Sugar high and low

Signs of High and Low Blood Sugar

One of the challenges of managing diabetes is maintaining consistent blood sugar (glucose) levels. Even with diligence, some situations can cause high blood sugar, or hyperglycemia, while others can bring on low blood sugar, or hypoglycemia. So it’s important to know the signs of both high and low levels, and what actions to take to bring them back within a desired range.

Monitoring your blood sugar levels with a glucose meter will do a lot to help you keep those levels steady and avoid the complications that can come with diabetes. According to the Mayo Clinic, how often you check your blood sugar level depends on many factors, including your age, the type and severity of your diabetes, the length of time that you’ve had the condition, and the presence of any diabetes-related complications.

About High Blood Sugar (Hyperglycemia)

Common signs of high blood sugar include frequent urination, fatigue, dry or itchy skin, feeling thirsty, more frequent infections, and eating more food but not gaining as much weight as usual, says Athena Philis-Tsimikas, MD of the Scripps Whittier Diabetes Institute in San Diego, California.

A blood sugar reading above 180 milligrams per deciliter (mg/dL) is considered above normal and can bring on these symptoms, although it’s possible to have high blood sugar without any symptoms, Dr. Philis-Tsimikas says. A reading above 300 mg/dL is considered severe. If your blood sugar is above 250 mg/dL for two days, Philis-Tsimikas advises informing your doctor and asking for specific treatment recommendations. Blood sugar levels above 300 mg/dL can cause nausea, drowsiness, blurred vision, confusion, and dizziness, especially when standing up from a sitting or lying position.

Hyperglycemia (High Blood Sugar)

One very high blood sugar level is not a cause for panic. Rather, it should serve as an alarm signaling the need for additional blood glucose monitoring and depending upon how you treat your diabetes; it may also mean that you need to take some extra insulin.

Very high blood sugar levels mean that the body does not have enough insulin around to use sugar as energy. Even though the level of sugar in the blood stream is very high, the body cells may be sending out the alarm that they are starving. In this case, the body will switch to burning fat as an energy source. This is a problem because excess burning creates byproducts such as ketones and acids. After several hours the blood can become too acidic for the body organs to work right. This leads to a life-threatening diabetes emergency called Diabetic Ketoacidosis (DKA). Full-blown DKA must be treated in a hospital, often in the Intensive Care Unit.

It is important to know that you must start monitoring for ketones right away (as soon as you have 2 or more blood sugar levels over 300 mg/dL) and follow the steps in the table below or call the diabetes team for assistance, you can often prevent the development of Diabetic Ketoacidosis.

Blood glucose

< 140 mg/dL

140-300mg/dL

>300mg/dL

Should I check ketones?

No. Unless you are very sick with a bad cold, flu or stomach bug

No. Unless you are very sick with a bad cold, flu or stomach bug

Yes – if this is your second high blood sugar in a row

What do I do if I have a trace of small ketones?

Drink Water

Drink Water

Drink water.

What do I do if I have moderate to large ketones?

Call the Diabetes Team. You might need more insulin to help clear the ketones.

Call the Diabetes Team. You might need more insulin to help clear the ketones

Call the Diabetes Team. You might need more insulin to help clear the ketones

When do I check a repeat blood sugar?

2 hours

2 hours

2 hours

Summit Medical Group Web Site

What is high blood sugar?

High blood sugar means that the level of sugar in your blood is higher than recommended for you. If you don’t keep your blood sugar at a normal, healthy level most of the time, you will increase your risk of heart and blood vessel disease, stroke, kidney problems, and loss of vision.

The medical term for high blood sugar is hyperglycemia. Blood sugar is also called blood glucose.

What is the cause?

Blood sugar that stays high is the main problem of diabetes. Your body breaks down some of the foods you eat into sugar. Normally the hormone insulin moves this sugar into your cells, where your body uses it for energy. In diabetes the insulin is not moving the sugar into the cells, so it builds up in the bloodstream and starts to cause problems.

