Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
If a person has diabetes and experiences any of the following, call a health
care professional:
Experiencing diabetes symptoms: this may mean
that the person's blood sugar level is not being controlled despite treatment
Blood sugar levels, when tested, are
consistently high (more than 200 mg/dL): Persistently high blood sugar levels
are the root cause of all of the complications of diabetes.
The patient's blood sugar level is often low (less than 70
mg/dL): this may mean that the diabetes management strategy is too aggressive. It also
may be a sign of infection or other stress on the body's organs such as kidney
failure, liver failure, adrenal gland failure, or the concomitant use of
certain medications.
An injury to the foot or leg, no matter how
minor: even the tiniest cut or blister can become very serious in a person
with diabetes. Early diagnosis and treatment of problems with the feet and
lower extremities, along with regular diabetic foot care, are critical in
preserving the function of the legs and preventing amputation.
Low-grade fever (less than 101.5 F or 38.6 C):
Fever is a sign of infection.
In patients with diabetes, many common infections can potentially be more dangerous for
them than for other people. Note any symptoms, such as painful urination, redness or swelling of the skin,
abdominal pain,
chest
pain, or cough, that may indicate where the infection is located.
Nausea or vomiting, but can keep liquids
down: The health care professional may adjust medications while the patient is sick,
and will probably recommend an urgent office visit or a visit to the emergency
department. Persistent nausea and vomiting can be a sign of diabetic ketoacidosis, a potentially life-threatening condition, as well as several
other serious illnesses.
Small sore(s) (ulcer) on the foot or le:. Any non-healing sore or ulcer on the feet or legs of someone with diabetes needs to be seen by a medical professional
right away. A sore less than 1 inch across, not draining pus, and not exposing deep tissue or bone, can safely be evaluated
by a health care professional, as long as the patient does not have fever and
their blood sugar levels are under control.
When you call a health care professional, tell them that you or someone you
know has diabetes and are concerned.
The patient will probably be referred to a nurse who will ask
questions and make a recommendation about what to do.
Be prepared for this conversation. Have a list of medications, medical problems, allergies to medicines, and
a blood sugar
diary handy by the phone.
The nurse may need any or all of this information to decide both the urgency of
the patient's condition and how best to recommend treatment for the problem.
Diabetic emergencies
The following situations can become 911 medical emergencies and warrant an immediate visit to a hospital emergency department.
The person with a severe diabetic complication may
travel to the emergency department by car or ambulance.
A companion should go along to speak for the person if
the person is not able to speak for himself or herself with the emergency care
professional.
Bring a list of medical problems, medications, allergies to medications, and the
person's blood sugar diary to the emergency department. This information will help the emergency care
professional diagnose the problem and treat it appropriately.
The following are signs and symptoms of diabetic complications that warrant emergency care.
Altered mental status: Lethargy, agitation, forgetfulness, or just strange behavior can be a sign of very low or very high blood sugar levels.
If a person has diabetes with an altered mental status:
Try giving them some fruit juice (about 6 ounces) or cake icing if the person is awake enough to
swallow normally without choking. Avoid giving things such as hard candy
that can lodge in the throat. The health care provider can prescribe
glucose wafers or gels that melt under the tongue.
Does not wake up and behave normally
within about 15 minutes, call 911.
Is not a known diabetic, these symptoms can be signs of stroke, drug intoxication, alcohol intoxication, oxygen starvation, and other serious medical conditions. Call 911 immediately.
Nausea or vomiting: If the patient is known to have diabetes and cannot keep food, medications, or fluids down at all,
they may have diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, or another complication of diabetes.
If the person:
Has not already taken the latest insulin
dose or oral diabetes medicine, do not take it without talking to a medical
professional.
Already has low blood sugar levels, taking additional insulin or medication will drive
the blood sugar level down even further, possibly to dangerous levels.
Fever above 101.5 F (38.6 C): If the primary health care
professional cannot see
the patient right away, seek emergency care for a person with diabetes with a
high fever. Note any other symptoms such as cough, painful
urination, abdominal pain, or chest pain.
High blood sugar level: If the patient's blood sugar level is above 400 mg/dL, and the primary health care
professional cannot see them right away, go to the closest emergency department. Very
high blood sugar levels can be a sign of diabetic ketoacidosis or hyperosmolar
hyperglycemic nonketotic syndrome, depending on the type of diabetes the
person has.
Both of these conditions can be fatal if not treated promptly.
Large sores or ulcers on the feet or legs: If the person has diabetes, a non-healing sore larger than 1 inch in diameter can be a sign of a potentially limb-threatening infection.
Other signs and symptoms that merit immediate care
are exposed bone or deep tissue in the wound, large areas of surrounding
redness and warmth, swelling, and severe pain in the foot or leg.
If left untreated, such a sore may ultimately require amputation of the limb.
Cuts or lacerations:
Any cut penetrating all the
layers of skin, especially on the legs, is a potential danger to a person with
diabetes. Proper wound care,
although important to anyone's recovery, is especially important in diabetics to assure
proper wound healing.
Chest pain: If
the person has diabetes, take very seriously any pain in the chest, particularly in the middle or on the left side, and seek medical attention immediately.
People with diabetes are more likely than
non-diabetic people to have a heart attack, with or without experiencing
chest pain.
Irregular heartbeats and unexplained shortness of breath may also be signs of heart attack.
Severe abdominal pain: Depending on the location, this can be a sign of heart attack, abdominal aortic aneurysm (widening of the large artery in the abdomen), diabetic ketoacidosis, or interrupted blood flow to the bowels.
All of these are more common in people with diabetes
than in the general population, and are potentially life-threatening.
People with diabetes also get other common causes of severe abdominal pain such as appendicitis, perforated ulcer, inflammation and infection of the
gallbladder, kidney stones, and
bowel obstruction.
Severe pain anywhere in the body is a signal for timely medical attention.
Type 2 diabetes mellitus is a group of disorders characterized by hyperglycemia and associated with microvascular (ie, retinal, renal, possibly neuropathic), macrovascular (ie, coronary, peripheral vascular), and neuropathic (ie, autonomic, peripheral) complications.
