Complications of diabetes mellitus
The
complications of diabetes mellitus are far less common and less severe in
people who have well-controlled blood sugar levels. Conversely, some genes
appear to provide protection against diabetic complications, as evidenced by
the absence of complications in a subset of long-term diabetes survivors.
complications of diabetes mellitus are far less common and less severe in
people who have well-controlled blood sugar levels. Conversely, some genes
appear to provide protection against diabetic complications, as evidenced by
the absence of complications in a subset of long-term diabetes survivors.
Wider health
problems accelerate the deleterious effects of diabetes. These include smoking,
elevated cholesterol levels, obesity, high blood pressure, and lack of regular
exercise
problems accelerate the deleterious effects of diabetes. These include smoking,
elevated cholesterol levels, obesity, high blood pressure, and lack of regular
exercise
Acute
Diabetic ketoacidosis
Diabetic
ketoacidosis (DKA) is an acute and dangerous complication that is always a
medical emergency and requires prompt medical attention. Low insulin levels
cause the liver to turn fatty acid to ketone for fuel (i.e., ketosis); ketone
bodies are intermediate substrates in that metabolic sequence. This is normal
when periodic, but can become a serious problem if sustained.
ketoacidosis (DKA) is an acute and dangerous complication that is always a
medical emergency and requires prompt medical attention. Low insulin levels
cause the liver to turn fatty acid to ketone for fuel (i.e., ketosis); ketone
bodies are intermediate substrates in that metabolic sequence. This is normal
when periodic, but can become a serious problem if sustained.
Elevated
levels of ketone bodies in the blood decrease the blood's pH, leading to DKA.
On presentation at hospital, the patient in DKA is typically dehydrated, and
breathing rapidly and deeply. Abdominal pain is common and may be severe. The
level of consciousness is typically normal until late in the process, when
lethargy may progress to coma. Ketoacidosis can easily become severe enough to
caus hypotension, shock, and death.
levels of ketone bodies in the blood decrease the blood's pH, leading to DKA.
On presentation at hospital, the patient in DKA is typically dehydrated, and
breathing rapidly and deeply. Abdominal pain is common and may be severe. The
level of consciousness is typically normal until late in the process, when
lethargy may progress to coma. Ketoacidosis can easily become severe enough to
caus hypotension, shock, and death.
Urine
analysis will reveal significant levels of ketone bodies (which have exceeded
their renal threshold blood levels to appear in the urine, often before other
overt symptoms). Prompt, proper treatment usually results in full recovery,
though death can result from inadequate or delayed treatment, or from
complications (e.g., brain edema). Ketoacidosis is much more common in type 1
diabetes than type 2.
analysis will reveal significant levels of ketone bodies (which have exceeded
their renal threshold blood levels to appear in the urine, often before other
overt symptoms). Prompt, proper treatment usually results in full recovery,
though death can result from inadequate or delayed treatment, or from
complications (e.g., brain edema). Ketoacidosis is much more common in type 1
diabetes than type 2.
Hyperglycemia hyperosmolar state
Hyperosmolar
nonketotic state (HNS) is an acute complication sharing many symptoms with DKA,
but an entirely different origin and different treatment. A person with very
high (usually considered to be above 300 mg/dl (16 mmol/L)) blood glucose
levels, water is osmotically drawn out of cells into the blood and the kidneys
eventually begin to dump glucose into the urine. This results in loss of water
and an increase in blood osmolarity.
nonketotic state (HNS) is an acute complication sharing many symptoms with DKA,
but an entirely different origin and different treatment. A person with very
high (usually considered to be above 300 mg/dl (16 mmol/L)) blood glucose
levels, water is osmotically drawn out of cells into the blood and the kidneys
eventually begin to dump glucose into the urine. This results in loss of water
and an increase in blood osmolarity.
If fluid is
not replaced (by mouth or intravenously), the osmotic effect of high glucose
levels, combined with the loss of water, will eventually lead to dehydration.
The body's cells become progressively dehydrated as water is taken from them
and excreted. Electrolyte imbalances are also common and are always dangerous.
As with DKA, urgent medical treatment is necessary, commonly beginning with
fluid volume replacement. Lethargy may ultimately progress to a coma, though
this is more common in type 2 diabetes than type 1
not replaced (by mouth or intravenously), the osmotic effect of high glucose
levels, combined with the loss of water, will eventually lead to dehydration.
The body's cells become progressively dehydrated as water is taken from them
and excreted. Electrolyte imbalances are also common and are always dangerous.
