Consequences of Untreated Type 1 Diabetes Mellitus

Untreated type 1 diabetes and poorly controlled type 1 diabetes are totally different scenarios.

Classic type 1 diabetes can not be left untreated. The consequences of untreated type 1 diabetes simply mean you are dead!

Consequences of poorly controlled type 1 diabetes include blindness, renal failure, nerve damage, and other long-term problems.

Untreated diabetes frequently results from a person being unaware that they have the condition.

7.2 million Americans are believed to have diabetes without a diagnosis, as reported by the Centers for Disease Control and Prevention (CDC) [Ref]

People with diabetes may neglect to seek treatment for it. High blood sugar symptoms are frequently unnoticeable and simple to ignore.

Your blood sugar may be high and you won’t even be aware of it if you don’t test it frequently.

Diabetes testing equipment, however, may be pricey, and insurance may not always cover it.

Untreated Type 1 Diabetes could lead to DKA which is a fatal complication. People may die within days.

Why Untreated Type 1 Diabetes is Fatal?

Leaving Type 1 Diabetes untreated is a very serious mistake and can result in death within days.

People with Type 1 Diabetes are insulin deficient and can develop DKA within 12 to 24 hours.

When insulin doses are missed, and often after missing even one single dose, the body starts utilizing fats instead of sugar.

Fat metabolism leads to the formation of ketone bodies. Ketones are acidic in nature and they turn the blood more acidic.

The normal blood PH is 7.40 (7.35 to 7.45). When ketones start to accumulate because of the deficiency of insulin, the blood PH starts to drop.

Blood PH <7.35:

• With a PH of <7.35, the patient may develop nausea, vomiting, and abdominal pain.

Blood PH <7.32:

• With further acidemia or acidity added to blood (because of more ketones), the person may start to notice difficulty in breathing.
• The person may be taking deep rapid breaths to remove ketones (acetone) via the respiratory tract.

Blood PH <7.0:

• When the PH drops to <7.0, the person may become confused and drowsy.
• Simultaneously body fluid and electrolytes become abnormal.
• The patient may develop hyperkalemia and severe dehydration.

Blood PH <6.8:

• Any PH below 6.8 is considered incompatible with life.

How rapidly a person goes into DKA depends on how deficient he/she is in insulin.

However, it may take as little as 12 to 24 hours for a person to develop DKA if insulin deficiency is 100% (meaning the person is not producing any insulin.

For a partially deficient Type 1 Diabetic individual, it may take as long as one week.

Take home message:

Untreated Type 1 diabetes can result in death within a few days. It is important not to miss your insulin dose, even a single dose!

In times of acute stress, one should check ketones in urine via a dipstick or Ketometer.

If urinary or blood ketones are positive after stopping insulin, don’t wait! Get one dose of your rapid and long-acting insulin and go straight to the emergency.

Your doctor will be giving you intravenous fluids, checking and correcting abnormal electrolytes, correcting acidosis by giving alkali (sodium bicarbonate) if acidosis is severe, and may give you antibiotics if an infection is an exacerbating factor.

Late complications of Untreated Type 1 Diabetes:

Untreated type 1 diabetes is rapidly fatal. However, uncontrolled Type 1 Diabetes can slowly damage your organs.

The target blood glucose for a diabetic should be:

• Fasting blood glucose of 70 to 115 (can be more relaxed in older type 1 diabetic patients)
• Random blood glucose of 100 to 150 (can be more relaxed in older type 1 diabetic patients)
• HbA1C of less than 6.5% (can be up to 7 – 7.5 in older diabetic patients with comorbid conditions like renal, liver, or heart diseases)

When the insulin dose is insufficient to achieve these targets, the person will develop complications.

Long-term complications may take five to ten years for a Type 1 diabetic to develop.

However, in patients with very high blood sugar and A1C crossing 11%, complications may develop in a few years.

Here are a few long-term complications of patients with poorly controlled Type 1 Diabetes:

Skin Complications of Poorly Controlled Type 1 Diabetes:

Skin complications of poorly controlled Type 1 diabetes are mostly related to non-healing ulcers.

