Diabetes mellitus is one of the most important topics in medical, nursing, pharmacy, and public health education. It affects blood glucose control, insulin action, metabolism, blood vessels, nerves, kidneys, eyes, heart, brain, and wound healing. A clear understanding of diabetes helps students answer exam questions, helps nurses give safer care, and helps patients understand why daily habits and medicines matter.
At its core, diabetes happens when the body cannot produce enough insulin, cannot use insulin properly, or both. Insulin helps move glucose from the blood into the cells, where it is used for energy. When insulin is missing or not working well, glucose remains in the bloodstream. Over time, high blood sugar damages tissues and raises the risk of serious complications.
This guide explains type 1 diabetes, type 2 diabetes, metabolic syndrome, diagnostic labs, insulin types, oral hypoglycemic medicines, hyperglycemia, hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state, foot care, diet, and patient education.
The key idea is easy to remember: high sugar damages slowly, but low sugar can become dangerous quickly. Both need prompt recognition, safe treatment, and long-term prevention.
What Is Diabetes Mellitus?
Diabetes mellitus is a chronic metabolic disorder in which blood glucose stays higher than normal. Glucose is the main sugar in the blood. It comes from food, especially carbohydrates, and from glucose stored in the liver.
The pancreas releases insulin, a hormone that helps glucose enter body cells. Insulin also helps potassium move into cells and helps the liver store extra glucose as glycogen.
When insulin is absent or ineffective, three major problems occur:
- Glucose stays in the blood
- Cells do not receive enough usable energy
- The body starts using fat and protein for fuel in severe cases
This is why uncontrolled diabetes can cause weight loss, weakness, dehydration, infections, ketones, acidosis, and organ damage.
Basic Pathophysiology of Diabetes
Insulin Function
Insulin works like a signal. It tells muscle, fat, and liver cells to take glucose from the blood. It also helps the body store energy after meals.
A useful learning phrase is:
Insulin puts glucose and potassium into the cell.
This matters because insulin treatment affects both blood sugar and potassium levels. During insulin therapy, especially in diabetic ketoacidosis, potassium can shift into cells and blood potassium can fall dangerously.
Glycogen and the Liver
Glycogen is stored glucose. The liver stores glucose as glycogen after meals and releases glucose during fasting, illness, stress, and sleep.
In diabetes, liver glucose production can become excessive. This contributes to high fasting blood sugar, especially in type 2 diabetes.
Type 1 Diabetes vs Type 2 Diabetes
Type 1 and type 2 diabetes both cause high blood glucose, but their causes are different.
| Feature | Type 1 Diabetes | Type 2 Diabetes |
|---|---|---|
| Main problem | Little or no insulin production | Insulin resistance |
| Usual onset | Often childhood or young age | Often adulthood, but increasing in youth |
| Cause | Autoimmune beta-cell destruction | Insulin resistance plus reduced insulin function over time |
| Body build | Often lean at diagnosis | Often linked with overweight or central obesity |
| Insulin need | Required for survival | May or may not be needed |
| Ketone risk | Higher risk of DKA | Lower DKA risk, higher HHS risk |
| Onset | Often faster | Often slower |
| Prevention | Not usually preventable | Risk can often be reduced with lifestyle changes |
Type 1 Diabetes
In type 1 diabetes, the immune system attacks pancreatic beta cells. These cells make insulin. As beta cells are destroyed, insulin production becomes very low or absent.
Without insulin, glucose cannot enter cells properly. The body begins breaking down fat for fuel, producing ketones. Too many ketones can lead to diabetic ketoacidosis, a life-threatening emergency.
Type 2 Diabetes
In type 2 diabetes, the body still makes insulin, especially early in the disease, but cells do not respond to it properly. This is called insulin resistance.
The pancreas first works harder by producing more insulin. Over time, beta cells may weaken, and insulin production may decline. Blood glucose rises gradually.
Major risk factors include:
- Family history
- Overweight or obesity
- Sedentary lifestyle
- High intake of refined carbohydrates and sugary drinks
- Older age
- History of gestational diabetes
- High blood pressure
- Abnormal cholesterol levels
- Polycystic ovary syndrome
Metabolic Syndrome and Diabetes Risk
Metabolic syndrome is a group of risk factors that increase the chance of type 2 diabetes, heart disease, and stroke. A person is usually considered to have metabolic syndrome when three or more related risk factors are present.
