minutes of moderate aerobic activity on most days of the week. Or aim to get at least 150 minutes of moderate aerobic activity a week. For example, take a brisk daily walk. If you can't fit in a long workout, break it up into smaller sessions throughout the day.Lose excess weight - If you're overweight, losing even 7 per cent of your body weight can lower the risk of Diabetes. For example, if you weigh 200 pounds (90.7 kilograms), losing 14 pounds (6.4 kilograms) can lower the risk of Diabetes. But don't try to lose weight during pregnancy. Talk to your doctor about how much weight is healthy for you to gain during pregnancy. To keep your weight in a healthy range, work on long-term changes to your eating and exercise habits. Remember the benefits of losing weight, such as a healthier heart, more energy and higher self-esteem.Dr Prashant Bhalekar is Consulting Intensivist
