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ACUTE
COMPLICATIONS OF DIABETES MELLITUS |
- Diabetic
Ketoacidosis
Occurs when ketone production by the liver exceeds cellular use and
renal excretion.
- Hyperglycemic
Hyperosmolar Syndrome
Characterized by coma, blood glucose in excess of 600 mg/dl and plasma
osmolarity of 310 mOsm/L. Seen most often in type 2 diabetes.
- Hypoglycemia
Occurs most often from insulin or oral hypoglycemic agents.
- Cerebral
symptoms include: headache, slowed problem solving, slurred speech,
impaired motor function, emotion and behavioral changes, seizure
and coma.
- Autonomic
symptoms include: hunger, anxiety, hypotension, sweating, vasoconstriction,
tachycardia
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SOMOGYI
EFFECT
- An
insulin induced hypoglycemia which triggers a compensatory increase
in catecholamines, glucagon, cortisol and growth hormone.
- These
counterregulatory hormones lead to elevated glucose and a degree of
insulin resistance.
- The
hypoglycemic event often occurs at night making diagnosis difficult.
- Treatment
could require altering the timing of carbohydrate intake and modifying
the administration of insulin or oral antihypoglycemic drugs.
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DAWN
PHENOMENON
- An
increased fasting blood glucose or insulin requirement between the hours
of 5 and 9AM.
- The
circadian rhythm of glucose tolerance may be altered in diabetics.
- It
usually produces only mild hypoglycemia, however, when combined with
the Somogyi effect profound hypoglycemia may result.
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CHRONIC
COMPLICATIONS OF DIABETES MELLITUS
- Peripheral
neuropathies
- Thickening
of vessel walls that serve nerves
- Demylenization
of nerves
- Nephropathies
- Diabetes
is responsible for 36% of new End Stage Renal Disease.
- 30%
of Americans seeking renal transplant are diabetics.
- Not
all diabetics develop severe nephropathy; there may be a familial
component
- Retinopathies
- Vascular
abnormalities include: microaneurysm and neovascularization.
- Twenty
years after diabetes onset nearly 60% of type 2 and 100% of type
1 diabetics will have some retinopathy.
- Diabetic
females should be followed carefully when pregnant; retinopathy
can be exacerbated.
- Infections
- Chronic
vascular changes conspire to reduce the diabetic's ability to fight
infection.
- Neuropathies
are responsible for complications from sepsis due to untended foot
ulcers to UTIs related to neurogenic bladder
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