Common criteria include:
| Risk Factor | Common Finding |
| Blood pressure | Around 130/85 mmHg or higher, or taking BP medicine |
| Blood glucose | Fasting glucose 100 mg/dL or higher, or taking diabetes medicine |
| Waist circumference | Increased abdominal obesity |
| Triglycerides | 150 mg/dL or higher |
| HDL cholesterol | Low HDL, often below 40 mg/dL in men or below 50 mg/dL in women |
Metabolic syndrome is important because it shows that diabetes is not only a sugar problem. It is linked with blood pressure, cholesterol, body fat distribution, inflammation, and vascular disease.
Diagnostic Tests for Diabetes
Diabetes is diagnosed using blood tests. Testing should be done through a healthcare provider or lab.
| Test | Normal | Prediabetes | Diabetes |
| A1C | Less than 5.7% | 5.7% to 6.4% | 6.5% or higher |
| Fasting plasma glucose | Less than 100 mg/dL | 100 to 125 mg/dL | 126 mg/dL or higher |
| 2-hour OGTT | Less than 140 mg/dL | 140 to 199 mg/dL | 200 mg/dL or higher |
| Random plasma glucose | Not used alone for normal range | Not used for prediabetes | 200 mg/dL or higher with symptoms |
HbA1C
HbA1C shows the average blood glucose level over the past 2 to 3 months. It helps monitor long-term control.
A high A1C means glucose has been staying high over time. For many adults with diabetes, treatment goals are individualized based on age, other illnesses, hypoglycemia risk, pregnancy status, and treatment plan.
Fasting Plasma Glucose
This test measures blood sugar after no calories for at least 8 hours. It is often done in the morning.
Oral Glucose Tolerance Test
The OGTT checks how the body handles glucose after a sweet glucose drink. It is useful in pregnancy and in some unclear cases.
Signs and Symptoms of High Blood Sugar
High blood sugar is called hyperglycemia. It may develop slowly or quickly depending on the cause.
Classic symptoms include the 3 Ps:
- Polyuria: frequent urination
- Polydipsia: excessive thirst
- Polyphagia: increased hunger
Other symptoms include:
- Dry mouth
- Fatigue
- Blurred vision
- Slow wound healing
- Recurrent infections
- Weight loss, especially in type 1 diabetes
- Numbness or tingling in hands or feet
- Dark skin patches around the neck or armpits in insulin resistance
A simple way to remember severe high sugar is:
Hot and dry can mean sugar is high.
The person may look dehydrated, flushed, thirsty, weak, and tired.
Common Causes of Hyperglycemia
High blood sugar can happen when glucose intake, illness, stress hormones, or medication needs exceed available insulin action.
Common causes include:
- Missed insulin or missed diabetes medicine
- Infection or sepsis
- Surgery or hospitalization
- Physical or emotional stress
- Steroid medicines such as prednisone
- Eating more carbohydrates than planned
- Reduced physical activity
- Insulin pump failure
- Expired insulin or incorrect insulin storage
In patients with diabetes, infection is a major trigger for dangerous hyperglycemia. Illness raises stress hormones, and stress hormones raise glucose.
Hypoglycemia: Low Blood Sugar
Hypoglycemia means blood sugar is too low. It is often defined as below 70 mg/dL. It is more immediately dangerous than mild to moderate hyperglycemia because the brain depends on glucose.
A useful memory phrase is:
Cold and clammy needs candy.
Common symptoms include:
- Sweating
- Shakiness
- Hunger
- Anxiety
- Irritability
- Headache
- Weakness
- Pale skin
- Fast heartbeat
- Confusion
- Drowsiness
- Seizures or unconsciousness in severe cases
Another memory tool is HIWASH:
| Letter | Symptom |
| H | Headache |
| I | Irritable |
| W | Weakness |
| A | Anxious |
| S | Sweaty |
| H | Hungry |
Causes of Hypoglycemia
Hypoglycemia often happens when insulin or diabetes medicine is too strong for the current food and activity level.
Common causes include:
- Too much insulin
- Skipped or delayed meals
- More exercise than usual
- Alcohol intake
- Insulin peak time
- Vomiting or poor oral intake
- Kidney disease reducing medicine clearance
- Sulfonylurea medicines
First Aid for Hypoglycemia
If the Person Is Awake and Able to Swallow
Use fast-acting carbohydrate.
Examples include:
- Glucose tablets
- Glucose gel
- 4 ounces of fruit juice
- 4 ounces of regular soda
- 1 tablespoon sugar, honey, or syrup
- Hard candies, based on label serving size
A common approach is the 15-15 rule:
- Give 15 grams of fast-acting carbohydrate.