Sometimes you may have high blood sugar even though you are taking diabetes medicine. This can happen for many reasons but it always means that your diabetes is not in good control. Some reasons why your sugar might go too high are:

  • Skipping your diabetes medicine
  • Not taking the right amount of diabetes medicine
  • Taking certain medicines that increase your blood sugar or make your blood sugar medicines work less well
  • Taking in too many calories by eating large portions of food, choosing too many high-calorie foods, or drinking too many high-sugar beverages
  • Eating too many carbohydrates, such as foods made mainly with sugar, white flour (in bread, biscuits, pancakes, for example), white potatoes, or white rice
  • Not getting enough physical activity (exercise lowers your blood sugar)
  • Having increased emotional or physical stress
  • Being sick, including colds, flu, an infected tooth, or a urinary tract infection, especially if you have a fever
  • If you are using insulin, having a problem with your insulin (for example, it may be the wrong type of insulin or the insulin may not be working because it has not been stored properly)
  • If you are using an insulin pump, having a problem with the pump (for example, the pump is turned off or the catheter has come out)

What are the symptoms?

Usually high blood sugar causes no symptoms, especially if it is brief. However, if the blood sugar gets very high–for example, 300 milligrams per deciliter (16.7 millimoles per liter) or higher– and stays that high for a day or longer, you may have symptoms. Symptoms may include:

  • Blurry vision
  • Dry mouth
  • Feeling very thirsty
  • Drinking a lot
  • Urinating a lot
  • Tiredness

Very high blood sugar—that is, a blood sugar level of 600 mg/dL (33.3 mmol/L) or higher–can cause coma and even death.

How is it diagnosed?

The level of sugar in your blood can be measured with blood tests you can do at home or at your healthcare provider’s office.

When you have diabetes, commonly recommended blood sugar levels are:

  • Morning fasting blood sugar test: 70 to 130 mg/dL, or 4 to 7.2 mmol/L (A fasting blood sugar test should be done before breakfast, after several hours of no food or drink except water.)
  • Blood sugar test 1 to 2 hours after a meal: less than 180 mg/dL (10 mmol/L)
  • Hemoglobin A1C blood sugar goals below 7%

How is it treated?

Ask your healthcare provider what you should do if your blood sugar goes too high. Because your sugar is likely to be higher if you are ill, also ask your healthcare provider for a “sick day plan.”

Very high blood sugar above 400 mg/dL (22.2 mmol/L) can be a medical emergency. In many cases it must be treated right away with IV fluids and insulin. You may need to stay at the hospital to get your blood sugar back to normal, to treat the cause of the high blood sugar, and to treat any problems caused by the high blood sugar, like dehydration,

How long will the effects last?

High blood sugar can be serious if it’s not treated. If your blood sugar runs too high over time (months or years), it can cause problems with your heart, eyes, kidneys, nerves, and blood vessels. A very high blood sugar can cause life-threatening problems, coma, or death.

If you have type 1 diabetes, untreated high blood sugar can result in a dangerous problem called ketoacidosis, which is a buildup of acids in the blood. This is life-threatening but it is preventable. It usually happens only if you have type 1 diabetes. Ask your provider if you should check your urine for these acids, called ketones, when your blood sugar is high. If there are ketones in your urine, let your provider know right away. Ketones are a warning sign that your diabetes is out of control. You need treatment right away in the emergency room or hospital.

High blood sugar caused by medicines you are taking usually goes away when you stop taking the medicine. Depending on the medicine, it may take days to weeks for your sugar to go back to your recommended blood sugar levels.

How can I take care of myself?

Follow your healthcare provider’s directions carefully to keep your blood sugar normal. This usually means you need to:

  • Eat a healthy diet as recommended by your healthcare provider. Ask for a referral to a dietitian if you are not sure how you should be eating.
  • Exercise according to your provider’s recommendation at least 4 to 5 days a week.
  • Take medicine exactly as directed, if any has been prescribed.
  • Check your blood sugar as often as your provider recommends and take your blood sugar records to every checkup. This helps your provider adjust your medicines.

Ask your healthcare provider:

  • When do I need to call you about a high blood sugar level?
  • How should I take care of myself if I’m sick and my blood sugar is going up?

Keep all appointments with your healthcare provider.

When Blood Sugar Is Too High

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Glucose, or sugar, is the body’s main fuel source. That means your body — including your brain — needs glucose to work properly. But even though we need glucose for energy, too much glucose in the blood can be unhealthy.

What Is Hyperglycemia?

Hyperglycemia (say: hi-per-gly-SEE-me-uh) is the medical word for high blood sugar levels. The hormone insulin is supposed to control the level of glucose in the blood. But someone with diabetes doesn’t make enough insulin — or the insulin doesn’t work properly — so too much sugar can get into the blood and make the person sick.

