Introduction:

Diabetes mellitus is a chronic condition that characterized by raised plasma glucose levels. 

Diabetes, results from the body’s inability to produce or use insulin properly, resulting in high

levels of blood sugar. 

There is a derangement in the Carbohydrate, Protein & Fat Metabolism, causing multiple Acute and Chronic complications.

Wider health problems accelerate the deleterious effects of diabetes. These include smokingelevated cholesterollevels, obesityhigh blood pressure, and lack of regular exercise.

Acute complications.

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is an acute and dangerous complication that is always a medical emergencyand requires prompt medical attention. Low insulin levels cause the liverto 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. 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:

A person with very high (usually considered to be above 300 mg/dl (16 mmol/L)) blood glucose levels, water is osmoticallydrawn 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.

  • 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 sympatheticactivation 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
  • Diabetic coma:
  • Diabetic coma is a medical emergencyin which a person with diabetes mellitusis comatose (unconscious) because of one of the acute complications of diabetes:
  • Severe diabetic hypoglycemia
  • Diabetic ketoacidosisadvanced enough to result in unconsciousness from a combination of severe hyperglycemiadehydrationand shock, and exhaustion
  • Hyperosmolar nonketotic comain which extreme hyperglycemiaand dehydration alone are sufficient to cause unconsciousne