- Wait 15 minutes.
- Recheck blood sugar.
- Repeat if still below target.
- Follow with a meal or snack if the next meal is not soon.
Avoid using high-fat foods as the first treatment. Chocolate, peanut butter, and high-fat milk can slow sugar absorption.
If the Person Is Unconscious or Cannot Swallow
Do not give food or drink by mouth. This can cause choking.
Emergency treatment may include:
- Glucagon, if available and prescribed
- Emergency medical services
- IV dextrose in clinical settings
For healthcare learners, severe hypoglycemia is a priority because the brain needs glucose. Treat it quickly and reassess.
Insulin Therapy in Diabetes
Insulin is required in type 1 diabetes. It is also used in type 2 diabetes when lifestyle measures and non-insulin medicines are not enough, during pregnancy in some cases, during hospitalization, during severe illness, or during diabetic emergencies.
Insulin can be given by:
- Subcutaneous injection
- Insulin pen
- Insulin pump
- IV infusion in hospital emergencies
The main insulin safety rule is to match insulin action with food intake, blood glucose monitoring, and activity.
Types of Insulin
| Insulin Type | Examples | Onset | Peak | Key Point |
| Rapid-acting | Lispro, aspart, glulisine | About 15 minutes | 30 to 90 minutes | Given near meals |
| Short-acting | Regular insulin | About 30 minutes | 2 to 4 hours | Common IV insulin in hospitals |
| Intermediate-acting | NPH | 1 to 2 hours | 4 to 12 hours | Cloudy insulin, peak hypoglycemia risk |
| Long-acting | Glargine, detemir, degludec | Slow | Minimal or no clear peak | Basal insulin, do not mix unless directed |
Rapid-Acting Insulin
Rapid insulin starts fast and covers meals. It has a higher risk of hypoglycemia if the patient does not eat after taking it.
Examples include:
- Insulin lispro
- Insulin aspart
- Insulin glulisine
Regular Insulin
Regular insulin is short-acting. In many hospital protocols, regular insulin is used for IV insulin treatment, including DKA and HHS management.
NPH Insulin
NPH is intermediate-acting and cloudy. It has a clear peak, so patients need education about timing meals and snacks.
The peak period is the danger zone for hypoglycemia.
Long-Acting Insulin
Long-acting insulin provides basal coverage. It usually has no strong peak.
Examples include:
- Insulin glargine
- Insulin detemir
- Insulin degludec
A simple nursing memory point is:
No peak, no mix for many long-acting insulins.
Always follow the exact product instructions and provider order.
Seven Practical Insulin Safety Tips
1. Match Peaks With Food
If insulin has a peak, the patient needs food coverage during that peak to reduce hypoglycemia risk.
2. Know Which Insulin Has No Major Peak
Long-acting basal insulin has minimal peak action. This makes it useful for background insulin needs.
3. Know IV Insulin Rules
IV insulin is used in controlled hospital settings with close monitoring. Regular insulin is commonly used for IV infusion protocols.
4. Draw Clear Before Cloudy
When mixing compatible insulins, draw clear before cloudy. Regular insulin is clear. NPH is cloudy.
Memory tip:
Clear days come before cloudy days.
5. Rotate Injection Sites
Rotate injection sites to prevent lipodystrophy, hard lumps, poor absorption, and unpredictable glucose control.
Common sites include:
- Abdomen
- Upper outer arms
- Thighs
- Buttocks
The abdomen is often preferred for consistent absorption. Stay at least 2 inches away from the umbilicus.
6. Continue Sick-Day Insulin as Directed
People with type 1 diabetes often need insulin even when they are not eating because illness raises glucose and ketone risk.
Never stop insulin during illness without medical guidance.
7. Treat Hypoglycemia Fast
If awake, give fast sugar. If unconscious or unable to swallow, seek emergency care and use prescribed glucagon if available.
