Acute complications:Ketoacidosis, hypoglycaemia, hyperosmolar non-ketotic coma, intercurrent illness.Chronic complications:Retinopathy, nephropathy, neuropathy, macrovascular disease and other.

Hypoglycaemia: Symptoms occur when blood glucose level drops to about 3.00mmol/l. The symptoms are sweating, tremor/trembling, palpitations/pounding heart, anxiety, tiredness, pallor, headache, hunger, dizziness, irritability, blurred vision, irritability, aggressive behaviour, slurred speech, confusion, drowsiness, convulsions, coma.

Diabetic ketoacidosis: Result of severe insulin deficiency - leading to a release of free fatty acids into the circulation. Symptoms develop over a period of few days ad may include polyuria, thirst, weight loss, weakness, leg cramps, hypotension, tachycardia, nausea, vomiting, abdominal pain and tenderness, dehydration, kussmaul respiration, blurred vision, ketotic breath, hypothermia, confusion, coma.

In the case of diabetic ketoacidosis hospitalization may be needed. Management incudes fluids, insulin (IV infusion), electrolyte balance (especially potassium), determine cause, antibiotics if there is an infection.

Retinopathy:  Main cause of blindness in adults in developed countries. Tiny blood vessels of retina become clogged and do not let enough blood through. Over the years, the swollen and weak blood vessels can form scar tissue and pull the retina away from the back of the eye. A detached retina can cause blindness. The management may include laser photocoagulation which is very helpful in destroying areas of retinal ischaemia. Good glycaemic control does not prevent retinopathy, but it does reduce the risk.

Other eye conditions more often found in diabetes patients:

• cataract – develop earlier in those with diabetes; higher risk if also taking corticosteroids

• glaucoma – more common in those with diabetes

• a transient visual disturbance is also common due to osmotic changes.

Nephropathy: People with diabetes are also more likely to develop kidney disease than other people. The renal vessels and the glomerulus (filtering part of the kidney) are the main areas affected. First sign of diabetes nephropathy is a microalbuminuria (presence of a protein called albumin in the urine) and elevated blood pressure - progresses to a macroproteinuria (large quantities of protein in the urine) with a decline in renal function. People with kidney failure must either have dialysis treatment (to substitute for some of the filtering functions of the kidneys) or receive a kidney transplant.

Urinary tract infections are also a cause of kidney problems. Diabetes can affect the nerves that control the bladder, making it difficult for a person to empty his or her bladder completely.

Macrovascular disease: Macrovascular complications include coronary heart disease, stroke and peripheral vascular disease. Risk for coronary heart disease, cerebrovascular disease and peripheral vascular disease is higher in people with diabetes. Blood vessel blockage in the heart (ischaemic heart disease) is caused by progressive narrowing of the coronary arteries, which nourish the heart muscle. The symptoms are intermittent chest pain, generally brought on by exertion and relieved after a few minutes' rest. This is due to a partial blockage of a heart, or coronary, artery and is called angina. Blocked or diseased heart arteries are often surgically bypassed or sometimes opened up with a balloon and kept open by insertion of a round mesh of metal called a stent.

Diabetic Neuropathy: Diabetic neuropathy is a descriptive term covering many clinical types or syndromes of neural damage. Subclinical neuropathy is found on electrophysiological testing, but no evidence of it on clinical examination. Progression is through initial biochemical abnormalities in the nerve to impairment in nerve conduction (asymptomatic) and to clinical neuropathy. Common abnormalities include:cardiovascular (eg postural hypotension); gastrointestinal (eg dysphagia, gastroparesis, constipation); genitourinary (eg impotence); sudomotor (eg gustatory sweating, nocturnal sweats); vasomotor (eg dependent oedema); eye (eg decreased pupil size, delayed response to light changes) and other.

Other complications include: sexual dysfunction, infections, dyslipidaemia, musculoskeletal changes (decreased bone mineral density), hypertension.

Also read