My aunt is 57 years old and has been suffering from diabetes since she
gave birth to her second child, 25 years ago, where she had
pre-eclampsia. The levels of glucose in her blood range from 2.50 to
5.00 or even higher. She is taking many peals on a daily bases (around
10) in order to reduce the glucose, protect her kidneys, her eyes and
I don't know what else. Despite her problem, she refuses to take
insuline injections. I think she only did it 7 or 8 times in her life,
when she felt extremely bad. She suffers from all the typical diabetes
symptoms (she is constantly sleepy, very thirsty, she has changes of
appetite...)
My questions are:
1) Lately, her feet, from knees to towes, have changed color (they
have darkened). Could this be a result of diabetes?
2) I have the impression that she is not thinking clearly, although
she has always been considered to be an intelligent person. She keeps
mis-interpreting what she hears and communication with her becomes
difficult because she gets ungry all the time and insults her fellow
speaker.  Could this also be a result of diabetes?
3) What can happen to her if she keeps refusing to take insuline on a
regular bases?
4) Is her life in danger?

Greetings Anthe:

Let me first state that I am not a licensed physician and the
information I offer is meant to be purely educational regarding your
query.  There is information pertaining to diabetes and the conditions
you list that are plaguing your aunt.


1) "Lately, her feet, from knees to towes, have changed color (they 
have darkened). Could this be a result of diabetes?"

Yes.  This is definitely mentioned in diabetes resources and is
usually a result of poor circulation.  Information on the site,
Virtual Hospital at http://www.vh.org/adult/patient/internalmedicine/diabetesfootcare/
reads in part:

"Decreased circulation may occur. If the following symptoms occur,
notify your doctor:
Feet are always cold. 
Legs that ache with walking and stop hurting with rest. 
Lack of hair growth on feet and lower legs. 
Shiny skin on lower legs. 
Legs are dark red or purple when dangling."

Do her legs also swell?
"Swelling can be a sign of vascular insufficiency (poor circulation)
which is a complication of diabetes. (Hair loss, skin discoloration
like dark or red patches of skin, lack of leg and toe hair and even a
purple or reddish skin tone also indicate the possibility of poor
circulation.)"
From http://www.durrettsoandp.com/Business/productsbusiness/diabeticanswrs.htm

Finally, PDR Health, the site at
http://www.gettingwell.com/content/lifelong_health/chapters/fgac16.shtml:

"What factors put a person at risk for leg artery disease? Basically,
they are the same ones that increase the risk of heart disease: older
age, cigarette smoking, high blood cholesterol, high blood pressure,
lack of exercise, and diabetes. In fact, up to 50 percent of all
people with leg artery disease have diabetes; for them, controlling
both conditions is crucial...

"Vein trouble, especially if left untreated, can result in chronic
swelling, aching, and tiredness in the legs. Over time, the ankles and
lower legs may take on a dark reddish tone with skin problems and even
leg ulcers...

"Diabetes increases your risk for leg artery disease fourfold, and
accounts for nearly half of all amputations in the U.S. that aren't
related to accidents. Why does diabetes make hardening of the arteries
so much more dangerous, especially in the feet and toes?

"Several different mechanisms are at work, and it's still not fully
understood which ones matter most. People with diabetes are prone to
nerve damage in the legs and feet, which means they often may overlook
minor injuries. This, combined with poor circulation that slows wound
healing, can cause small wounds to develop into more serious
infections. Diabetes also makes people more likely to develop
blockages in smaller vessels far from the heart, and those blockages
tend to be more widespread and harder to treat."

The only way to truly know what is causing the condition in her legs
is to see a physician.  However, the occurrence seems in line with
diabetic complications.  Also see "Damage to feet and legs" at
http://www.lhj.com/lhj/story.jhtml?storyid=/templatedata/lhj/story/data/DB_LongTermComplications_04082002.xml&categoryid=/templatedata/lhj/category/data/Diabetes_RecognizingTheSymptoms.xml&page=15

**************

2) "I have the impression that she is not thinking clearly, although 
she has always been considered to be an intelligent person. She keeps
mis-interpreting what she hears and communication with her becomes 
difficult because she gets ungry all the time and insults her fellow 
speaker.  Could this also be a result of diabetes?"

Diabetes mellitus symptoms are defined at
http://www.hopkinsafter50.com/html/silos/diabetes/libDiabetes.php and
one is "Emergency symptoms of hyperosmolar nonketotic states: extreme
thirst, lethargy, weakness, mental confusion, coma."  Emergency
measures referenced there in suggestions for Type II diabetes are "For
type 2 diabetes: Call an ambulance immediately if you develop symptoms
of a hyperosmolar nonketotic state; these include extreme thirst,
lethargy, weakness, and mental confusion."

Again, a licensed physician is the one to consult to discover what
type of diabetes she has - only a doctor's diagnosis will be the most
accurate.

It appears that a hypoglycemic episode is what she may be experiencing
 and http://joslin.org/education/library/low_bs_danger.shtml addresses
the "insults" offers: "Low blood sugar or hypoglycemia is one of the
most common problems associated with insulin treatment, but it can
also happen to people with diabetes taking pills...Most hypoglycemia
is mild with recognizable symptoms, and if quickly and appropriately
treated it is more of an inconvenience than a cause for alarm.
However, severe hypoglycemia that causes mental confusion,
antagonistic behaviors, unconsciousness or seizures is a reason for
alarm."