Oral and Injectable Medicines for Type 2 Diabetes
Type 2 diabetes treatment often begins with lifestyle changes and may include medicines. Modern treatment is individualized. The best medicine depends on blood sugar level, weight, kidney function, heart disease risk, cost, side effects, and patient preference.
| Medicine Class | Examples | Main Action | Key Safety Point |
| Biguanide | Metformin | Lowers liver glucose production and improves insulin sensitivity | GI upset, kidney function checks, rare lactic acidosis risk |
| Sulfonylureas | Glipizide, glyburide, glimepiride | Stimulates pancreas to release insulin | Hypoglycemia and weight gain |
| TZDs | Pioglitazone | Improves insulin sensitivity | Avoid or use caution in heart failure and liver disease |
| GLP-1 receptor agonists | Semaglutide, liraglutide, dulaglutide | Increases glucose-dependent insulin, slows gastric emptying, reduces appetite | GI effects, not a substitute for insulin in type 1 |
| SGLT2 inhibitors | Empagliflozin, dapagliflozin, canagliflozin | Helps kidneys remove glucose in urine | Genital infections, dehydration risk, ketoacidosis warning |
| DPP-4 inhibitors | Sitagliptin, linagliptin | Increases incretin effect | Usually low hypoglycemia risk alone |
| Insulin | Basal or bolus insulin | Replaces or supplements insulin | Hypoglycemia risk |
Metformin
Metformin is commonly used in type 2 diabetes. It helps the liver make less glucose and helps the body use insulin better.
Important teaching points:
- Take as prescribed, often with food to reduce stomach upset
- Kidney function should be monitored
- Alcohol misuse increases safety concerns
- Follow provider instructions around contrast imaging or surgery
Sulfonylureas
Sulfonylureas help the pancreas release more insulin. They can lower blood glucose well, but they can also cause hypoglycemia.
Teaching points:
- Do not skip meals
- Watch for sweating, shaking, hunger, confusion, or weakness
- Use caution in older adults
- Use caution with kidney or liver impairment
- Alcohol can increase hypoglycemia risk
Thiazolidinediones
Pioglitazone is a common TZD. It improves insulin sensitivity but can cause fluid retention.
Warning signs include:
- New swelling in legs
- Shortness of breath
- Sudden weight gain
- Crackles in lungs
- Worsening heart failure symptoms
Diet and Lifestyle Education
Diet does not mean starvation. It means steady glucose control.
Carbohydrate Quality
Not all carbohydrates affect the body in the same way.
Better choices often include:
- Whole grains
- Beans
- Lentils
- Vegetables
- Nuts and seeds
- High-fiber foods
- Unsweetened dairy as appropriate
Limit or avoid frequent intake of:
- Sugary soda
- Candy
- Sweetened juice
- White bread
- White rice in large portions
- Fried potatoes
- Refined snacks
- Desserts taken often or in large amounts
A simple teaching phrase is:
Choose high-fiber foods more often and simple sugars less often.
Exercise
Physical activity improves insulin sensitivity. It helps glucose move into muscles and supports weight, blood pressure, cholesterol, and mood.
Patients taking insulin or sulfonylureas need education because exercise can lower blood sugar and increase hypoglycemia risk.
Diabetic Foot Care
Diabetic foot care is a major part of long-term safety. High glucose can damage nerves and blood vessels. When feeling is reduced, a small cut can become a serious infection before the patient notices it.
Daily Foot Care Rules
Patients should:
- Check feet every day
- Wash feet with warm, not hot, water
- Dry between toes
- Wear clean, soft socks
- Wear properly fitting shoes
- Check inside shoes before wearing
- Trim nails straight across
- Report wounds, blisters, redness, swelling, or drainage
- See a podiatrist if nails are hard to trim safely
What to Avoid
Patients should avoid:
- Walking barefoot
- Flip-flops or poor-fitting sandals
- High heels for long periods
- Tight shoes
- Nylon socks if they cause sweating or friction
- Hot water bottles or heating pads
- Cutting corns or calluses at home
- Over-the-counter corn removal chemicals
- Rubbing feet hard
- Heavy powder buildup between toes
The goal is simple:
Keep feet clean, dry, protected, and injury-free.
Chronic Complications of Diabetes
Long-term high glucose harms blood vessels and nerves.
| Organ/System | Complication | Possible Result |
| Kidneys | Diabetic nephropathy | Protein in urine, high creatinine, kidney failure |
| Eyes | Diabetic retinopathy | Vision loss, blindness |
| Heart | Coronary artery disease | Heart attack |
| Brain | Cerebrovascular disease | Stroke |
| Nerves | Neuropathy | Numbness, pain, foot ulcers |
| Blood vessels | Atherosclerosis | Poor circulation, delayed healing |
Good glucose control matters, but diabetes care also includes blood pressure control, cholesterol management, smoking cessation, kidney checks, eye exams, and foot exams.
Diabetic Ketoacidosis
Diabetic ketoacidosis, or DKA, is an acute diabetes emergency. It is more common in type 1 diabetes but can happen in type 2 diabetes too.