If you have high blood sugar levels, you may need treatment to lower your blood sugar. Your parents and your diabetes health care team will tell you what your blood sugar levels should be and what to do if they get too high.

Managing diabetes is like a three-way balancing act because you have to watch:

  1. the medicines you take (insulin or pills)
  2. the food that you eat
  3. the amount of exercise you get

All three need to be balanced. If any one of these is off, blood sugar levels can be, too. Your parents and doctor can help you with this balancing act.

The Causes of High Blood Sugar

In general, higher than normal blood glucose levels can be caused by:

  • not taking your diabetes medicine when you’re supposed to or not taking the right amounts
  • eating more food than your meal plan allows (without adjusting your insulin or diabetes pills)
  • not getting enough exercise
  • having an illness, like the flu
  • taking other kinds of medicines that affect how your diabetes medicines work

Keeping blood sugar levels close to normal can be hard sometimes, and nobody’s perfect. Grown-ups can help you stay in balance if you have diabetes. Sometimes blood sugar levels can be high because you’re growing and your doctor needs to make some changes in your diabetes treatment plan.

Signs That Blood Sugar Levels Are High

People with high blood sugar may:

  • pee a lot. When blood sugar levels get too high, the kidneys flush out the extra glucose into your urine (pee), which is why people who have high blood sugar levels need to pee more often and in larger amounts.
  • drink a lot. Because you’re losing so much fluid from peeing so much, you can get very thirsty.
  • lose weight. If there isn’t enough insulin to help the body use glucose, the body starts to break down your muscle and fat for energy — and you lose weight.
  • feel tired. Because the body can’t use glucose for energy properly, you may feel really tired.

High blood sugar levels don’t always cause these symptoms. Sometimes you can have high blood sugar levels without even knowing it. But if left untreated, they can cause serious health problems. That’s why it’s important to work with your parents and diabetes team to keep your blood sugar levels in a healthy range. This can mean checking your blood sugar levels a few times a day, even when you feel fine.

How Are High Blood Sugar Levels Treated?

To treat high blood sugar, it helps to know what is causing it. You might need to take more insulin or diabetes pills because you’re growing and eating more food, or you might need to get more exercise each day.

Having high blood sugar levels every once in a while isn’t a big deal. It happens to everyone with diabetes from time to time. But if your blood sugar levels are high a lot, your diabetes health care team will have to help you figure out how to get them back to a healthy level.

What Is Diabetic Ketoacidosis (DKA)?

Someone who has high blood sugar can develop a serious problem with a serious-sounding name: diabetic ketoacidosis (say: kee-toh-ah-sih-DOH-sis). This happens if the body gets desperate for a source of fuel. The body wants to use glucose (sugar). But without insulin, that glucose stays stuck in the blood — and isn’t available to the cells — so the body uses fat instead.

But that can sometimes cause problems. Why? Because when the body uses fat, chemicals called ketones (say: KEE-tones) are produced. These ketones get into a person’s blood and urine (pee) and they can make a person very sick. DKA is a very serious problem for people with diabetes, but the good news is that it can be prevented and treated.

Symptoms of DKA

The symptoms of DKA usually don’t develop all at once — they usually come on slowly over several hours. Be sure to tell a parent or another adult if you have these symptoms of high blood sugar, which usually happen before a person develops DKA:

  • You’re really tired.
  • You’re really thirsty or peeing way more than usual.
  • You have a very dry mouth.

If the person doesn’t get treatment to help get their blood sugar levels down to where they should be, he or she may go on to get the following symptoms of DKA and could even pass out:

  • belly pain
  • nausea or throwing up
  • fruity-smelling breath
  • trouble breathing
  • confusion

Sometimes DKA can feel like the flu or another illness, so your parent or another adult will check you for ketones to see if you might have DKA. Checking for ketones is easy — you can test some of your urine (pee) – or sometimes your blood – to see if your ketones are too high.

How Is DKA Treated?

DKA can be treated but you must go the doctor or hospital right away. To feel better, a person with DKA needs to get insulin and fluids through a tube that goes into a vein in the body.

Can High Levels and DKA Be Prevented?

These two problems don’t sound like much fun, so you’re probably wondering how to prevent them. The solution is to keep your blood sugar levels as close to normal as possible, which means following your diabetes management plan. Checking your blood sugar levels several times a day will let you and your parents know when your blood sugar level is high. Then you can treat it and help prevent DKA from happening.