As with DKA, urgent medical treatment is necessary, commonly beginning with
fluid volume replacement. Lethargy may ultimately progress to a coma, though
this is more common in type 2 diabetes than type 1
Hypoglycemia
Hypoglycemia,
or abnormally low blood glucose, is an acute complication of several diabetes
treatments. It is rare otherwise, either in diabetic or non-diabetic patients.
The patient may become agitated, sweaty, weak, and have many symptoms of
sympathetic activation of the autonomic nervous system resulting in feelings
akin to dread and immobilized panic.
or abnormally low blood glucose, is an acute complication of several diabetes
treatments. It is rare otherwise, either in diabetic or non-diabetic patients.
The patient may become agitated, sweaty, weak, and have many symptoms of
sympathetic activation of the autonomic nervous system resulting in feelings
akin to dread and immobilized panic.
Consciousness
can be altered or even lost in extreme cases, leading to coma, seizures, or
even brain damage and death. In patients with diabetes, this may be caused by
several factors, such as too much or incorrectly timed insulin, too much or
incorrectly timed exercise (exercise decreases insulin requirements) or not
enough food (specifically glucose containing carbohydrates). The variety of
interactions makes cause identification difficult in many instances.
can be altered or even lost in extreme cases, leading to coma, seizures, or
even brain damage and death. In patients with diabetes, this may be caused by
several factors, such as too much or incorrectly timed insulin, too much or
incorrectly timed exercise (exercise decreases insulin requirements) or not
enough food (specifically glucose containing carbohydrates). The variety of
interactions makes cause identification difficult in many instances.
It is more
accurate to note that iatrogenic hypoglycemia is typically the result of the
interplay of absolute (or relative) insulin excess and compromised glucose
counterregulation in type 1 and advanced type 2 diabetes. Decrements in
insulin, increments in glucagon, and, absent the latter, increments in
epinephrine are the primary glucose counterregulatory factors that normally
prevent or (more or less rapidly) correct hypoglycemia.
accurate to note that iatrogenic hypoglycemia is typically the result of the
interplay of absolute (or relative) insulin excess and compromised glucose
counterregulation in type 1 and advanced type 2 diabetes. Decrements in
insulin, increments in glucagon, and, absent the latter, increments in
epinephrine are the primary glucose counterregulatory factors that normally
prevent or (more or less rapidly) correct hypoglycemia.
In
insulin-deficient diabetes (exogenous) insulin levels do not decrease as
glucose levels fall, and the combination of deficient glucagon and epinephrine
responses causes defective glucose counterregulation.Furthermore, reduced
sympathoadrenal responses can cause hypoglycemia unawareness. The concept of
hypoglycemia-associated autonomic failure (HAAF) in diabetes posits that recent
incidents of hypoglycemia causes both defective glucose counterregulation and
hypoglycemia unawareness.
insulin-deficient diabetes (exogenous) insulin levels do not decrease as
glucose levels fall, and the combination of deficient glucagon and epinephrine
responses causes defective glucose counterregulation.Furthermore, reduced
sympathoadrenal responses can cause hypoglycemia unawareness. The concept of
hypoglycemia-associated autonomic failure (HAAF) in diabetes posits that recent
incidents of hypoglycemia causes both defective glucose counterregulation and
hypoglycemia unawareness.
By shifting
glycemic thresholds for the sympathoadrenal (including epinephrine) and the
resulting neurogenic responses to lower plasma glucose concentrations,
antecedent hypoglycemia leads to a vicious cycle of recurrent hypoglycemia and
further impairment of glucose counterregulation. In many cases (but not all),
short-term avoidance of hypoglycemia reverses hypoglycemia unawareness in
affected patients, although this is easier in theory than in clinical
experience.
glycemic thresholds for the sympathoadrenal (including epinephrine) and the
resulting neurogenic responses to lower plasma glucose concentrations,
antecedent hypoglycemia leads to a vicious cycle of recurrent hypoglycemia and
further impairment of glucose counterregulation. In many cases (but not all),
short-term avoidance of hypoglycemia reverses hypoglycemia unawareness in
affected patients, although this is easier in theory than in clinical
experience.
In most
cases, hypoglycemia is treated with sugary drinks or food. In severe cases, an
injection of glucagon (a hormone with effects largely opposite to those of
insulin) or an intravenous infusion of dextrose is used for treatment, but
usually only if the person is unconscious. In any given incident, glucagon will
only work once as it uses stored liver glycogen as a glucose source; in the
absence of such stores, glucagon is largely ineffective. In hospitals,
intravenous dextrose is often used.
cases, hypoglycemia is treated with sugary drinks or food. In severe cases, an
injection of glucagon (a hormone with effects largely opposite to those of
insulin) or an intravenous infusion of dextrose is used for treatment, but
usually only if the person is unconscious. In any given incident, glucagon will
only work once as it uses stored liver glycogen as a glucose source; in the
absence of such stores, glucagon is largely ineffective. In hospitals,
intravenous dextrose is often used.