High blood sugars provide the best environment for bacterial growth. People with uncontrolled diabetes can develop skin infections that spread rapidly.

Most infections are polymicrobial. In addition, fungi and other opportunistic infections are also frequently seen in people with uncontrolled diabetes.

Infections commonly involve the genitals and feet but may also involve relatively cleaner areas like the hands and face.

People undergoing any invasive procedure should try to keep their sugars within range and keep their bodies clean to avoid infections.

In fact, a person’s skin issues may be the first indication that they have diabetes. These may progress significantly if diabetes is left untreated.

Some of the skin lesions such as diabetic dermopathy are harmless, others like cellulitis and infections may spread rapidly and can be limb threatening.

In any case, you should be careful of any abnormalities in your skin and discuss any worries you have with your doctor; it’s always better to be safe than sorry.

Fortunately, most skin disorders may be avoided or are simple to cure if discovered early.

Commonly patients develop ulcers, blisters, and infections. These skin infections are more likely to affect your feet.

Other diabetes-related skin diseases may include acanthosis nigricans in which tan or brown elevated spots develop on the sides of the neck, under the arms, and in the groin.

They can occasionally develop on the hands, elbows, and knees as well. People who are extremely overweight are more likely to develop acanthosis nigricans.

The best course of action is weight loss. Some creams might enhance the appearance of the spots.

Other skin conditions include:

• Digital sclerosis causes the development of thick, waxy, and tight skins on the posterior sides of the hands.
• Eruptive xanthomatosis is another manifestation of untreated diabetes. It comprises skin growths that are hard, yellow and resemble peas.

Untreated Type 1 Diabetes and Cognitive problems:

Diabetes that is not under control increases the chance of developing memory loss and other cognitive issues.

Blood arteries, glial cells, and nerve cells in the brain and peripheral nerves of the body can be affected if the blood glucose is high.

Another way that diabetes could impair memory is by silently damaging the capillaries (which are the small blood vessels that form the network for the exchange of oxygen and glucose between blood vessels and tissue cells).

There is also evidence that any type of diabetes can increase the chances of cognitive impairment in individuals. [Ref]

This is why treating type 1 diabetes is essential as prolonged uncontrolled diabetes will leave you with cognitive abnormalities.

Foot Complications:

Diabetes-related neuropathy or diabetic neuropathy is of six different types. It is a term used when symptoms of neuropathy are described in a diabetic patient.

Diabetic neuropathy commonly affects the nerves of the legs as these nerves are the longest in our body and are likely to be affected the most.

Common symptoms of diabetic neuropathy include numbness, tingling or paraesthesias, burning, and electric current-like pains in your legs.

A rock in your sock that is slicing your foot, for instance, could not even be felt by you. Unnoticed and untreated wounds might grow infectious.

Untreated Diabetes or poorly controlled diabetes can lead to reduced blood flow to the limbs impairing wound healing.

Arteries narrow or get blocked as a result of this disorder. Poor circulation (reduced blood flow) might make it challenging for an infection or foot ulcer brought on by diabetes to heal.

Peripheral arterial disease has been strongly linked with coronary artery disease. Management includes aspirin, statins, and vasodilators.

Infections in Patients with Untreated Diabetes:

High blood sugar levels may reduce a person’s immune system’s ability to defend itself. Long-term diabetics have a higher risk of infection, reduced blood flow to the limbs, and peripheral nerve damage.

Sugar levels in your blood and tissues are too high, which encourages bacterial growth and the infection may spread rapidly.

People who do not tend to their diabetes can be seen with fungal infections of the nose and throat.

On another note, one of the main reasons people get UTIs is untreated diabetes. Germs like Escherichia coli are frequently to blame for these UTIs.

Infections of the kidneys and bladder inflammation are both frequent as well.

Loss of Vision (Diabetic Retinopathy):

Diabetic retinopathy is the leading cause of blindness worldwide. Diabetic retinopathy is caused by the blood vessels in the retina being destroyed by high blood sugar.