What else can you do? Wear a medical identification bracelet that says you have diabetes. Then, if you are not feeling well, whoever’s helping you — even if the person doesn’t know you — will know to call for medical help. And the doctors will be able to get you better more quickly if they know you have diabetes. These bracelets also can include your doctor’s phone number or a parent’s phone number. The quicker you get the help you need, the sooner you’ll be feeling better!

Reviewed by: Steven Dowshen, MD Date reviewed: September 2016

Dizziness in diabetes

An electrophysiological study of vestibular function found abnormalities in over one-third of people with type 2 diabetes, linked to HbA1c.14 Studies of rats with diabetes found morphological abnormalities in their vestibular system.15

Vestibular function was assessed in 95 young people with type 1 diabetes aged 6–28 years. ‘Within the diabetic group 6 patients complained about vertigo and balance disorders. Spontaneous nystagmus occurred in 10 cases… Impaired optokinesis occurred in 36 cases and impaired eye tracking test in 33 cases. In caloric tests there was partial canal paresis in 4 cases and directional preponderance in 7 cases.’ There were few abnormalities among age-matched controls without diabetes. Among patients with a history of severe hypoglycaemia, 26.6% had spontaneous nystagmus compared with none of those without hypoglycaemic episodes.16

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) was found in 8% of individuals with moderate or severe dizziness or vertigo in a German study which showed a lifetime prevalence of BPPV of 2.4%, a one-year prevalence of 1.6% and a one-year incidence of 0.6%.17

Some studies suggest that people with diabetes are more at risk of BPPV than those without diabetes. Among people with type 2, 84% had ‘abnormal test performance on assessment of at least one vestibular end organ’.18 Among patients aged >18 years with a vestibular diagnosis for symptoms of dizziness, BPPV was found in 46% of people with diabetes vs 37% in those without diabetes. However, logistic regression analysis showed that the presence of hypertension mediated the higher frequency of BPPV in diabetes.19

BPPV is treatable, so seek expert advice if you suspect this diagnosis.

Medication

Drugs designed to drop blood pressure can obviously cause dizziness (see above), as can those producing hypovolaemia such as diuretics and SGLT2 inhibitors. Diabetes medications may cause dizziness from hypoglycaemia.

Several antibiotics may produce dizziness including quinolones and fluoroquinolones (e.g. ciprofloxacin), macrolides (e.g. erythromycin), and especially aminoglycosides like gentamicin. Gentamicin can cause permanent ototoxicity with deafness and vertigo, especially in renal impairment – adjust the dose and monitor gentamicin levels according to manufacturers’ guidance. Antifungals including amphotericin B and fluconazole, non-steroidal anti-inflammatory drugs, statins, and neuropathic pain relievers (for example, amitriptyline, duloxetine, and pregabalin) can cause dizziness; and gabapentin causes vertigo.20,21

Maternally-inherited diabetes and deafness (MIDD)

This mitochondrial disorder inherited from affected mothers may affect some 1% of all people with diabetes. It is woefully under-diagnosed. In addition to diabetes and deafness, patients may suffer vestibular dysfunction with dizziness and unsteadiness. They are often thin with short stature, and may have myopathy, heart problems and renal disease.22

A man with a rare MIDD mutation had multiple tumours including acoustic neuroma. Such tumours are unusual but this is a reminder not to forget serious intracranial causes of dizziness such as vascular events or tumours.23

Driving

‘You must tell DVLA if you suffer from dizziness that is sudden, disabling or recurrent.’24

Summary

Dizziness and vertigo are common and their effect on patients varies from a minor nuisance to serious disability. Patients use many words to describe dizziness. Clarify exactly what is meant. Dizzy people are more at risk of falls. Elucidate the cause(s) of the dizziness, remembering that people with diabetes have many reasons for this symptom and that one individual may combine several reasons.

Potentially dangerous causes include hypoglycaemia and postural hypotension. Review medications – many drugs can cause dizziness. Remember BPPV in patients with vertigo – treatment is usually effective.

Tell patients with sudden, disabling or recurrent dizziness or vertigo not to drive.

Dizziness may be a vague symptom, but its impact for the patient is not. Find the cause and treat it.

