Complications

by Dr. Denis Daneman, MB BCh FRCPC

Dr. Denis Daneman is Chief of the Division of Endocrinology and Associate Director of the Research Institute for the Hospital for Sick Children and Professor of Pediatrics at the University of Toronto.

Hypoglycemia
Diabetic ketoacidosis
Long-term complications
Screening for complications

Hypoglycemia - also called low blood sugar; hypoglycemic reactions; hypos; insulin reaction or just reactions - occurs when the blood sugar falls below the normal range.

This may happen because:

• there is too much insulin given without enough food;
• if the child misses or delays a meal or a snack for too long; or
• if the child does a lot of physical activity which uses up the available sugar.

Early warning symptoms of low blood sugar include:

• Shakiness
• Sweating
• Hunger
• Tiredness
• Fear

The child will look pale. If not treated, symptoms may become more severe with the development of confusion, a seizure (convulsion) or unconsciousness (coma).

When symptoms are mild, it is easiest to treat hypoglycemia by drinking about half a cup of juice or other sugary drink, like pop.

If it becomes more severe, a medication called glucagon may need to be injected.

Make sure that both you and your child are aware of the causes of hypoglycemia and its symptoms so that hypoglycemia can be avoided wherever possible.

Treat a hypoglycemic reaction as soon as the symptoms begin. Do not wait until it gets severe!

Discuss appropriate treatment of hypoglycemia with your diabetes health care team.

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Diabetic ketoacidosis, or DKA, develops when the amount of insulin available is not enough to keep the sugar in balance and prevent fat stores from being broken down. This may happen when diabetes is first diagnosed or later if either insulin doses are missed or if there is a severe infection that stresses the body.

DKA starts with increased thirst and urination and proceeds to vomiting, drowsiness and dehydration.

Treatment of DKA involves hospitalization and intravenous (into the vein) administration of water, insulin and salts to replace what the body is missing.

This situation can be life-threatening.

Most episodes of DKA and hypoglycemia can be avoided by carefully following your diabetes routines: regular blood glucose checks, appropriate food intake and correct adjustments of insulin doses to maintain the balance.

Treatment of DKA should be discussed with your diabetes health care team. 

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The full-blown chronic or long-term complications of diabetes (such as blindness and kidney failure) rarely, if ever, develop during childhood. However, it is during childhood that the risk of complications starts.

The most important way to prevent or delay the onset or progression of these complications is to keep in good health by:

• controlling blood sugars well;
• leading an active lifestyle; and
• not smoking.

During the teen years it starts to be important to do certain tests to see if the earliest signs of these long-term complications may be developing, such as regular eye check-ups, blood pressure measurements and urine tests.

A child with type 1 diabetes is at risk of developing complications from living with diabetes. Throughout childhood it is recommended to conduct regular assessment of growth, puberty and blood pressure.

Some of these complications due to diabetes include increased risk of:

• heart disease
• high blood pressure
• nerve damage
• kidney disease
• blindness, and
• severe leg and foot problems.

Minimizing blood glucose fluctuations and maintaining good diabetes control are the best ways to help avoid long-term complications in diabetes.

Diabetic retinopathy (eye damage) is rare in children with type 1 diabetes who are under 10 years of age. It is important to start to screen for eye damage by an ophthalmologist (eye specialist) annually five years after the onset of type 1 diabetes in children over 15 years of age.

Fortunately, with good blood sugar control and normal blood pressure, there is a reduced risk of developing diabetes related kidney disease (diabetic nephropathy).

If the kidneys are affected, small amounts of albumin (a protein) are secreted in the urine. This is called "microalbuminuria".

Screening annually for microalbuminuria is recommended for people over 15 years of age with a five-year history of type 1 diabetes.

When diabetes is first diagnosed, a diabetes nurse educator and a podiatrist can provide advice about foot care, foot hygiene and the correct footwear for the child.

Good blood sugar control is important in avoiding nerve damage and serious infections in the feet.

For more information on foot care in diabetes, check out the Complications page in the Keeping Well with Diabetes section in Living with Diabetes. 

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