The antagonism mentioned fits your query: "insults her fellow
speaker."  It may be that when she behaves like this, she is actually
experiencing a hypoglycemic episode.  If so, they do sound quite
serious for the sufferer.  Known also as "insulin shock" the symptoms
listed at http://cpmcnet.columbia.edu/texts/guide/hmg14_0008.html are:

"HYPOGLYCEMIA (INSULIN SHOCK)
SYMPTOMS OF HYPOGLYCEMIA
Distress is relatively rapid, usually in a matter of minutes. 
Hunger. 
Sweating. 
Cold, clammy feeling. 
Paleness. 
Trembling, anxiety. 
Rapid heartbeat. 
Feeling of weakness or faintness. 
Irritability and change in mood or personality. 
Loss of consciousness."

The reference to "Irritability and change in mood or personality" also
fits the description in your query.

************

3) "What can happen to her if she keeps refusing to take insuline on a
regular bases?"

"If it's untreated or treated poorly, diabetes can cause very serious
complications, such as eye, kidney, and nerve damage. Nearly all
complications develop from having high blood glucose levels over many
years. These problems threaten people with both Type 1 and Type 2
diabetes. Your vulnerability increases the longer you've had the
disease and the higher your blood glucose levels have gotten."
From http://www.lhj.com/lhj/story.jhtml;jsessionid=SEFFTLT4LC02JQFIBQPR42WAVABCIIV0?storyid=/templatedata/lhj/story/data/DB_LongTermComplications_04082002.xml&categoryid=/templatedata/lhj/category/data/Diabetes_RecognizingTheSymptoms.xml

The above site offers much information regarding the disease and the
various complications and an index of articles is located at
http://www.lhj.com/lhj/category.jhtml?categoryid=/templatedata/lhj/category/data/Diabetes_RecognizingTheSymptoms.xml

You may also want to review the various questions at
http://www.diabetes123.com/dteam/index_behavior_1998.htm .  There are
hundreds of questions from concerned family members regarding numerous
aspects of diabetes on that site.  Very educational. (Also, see
question 33 regarding mood swings.)

"Not recognizing or simply ignoring diabetes may result in; heart
failure, stroke, kidney disease, blindness and amputations. This is
all a result of an impaired blood circulation in the body of the
person with diabetes."
From http://www.injectionlocator.com/DiabetesFlyer.htm

A definition of the symptoms of hyperglycemia (diabetic coma) at
http://cpmcnet.columbia.edu/texts/guide/hmg14_0008.html are:

"HYPERGLYCEMIA (DIABETIC COMA)
SYMPTOMS OF HYPERGLYCEMIA
Distress develops gradually. 
Increased thirst and urination, usually for 1 to several days;
increasing amounts of sugar are "spilled" into the urine.
Nausea, vomiting, and abdominal pain. 
Feeling of weakness or fatigue. 
Dehydration (dry mouth and skin, sunken eyes). 
Breath smells fruity. 
Heavy, labored breathing that is rapid and deep. 
Drowsiness or loss of consciousness."

Treatment is stated as "Take the person to an emergency room as
quickly as possible. Any acute change in alertness, consciousness, or
mental status in a diabetic warrants immediate medical attention."

***********

4) "Is her life in danger?"

My untrained opinion?  Definitely.  Again, I stress the need for her
to see a physician soon and discover his opinion.  Ignoring diabetes
will eventually cause a person's extended infimity and/or death in a
variety of ways: blindness, amputation of leg(s), brain damage, coma,
blood clots, kidney failure, etc.

I can tell you care deeply about your aunt and you want her to be
healthy.  However, she is an adult and will ultimately choose her own
destiny.  Personally, I can think that only depression would affect
her wanting to risk her life in the manner you describe.  Perhaps she
also needs to consider seeing a counselor or psychologist.  It may be
that her depression is the reason she evidences no interest in
improving her health.

Should you require clarification of any of the links or information I
have provided, please request it and I will be happy to respond.


SEARCH STRATEGY:

diabetes dark legs
diabetes poor circulation
diabetes dark legs poor circulation
diabetes mental confusion
"diabetes mellitus"
diabetes refuses insulin
diabetes forgets insulin
"ignoring diabetes "
insulin shock
diabetes complications

Thank you very much for a detailed and complete answer. My thanks to
drbrains-ga, who has contributed with a useful comment

Actually, insulin may not be the best thing for people with Type II
(insulin-resistant) diabetes, as it causes them to gain weight as fat,
and may not lower their risk of death from all causes.  Researchers
are changing the way they think about diabetes, and it may be that
injecting insulin under the skin isn't the best way to treat it.

That said, blood sugar levels that range from 250-500 on a daily basis
are dangerous in both the long term (stroke, heart attack, kidney
disease, foot amputation, blindness, painful neuropathy) and the short
term (ketoacidosis or nonketotic coma, both of which can be fatal.) 
In many cases, it's best to try to keep the glucose level between 80
and 126, although that's not always possible.

Depression is very commonly associated with diabetes, and may be a
cause of the irritability you mention.  Dementia - the loss of
cognitive capacity - is also associated with severe longstanding
diabetes, and can manifest as irritability, especially when the
insults serve to change the topic of conversation away from areas of
poor memory or other difficulty.

Sounds like, although your relative may not need insulin, she may need
closer attention from her medical caretakers.

Thank you for your rating, comments and added generosity!  I hope you
will be able to convince your aunt to seek assistance in becoming
healthier.