Dr Rowan Hillson, MBE,
Past National Clinical Director for Diabetes

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2. The Compact Oxford English Dictionary, 2nd edn. Oxford: Clarendon Press, 1991.
3. Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist 2008;14:355–64.
4. Brody DL. Concussion Care Manual: A Practical Guide. Oxford University Press, 2014.
5. Laura1976. http://www.diabetes.co.uk/forum/threads/weak-legs-and-balance-problems.47040/ .
6. McAulay V, et al. Symptoms of hypoglycaemia in people with diabetes. Diabet Med 2001;18:690–705.
7. Warren R, et al. The symptoms of hyperglycaemia in people with insulin-diabetes: classification using principle components analysis. Diabetes Metab Res Rev 2003;19:408–14.
8. Davis BR, et al. The association of postural changes in systolic blood pressure and mortality in persons with hypertension: the Hypertension Detection and Follow-up Program experience. Circulation 1987;75:340–6.
9. Wu J-S, et al. Postural hypotension and postural dizziness in patients with non-insulin-dependent diabetes. Arch Intern Med 1999;159:1350–6.
10. Low PA, et al. Autonomic symptoms and diabetic neuropathy: A population-based study. Diabetes Care 2004;27:2942–7.
11. NICE. Hypertension in adults: diagnosis and management. Clinical guideline 2011 Updated: 2016. https://www.nice.org.uk/guidance/cg127 .
12. Agrawal Y, et al. Disorders of balance and vestibular function in U.S. adults. Arch Intern Med 2009;169:938–44.
13. Walley M, et al. Dizziness and loss of balance in individuals with diabetes: Relative contribution of vestibular versus somatosensory dysfunction. Clin Diabetes 2014;32:76–7.
14. Konukseven O, et al. Electrophysiologic vestibular evaluation in type 2 diabetic and prediabetic patients: Air conduction ocular and cervical vestibular evoked myogenic potentials. Int J Audiol 2015;54:536–43.
15. Myers SF, Ross MD. Morphological evidence of vestibular pathology in long-term experimental diabetes mellitus. II. Connective tissue and neuroepithelial pathology. Acta Otolaryngol 1987;104:40–9.
16. Gawron W, et al. Are there any disturbances in vestibular organ of children and young adults with type I diabetes? Diabetologia 2002;45:728–34.
17. von Brevern M, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007;78:710–5.
18. Ward BK, et al. Characterization of vestibulopathy in individuals with type 2 diabetes mellitus. Otolaryngol Head Neck Surg 2015;153:112–8.
19. D’Silva LJ, et al. Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension. J Vestib Res 2016;25(5–6):233–9.
20. Chimirri S, et al. Vertigo/dizziness as a drugs’ adverse reaction. J Pharmacol Pharmacother 2013;4(Suppl 1):S104–9.
21. Electronic medicines compendium. https://www.medicines.org.uk/emc/ .
22. Diabetes Genes. Maternally Inherited Diabetes and Deafness. http://www.diabetesgenes.org/content/maternally-inherited-diabetes-and-deafness-midd .
23. Suzuki Y, et al. Multiple tumors in mitochondrial diabetes associated with tRNALeu(UUR) mutation at position 3264. Diabetes Care 2003;26:1942–3.
24. DVLA. https://www.gov.uk/dizziness-and-driving .

Dizziness in diabetes

Why Do I Get Dizzy After I Eat?

Several different conditions and underlying causes have the potential to cause dizziness after eating. Sometimes, you may simply stand up too fast after sitting a long time. This sudden shift in fluid volumes and blood flow can cause temporary dizziness.

Postprandial hypotension

Postprandial hypotension is a condition that occurs after eating. It’s caused by increased blood flow to the stomach and intestines, which takes blood flow away from other parts of the body.

As a result, the heart rate speeds up to pump more blood through the body. The blood vessels also tighten. Both factors can cause a person to feel dizzy after eating. About one-third of older women and men commonly experience this condition.

In addition to dizziness, a person with postprandial hypotension may have these symptoms:

  • angina (chest pain)
  • feeling faint
  • nausea
  • visual changes

In rare instances, postprandial hypotension can cause ministrokes. These are also known as transient ischemic attacks. People with high blood pressure are at risk for postprandial hypotension.

Doctors haven’t yet found a cure for postprandial hypotension but can recommend dietary and lifestyle changes that can help reduce the condition’s incidence.

Nondiabetic hypoglycemia

Nondiabetic hypoglycemia is a rare condition that can cause dizziness after eating due to a sudden drop in blood sugar.

A person with nondiabetic hypoglycemia can have reactive hypoglycemia, which is where blood sugar drops instead of increases after eating.