DKA develops when insulin is too low. Cells cannot use glucose properly, so the body breaks down fat. Fat breakdown produces ketones. Ketones are acidic, and too many ketones cause metabolic acidosis.
Common Causes of DKA
The common triggers are:
- Infection
- Flu or stomach illness
- Skipped insulin
- Insulin pump failure
- Surgery
- Major stress
- Heart attack or stroke
- Steroid use
- New, undiagnosed type 1 diabetes
Signs and Symptoms of DKA
Common signs include:
- High blood sugar, often above 250 mg/dL
- Ketones in blood or urine
- Excessive thirst
- Frequent urination
- Dry skin and mouth
- Nausea and vomiting
- Abdominal pain
- Deep, rapid breathing, called Kussmaul respirations
- Fruity breath
- Weakness
- Confusion
- Metabolic acidosis
DKA Treatment Basics
DKA is treated in the hospital. Core treatment includes:
- IV fluids for dehydration
- IV insulin to reduce glucose and stop ketone production
- Electrolyte replacement, especially potassium
- Treatment of the trigger, such as infection
A major safety point is potassium. Even when blood potassium looks normal or high at first, total body potassium may be depleted. Insulin pushes potassium into cells, so blood potassium can fall quickly during treatment.
Hyperosmolar Hyperglycemic State
Hyperosmolar hyperglycemic state, or HHS, is another life-threatening diabetic emergency. Older teaching materials may call it HHNS, but HHS is the common current term.
HHS is more common in type 2 diabetes. It usually develops more slowly than DKA and causes extreme dehydration.
HHS Features
| Feature | HHS |
| Common diabetes type | Type 2 |
| Blood glucose | Often extremely high, commonly above 600 mg/dL |
| Ketones | Absent or mild |
| Acidosis | Usually absent or mild |
| Dehydration | Severe |
| Mental status | Confusion, lethargy, decreased consciousness |
| Onset | Slower than DKA |
Causes of HHS
Common triggers include:
- Infection
- Stroke
- Heart attack
- Surgery
- Poor fluid intake
- Older age
- Poor diabetes control
- Running out of medicines
- Medicines that raise glucose or fluid loss
HHS Treatment Basics
HHS treatment requires emergency care. It focuses on:
- Careful IV hydration
- Electrolyte monitoring
- Insulin therapy
- Treating the underlying cause
- Monitoring mental status, kidney function, and urine output
A key difference:
DKA danger centers on ketones and acidosis. HHS danger centers on severe dehydration and hyperosmolar blood.
DKA vs HHS Comparison Table
| Feature | DKA | HHS |
| Common type | Type 1 | Type 2 |
| Onset | Faster | Slower |
| Glucose | Usually above 250 mg/dL | Often above 600 mg/dL |
| Ketones | Present | Absent or mild |
| Acidosis | Present | Usually absent or mild |
| Breathing | Kussmaul breathing | Usually no Kussmaul breathing |
| Breath | Fruity breath common | Fruity breath usually absent |
| Dehydration | Present | More severe |
| Mental changes | Can occur | Common and often prominent |
| Main treatment | Fluids, insulin, potassium | Fluids first, insulin, electrolytes |
Potassium and Diabetes Emergencies
Potassium is essential for heart and muscle function. Both high and low potassium can cause dangerous heart rhythms.
| Potassium Problem | Possible ECG Findings | Clinical Concern |
| High potassium | Peaked T waves, possible ST changes | Dangerous arrhythmias |
| Low potassium | Flat T waves, ST depression, U waves | Muscle weakness, arrhythmias |
IV Potassium Safety
In clinical settings:
- Never give IV potassium push
- Use an infusion pump
- Monitor the heart when indicated
- Use correct dilution and rate
- Check kidney function and urine output
- Recheck labs as ordered
This is a major nursing safety topic because rapid potassium administration can be fatal.
Sick-Day Diabetes Rules
Illness can raise blood sugar even when the patient is eating less. This surprises many patients.
Sick-day education should include:
- Check glucose more often
- Check ketones if advised, especially in type 1 diabetes
- Continue insulin as directed
- Drink fluids
- Do not stop insulin without medical advice
- Call the healthcare team for vomiting, high ketones, persistent high glucose, breathing difficulty, or confusion
For type 1 diabetes, insulin is usually still needed during illness, even with poor appetite. Stopping insulin can trigger DKA.
Nursing Priorities in Diabetes Care
Nursing care focuses on safety, monitoring, education, and prevention.