Swollen, leaky, or ruptured blood vessels can cause eyesight to blur or stop blood flow.

Although occasionally new blood vessels can grow, they aren’t always healthy and may exacerbate pre-existing vision problems. Diabetes-related retinopathy frequently affects both eyes.

Kidney Failure (Diabetic Nephropathy):

Diabetic Nephropathy is one of the most feared complications of diabetes. It may be unnoticed until very late.

Classically, patients develop pouring out proteins in their urine. The urinary microalbumin or albumin to creatinine ratio is the only clue indicating the development of kidney disease in a patient with untreated or poorly controlled diabetes.

Symptoms only develop very late. These include frothy urine, swelling of the legs and around the eyes (periorbital puffiness), and fatigue.

A kidney’s blood vessel clusters, called glomeruli, that filter waste from the blood might get damaged over time if diabetes is not properly managed. It may also result in excessive blood pressure and renal damage.

Increased pressure in the kidneys’ sensitive filtration mechanism from high blood pressure might result in further renal damage.

Untreated diabetes can lead to renal failure, which can result in fluid retention, swollen arms, and legs, increased blood pressure, or lungs packed with fluid (pulmonary edema).

It can also induce hyperkalemia, which can have dangerous effects on both the mother and the fetus during pregnancy.

Cardiac Complications (Diabetic Cardiomyopathy):

Heart disease is both extremely prevalent and dangerous. In the US, it is the top cause of mortality for both men and women.

Diabetes doubles your risk of developing heart disease or a stroke, and it also puts you at a younger age than someone without diabetes. Your risk of developing heart disease increases the longer you have diabetes. [Ref]

Over time, excessive blood sugar might harm your heart’s nerves and blood vessels. Additionally, diabetic patients are more likely to have other heart disease risk factors:

When you leave your blood sugar untreated, it gets out of control and results in conditions that include high blood pressure where the arteries can be damaged.

Symptoms of heart failure include shortness of breath (especially lying down and while exerting), chest pain, palpitations, apprehension, swelling of the feet, and fatigue.

Diabetes and Autoimmune diseases

Several autoimmune diseases are co-related with diabetes type 1. It is because the defense system of the body gets weaker and weaker with time and the body becomes unable to deal with these situations.

Some of the autoimmune diseases related to diabetes are listed below:

• Anemia.
• Vitiligo.
• Rheumatoid arthritis.
• Crohn’s disease.
• Gastritis.
• Neurodermatitis.
• Psoriasis.
• Alopecia.

Apart from the above-mentioned diseases, different other autoimmune diseases, as well as endocrine defects, can be the consequences of untreated type 1 or type 2 disease.

General Symptoms of Untreated Type 1 Diabetes:

Uncontrolled or Untreated type 1 or type 2 diabetes patients may complain of severe weakness and lethargy. They may lose significant weight despite eating properly and healthily.

Because insulin is required for the cellular uptake of glucose, insufficient insulin can result in starvation at the cellular level.

This results in muscle wasting and weight loss. In addition, people may develop autonomic diabetic gastroparesis. This complication of diabetes affects the stomach and bowels.

People may develop bloating, gases, diarrhea, constipation, or diarrhea alternating with constipation, and abdominal pain.

Because GI symptoms are very disturbing, people with uncontrolled diabetes may lose interest in foods and avoid meals.

This could exacerbate the muscle wasting, cachexia, and weight loss associated with uncontrolled diabetes.

What can you do?

The greatest approach to stop diabetes-related issues from becoming life-threatening is to get tested and treated for it as soon as possible.

Untreated diabetes type 1 or 2 can affect all the organs and systems in your body, starting from the eyes, kidneys, and nerves.

The heart and kidneys are silently affected and are diagnosed until it’s very late. This emphasizes screening for potential complications at regular intervals.

Understand the symptoms of untreated diabetes, particularly if you have a family history of diabetes and other health conditions that may increase your chance of either type 1 or type 2 diabetes.

Identifying complications at an early stage can save the person from long-term disability and death.