Doctors don’t fully know the underlying cause of this condition, but they suspect that the food causes the body to release too much insulin.

Insulin is a hormone responsible for processing blood sugar and lowering glucose levels. As a result, a person’s blood sugar levels drop too fast and they feel dizzy.

Symptoms associated with nondiabetic hypoglycemia include:

  • confusion or nervousness
  • feeling anxious
  • feeling very sleepy
  • hunger
  • irritability
  • shaking
  • sweating

In some cases, this condition can be treated surgically and cured. Where it can’t be treated, dietary changes can help manage symptoms by reducing the likelihood that a significant drop in blood sugar will happen.

A doctor may also encourage you to check your blood sugar levels after you eat so that you can eat a snack to boost your blood sugar levels before they get any lower.

Dietary triggers

Sometimes something you ate can trigger a condition (temporary or chronic) that makes you feel dizzy. For example, eating certain foods has been linked with migraines, one symptom of which is dizziness.

Examples of foods known to cause migraine headaches include:

  • alcohol
  • chocolate
  • milk products
  • foods with monosodium glutamate
  • pickled foods
  • nuts

Drinking caffeine-containing products such as coffee or sodas may also contribute to dizziness in some people. Sensitivity to caffeine varies widely.

Caffeine is a stimulant and can increase your heart rate. Those with a history of heart-related problems and those who are older may not be able to tolerate these changes in heartbeat. Dizziness may be the result.

Some people with conditions like vertigo or Meniere’s disease may also find their dizziness gets worse after eating certain foods. These conditions involve the inner ear and can affect your balance. Trigger foods may include those with a high salt content, alcohol, and foods known to trigger migraines.

Complications of Type 2 Diabetes

It’s important to get your blood sugar under control to avoid these serious conditions:

  • Hypoglycemia . If your blood sugar falls below 70 milligrams per deciliter (mg/dL), it can lead to accidents, coma, and death.
  • Hyperglycemia . Blood sugar that goes above 180 to 200 mg/dL can give you heart, nerve, kidney, and vision problems. Over the long term, it also can cause coma and death.

Over time, people with type 2 diabetes may have other health problems:

  • Diabetic ketoacidosis . When you don’t have enough insulin in your system, your blood sugar rises, and your body breaks down fat for energy. Toxic acids called ketones build up and spill into your urine. It can cause coma and death if you don’t treat it.
  • Heart and blood vessel diseases. People with diabetes are more likely to have conditions like high blood pressure and high cholesterol, which play a role in heart disease. Also, high blood sugar can damage your blood vessels and the nerves that control your heart.
  • High blood pressure. Diabetes doubles your risk of high blood pressure, which makes you more likely to have heart disease or stroke.
  • Nerve damage (diabetic neuropathy) . This can cause tingling and numbness, most often in your feet and legs. But it can also affect your digestive system, urinary tract, blood vessels, and heart.
  • Eye damage. Diabetes can cause:
    • Glaucoma, a buildup of pressure in your eyes
    • Cataracts, a cloudiness of your lens
    • Retinopathy, which is damage to the blood vessels in your eyes
  • Kidney disease . Your kidneys may have to work harder to filter out the extra sugar, along with all the other waste products in your blood.
  • Hearing problems. Doctors aren’t sure why this happens, but they think high blood sugar levels damage the small blood vessels in your ears.
  • Skin problems . Diabetes can cause:
    • Infections. You’re more likely to get bacterial and fungal infections.
    • Itching. Causes include infections, dry skin, and poor circulation. You might notice it on your lower legs.
    • Acanthosis nigricans. These velvety darker areas can appear on your neck, armpits, groin, hands, elbows, and knees.
    • Diabetic dermopathy. Changes to small blood vessels that look like red or brown scaly patches. They often show up on your feet and the fronts of your legs.
    • Necrobiosis lipoidica diabeticorum. This rare condition also affects your blood vessels. It starts as a dull, red, raised area, but winds up as a shiny scar with a violet border. Your skin could itch or crack open. Women are more likely to get this than men.
    • Allergic reactions. You could get these in response to insulin or another diabetes medication.
    • Diabetic blisters(bullosis diabeticorum). These sores look like burn blisters and can show up on the backs of your fingers, hands, toes, feet, and sometimes legs or forearms.
    • Disseminated granuloma annulare. You might get red, brown, or skin-colored rings or arc-shaped raised areas on your fingers, ears, or trunk.

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