Assessment Priorities
Assess:
- Blood glucose trends
- Food intake
- Timing of insulin and meals
- Signs of hypoglycemia
- Signs of hyperglycemia
- Infection signs
- Hydration status
- Skin and feet
- Vision changes
- Kidney function labs
- Medication adherence
Reassessment After Treatment
After treatment for acute problems, monitor:
- Blood glucose
- Vital signs
- Mental status
- Capillary refill
- Skin temperature and color
- Urine output
- Electrolytes
- Ketones when relevant
- Hydration status
Urine output of about 30 mL/hour or more is often used as a basic adult perfusion indicator, but clinical context matters.
Patient Education Summary
Patients need simple instructions they can follow daily.
Key teaching points:
- Take medicines as prescribed
- Do not skip meals after insulin or sulfonylureas
- Carry fast sugar
- Know signs of low and high sugar
- Check glucose as directed
- Follow sick-day rules
- Keep feet clean and protected
- Report wounds early
- Attend eye, kidney, foot, and dental checks
- Maintain activity and balanced meals
- Avoid smoking
- Ask before changing medicines
The best diabetes plan is consistent, realistic, and personalized.
FAQs
1. What is the main difference between type 1 and type 2 diabetes?
Type 1 diabetes happens when the body produces little or no insulin because of autoimmune beta-cell destruction. Type 2 diabetes happens mainly because the body becomes resistant to insulin. Type 1 usually needs lifelong insulin. Type 2 may be managed with lifestyle changes, oral medicines, injectable medicines, and sometimes insulin.
2. What blood sugar level is considered low?
Blood glucose below 70 mg/dL is usually considered low. Low blood sugar is called hypoglycemia and should be treated quickly. Symptoms include sweating, shaking, hunger, headache, weakness, anxiety, and confusion. Severe hypoglycemia can cause seizures or unconsciousness.
3. What is the fastest way to treat low blood sugar?
If the person is awake and able to swallow, give fast-acting carbohydrate such as glucose tablets, juice, regular soda, sugar, or glucose gel. Recheck blood sugar after 15 minutes and repeat if needed. Avoid high-fat foods like chocolate or peanut butter as first treatment because they slow absorption. If the person is unconscious, do not give anything by mouth and seek emergency help.
4. What are the 3 Ps of diabetes?
The 3 Ps are polyuria, polydipsia, and polyphagia. Polyuria means frequent urination. Polydipsia means excessive thirst. Polyphagia means increased hunger.
5. Why is insulin needed in type 1 diabetes?
People with type 1 diabetes do not make enough insulin to survive safely. Without insulin, glucose cannot enter cells properly and the body starts breaking down fat. This produces ketones and can lead to diabetic ketoacidosis. Insulin prevents severe hyperglycemia, ketosis, dehydration, and acidosis.
6. Which insulin has the highest peak-related hypoglycemia risk?
Insulins with clear peaks, such as rapid-acting insulin, regular insulin, and NPH, have peak-related hypoglycemia risk. NPH has a notable peak several hours after injection. Patients need food timing education when using these insulins. Long-acting basal insulins usually have minimal or no clear peak.
7. What is DKA?
DKA stands for diabetic ketoacidosis. It is a serious emergency caused by low insulin, high blood glucose, ketone buildup, and metabolic acidosis. Symptoms include thirst, frequent urination, vomiting, abdominal pain, fruity breath, deep rapid breathing, and confusion. It needs hospital treatment with fluids, insulin, electrolytes, and treatment of the trigger.
8. What is HHS or HHNS?
HHS means hyperosmolar hyperglycemic state. It is a severe diabetes emergency usually linked with type 2 diabetes. It causes extremely high blood sugar, severe dehydration, and mental status changes, usually without major ketone buildup. It needs urgent hospital treatment, especially IV fluids and close monitoring.
9. Why is diabetic foot care important?
Diabetes can damage nerves and blood vessels in the feet. A patient may not feel pain from a cut, blister, burn, or pressure injury. Poor blood flow can slow healing and increase infection risk. Daily foot checks, proper shoes, clean socks, and early reporting of wounds help prevent ulcers and amputation.
10. Can type 2 diabetes be treated without insulin?
Many people with type 2 diabetes are treated without insulin, especially early in the disease. Treatment may include nutrition changes, physical activity, weight management, metformin, GLP-1 medicines, SGLT2 inhibitors, or other drugs. Some people need insulin later if beta-cell function declines or glucose remains high. Treatment should be individualized by a healthcare professional.
