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Acute Complications – Diabetes Mellitus

Hyperglycaemic Hyperosmolar
Diabetic Ketoacidosis (DKA) Non-Ketotic Syndrome (HHNS)
Hyperglycaemia Hypoglycaemia
Absolute Insuli n Deficiency (Type I) (Hyperosmolar Non-Ketotic Coma)
Relative Insulin Deficiency (Type II)
Deficient Insulin Action Relative Insulin Deficiency (Rare) Characteristics Complication of
• ↓ Insulin Secretion Hyperglycaemia Hyperglycaemia Insulin Treatment (Diabetes Type I, II)
• Insulin Resistance Hepatic Gluconeogenesis Hyperosmolarity Oral Hypoglycaemic Drugs
Hyperglycaemia Glycogenolysis (2° to ↓ Insulin) Dehydration (stimulate endogenous insulin
• ↓ Uptake of Glucose into Muscle, Lipolysis Without Significant Ketoacidosis secretion)(eg. Sulfonylureas, Benzoi c
Adipose Tissue ↑ Free Fatty Acids (Insulin present – Inhibit Ketogenesis) acid derivatives)
• Glucose stop converting to Glycogen Free Fatty Acids → Ketone Bodies Due to Hypoglycaemia occur often
Glycosuria (in Liver) Severe Dehydration Exercise
• ↑ Glucose Excee d Renal Threshold Ketones Do not Drink enough H2O to Fasting
for absorption of Glucose Acetone compen sate for urinary losses Characteristics
• Induce Os motic Diuresis (Fruity Breath Odour) (Chronic Hyperglycaemia) ↓ Insulin Levels
Polyuria (loss H2O, Electrolytes) β-Hydroxybutyrate Risk Factors ↑ Counterregulatory Hormones (slight)
(Induce Nau sea, Vomiting) Elderly Diabetic ↑ Blood Glucose
• Significant Loss of Calories
(Urinary Glucose Loss > 75g/dL) (Aggravate Fluid, Electrolyte Loss) Disabled (eg. Stroke, Infection) Precipitation of Hypoglycaemia
(75g/dL x 4kCal/g = 300kCal/dL) Acetoacetate Inadequate H2O intake Inappropriate dosing with
Polydipsia Ketonemia Coma • Exogenous Insulin
• Dehydration Early Stage Late Stage Caused by Hyperosmolarity • Induction of En dogenous Ins ulin
• Stimulate Thirst Center Buffer (H CO3-) Ketonuria Severe loss of ICF in Brain Acute Response to Hypoglycaemia
Polyphagia Ketoacidosis Effective Plasma Osmolarity reaches ↑ Glucagon
• Protein, Fat Catabolism Kussmaul 340mOsm/ L (280 -295mOsm/L) ↑ Catecholamines
• Negative Energy Balance Respiration Delay in seeking Medical Attention Acute Treatment of Hypoglycaemia
(Deep Rapid Absence of Ketoacidosis Rapid Oral Glucose
Clinical
Breathing) Absence of Symptoms (Na usea, Intravenous Glucose
Polyuria, Polydipsia, Polyphagia
Vomiting, Respiratory Difficulties) Intramuscular Glucagon
Weight Loss (dehydration, calories loss)
Hypokalaemia Mild Ketonuria can occur Somogyi Phenomenon
Blurred Vision
Due to If Patient has not been eating Rebound Hyperglycaemia
(change of H2O content of lens of eyes)
Acidosis, Insulinopenia, ↑ Glucose K+ Loss Due to actions of counter regulatory
Impair ↓ ↓ Severe than Diabetic Ketoacidosis hormones
Neutrophil Chemotaxis, Phagocytosis K+ shift from Aggravated by Excessive Glucose
Women Men Intracellular → Extracellular
Candidal Candidal Initial Catecholamine Symptoms
(to exchange with H+ due to Acidosis)
Sweating, Weakness, Anxiety,
vulvovaginitis balanitis (to maintain K+ levels)
↓
Faintness, Shakiness, Tremor,
Extracellular K+ is lost in Urine Palpitations, Tachycardia
(due to Osmotic Diuresis) Neuroglycope nic Symptoms
Dilutional Hyponatraemia Confusi on, Irritability, Headaches,
Due to ↑ Serum Osmolarity Abnormal Behaviour, Diplopia, Motor
(Water Intracellular → Extracellular) Incoordination, Coma, Weakness,
Loss of Sodium in Urine Convulsion
During Osmotic Diuresis Nocturnal Hypoglycaemia
Morning Headaches lassitude night
sweat nightmares
Difficulty in awakening, Psychologic
changes
Restlessness during Sleep
Loudness Respirations