Diabetic coma
Diabetic coma
is a medical emergency in which a person with diabetes mellitus is comatose
(unconscious) because of one of the acute complications of diabetes:
is a medical emergency in which a person with diabetes mellitus is comatose
(unconscious) because of one of the acute complications of diabetes:
1. Severe diabetic hypoglycemia
2. Diabetic ketoacidosis advanced enough
to result in unconsciousness from a combination of severe hyperglycemia,
dehydration and shock, and exhaustion
to result in unconsciousness from a combination of severe hyperglycemia,
dehydration and shock, and exhaustion
3. Hyperosmolar nonketotic coma in which
extreme hyperglycemia and dehydration alone are sufficient to cause
unconsciousness.
extreme hyperglycemia and dehydration alone are sufficient to cause
unconsciousness.
In most
medical contexts, the term diabetic coma refers to the diagnostical dilemma
posed when a physician is confronted with an unconscious patient about whom
nothing is known except that he has diabetes. An example might be a physician
working in an emergency department who receives an unconscious patient wearing
a medical identification tag saying DIABETIC.
medical contexts, the term diabetic coma refers to the diagnostical dilemma
posed when a physician is confronted with an unconscious patient about whom
nothing is known except that he has diabetes. An example might be a physician
working in an emergency department who receives an unconscious patient wearing
a medical identification tag saying DIABETIC.
Paramedics
may be called to rescue an unconscious person by friends who identify him as
diabetic. Brief descriptions of the three major conditions are followed by a
discussion of the diagnostic process used to distinguish among them, as well as
a few other conditions which must be considered.An estimated 2 to 15 percent of
diabetics will suffer from at least one episode of diabetic coma in their lifetimes
as a result of severe hypoglycemia.
may be called to rescue an unconscious person by friends who identify him as
diabetic. Brief descriptions of the three major conditions are followed by a
discussion of the diagnostic process used to distinguish among them, as well as
a few other conditions which must be considered.An estimated 2 to 15 percent of
diabetics will suffer from at least one episode of diabetic coma in their lifetimes
as a result of severe hypoglycemia.
Erectile Dysfunction
Estimates of
the prevalence of erectile dysfunction in men with diabetes range from 20 to 85
percent. Erectile dysfunction is a consistent inability to have an erection
firm enough for sexual intercourse. Among men with erectile dysfunction, those
with diabetes are likely to have experienced the problem as much as 10 to 15
years earlier than men without diabetes.
the prevalence of erectile dysfunction in men with diabetes range from 20 to 85
percent. Erectile dysfunction is a consistent inability to have an erection
firm enough for sexual intercourse. Among men with erectile dysfunction, those
with diabetes are likely to have experienced the problem as much as 10 to 15
years earlier than men without diabetes.
Respiratory infections
The immune
response is impaired in individuals with diabetes mellitus. Cellular studies
have shown that hyperglycemia both reduces the function of immune cells and
increases inflammation. The vascular effects of diabetes also tend to alter
lung function, all of which leads to an increase in susceptibility to
respiratory infections such as pneumonia and influenza among individuals with
diabetes. Several studies also show diabetes associated with a worse disease
course and slower recovery from respiratory infections.
response is impaired in individuals with diabetes mellitus. Cellular studies
have shown that hyperglycemia both reduces the function of immune cells and
increases inflammation. The vascular effects of diabetes also tend to alter
lung function, all of which leads to an increase in susceptibility to
respiratory infections such as pneumonia and influenza among individuals with
diabetes. Several studies also show diabetes associated with a worse disease
course and slower recovery from respiratory infections.
Periodontal disease
Diabetes is
associated with periodontal disease (gum disease)[8] which may make diabetes
more difficult to treat. Gum disease is frequently related to bacterial
infection by organisms such as Porphyromonas gingivalis and Actinobacillus
actinomycetemcomitans. A number of trials have found improved blood sugar
levels in type 2 diabetics who have undergone peridontal treatment
associated with periodontal disease (gum disease)[8] which may make diabetes
more difficult to treat. Gum disease is frequently related to bacterial
infection by organisms such as Porphyromonas gingivalis and Actinobacillus
actinomycetemcomitans. A number of trials have found improved blood sugar
levels in type 2 diabetics who have undergone peridontal treatment
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