By: New chua, Ceasar jay T.

and
Mirambel, Mark P.
1. Hypoglycemia (Low blood glucose)
Causes:
Excess of Insulin - If a patient injects too much
insulin blood glucose level can fall low enough to
cause hypoglycemia.
Weight loss - A diabetic may develop
hypoglycemia if the same dose of insulin is taken
even after losing weight.
Delay and omission of meals - A diabetic, taking
insulin or oral drugs should have uniform and
regular meals.
Alcohol intake
overexertion without additional carbohydrate
compensation
Symptoms of hypoglycemia:
Anxiety
Confusion
headache
Extreme hunger
Fatigue
Irritability
Sweating or clammy skin
Trembling hands
unconsciousness
Management:
Check your sugar.
Drink one-half cup of squash, fizzy drink or sweetened
fruit juice and eat a sweet or glucose tablet. If you
skipped a meal, eat something now. 15 to 20 grams of
carbohydrates should raise your blood glucose level.
Rest. Get off your feet and take a break.
Recheck your blood sugar after 15 or 20 minutes.
Observe. Pay attention to how you feel for the next few
hours.
If you still have symptoms, check your sugar again an
hour after eating. Keep snacking if blood sugar is low.
If your sugar level stays low after two hours, or if your
symptoms aren't improving, seek medical advice.
Prevention:
The client must identify clinical manifestation
and to manage hypoglycemia.
Do not skip meals.
Right insulin dosage
A diabetic should carry on his/her person an
identification card - Such a card is of great value
in treating an unconscious person.
there should be available glucagon for extreme
hypoglycemia. Ask doctor if you should have it at
home.
2. Lipohypertrophy
abnormal accumulation of fat underneath the
surface of the skin.
most common cutaneous complication of
insulin therapy.
Cause: Repeated insulin injections in the same
location can cause fat and scar tissue to
accumulate.
Prevention: rotate within your injection site
each time you inject.
3. Lipoatrophy
loss of body fat, localized. This looks like a
dent in the skin, but the skin itself seems fine.
The size can vary. It could be in one spot or
many. There might also be tender or painful
bumps.
Cause: Repeated injections in or pressure on
the same place
Prevention: rotation of injection site
4. Insulin allergy
Insulin allergy, or immediate-type
hypersensitivity, is a rare condition in which local
or systemic urticaria is due to histamine release
from tissue mast cells sensitized by adherence of
anti-insulin IgE antibodies. In severe cases,
anaphylaxis results. When only human insulin has
been used from the onset of insulin therapy,
insulin allergy is exceedingly rare. Antihistamines,
corticosteroids, and even desensitization may be
required, especially for systemic hypersensitivity.
There have been case reports of successful use of
insulin lispro in those rare patients who have a
generalized allergy to human insulin or insulin
resistance due to a high titer of insulin antibodies
5.Immune insulin resistance
Most insulin-treated patients develop a low
titer of circulating IgG anti-insulin antibodies
that neutralize to a small extent the action of
insulin. With the old animal insulins, a high
titer of circulating antibodies sometimes
developed, resulting in extremely high insulin
requirements - often more than 200 units
daily. This is now rarely seen with the switch to
highly purified pork or human insulins and has
not been reported with the analogs
6. Blurring of vision
During the initial period of insulin treatment, a
diabetic may notice blurring of vision and
difficulty in reading. This complaint is due to a
rapid change in the shape of the lens of the
eye as the elevated blood glucose level is
brought down. The shape of lens gets adjusted
within two to three weeks. Hence a diabetic
should not change his glasses, in a hurry, if
he/she develops this complication.
7. Weight gain
Weight gain when diabetes is controlled by
insulin is inevitable. This is due to rebuilding of
depleted muscle and fat mass, cessation of
loss of energy in the form of glucose in urine
and correction of dehydration. Extra
carbohydrates consumed to prevent
hypoglycaemia, contribute to this weight gain
.The snacks taken in between the main meals,
to prevent hypoglycaemia, should be reckoned
in the diet.
8. Swelling of the face and/or feet
At the start of treatment, of poorly controlled
diabetes with insulin, the patient may get
swelling of face and/or feet, due to retention
of sodium and water. This complication is
temporary and passes in a few days. The
doctor may give the diabetic a small dose of
diuretic (a drug which increases the urine) or
ephedrine if this swelling is significant.
9. Hypokalemia (low blood potassium)
may occur because insulin stimulates
movement of potassium from blood into cells.
Combining insulin with potassium-
lowering drugs may increase the risk of
hypokalemia.
10. Abscess
This complication is rare because the
preservative added to insulin has antibacterial
properties.