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

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.

 

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.

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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