Complications of Diabetes Mellitus (Chronic (Macrovascular complications,…
Complications of Diabetes Mellitus
Hypertonic (translational) hyponatremia (sweet 16): Glycosuria and polyuria. blood glucose >400 mg/dL, increased thirst -> polydipsia, weight loss, polyphagia
Visual acuity changes: Lens converts glucose -> sorbitol -> lens thickens -> myopic shift in vision
DKA: Metabolic emergency in Type 1 DM and LADA. Initial manifestation in 40% of children. Arterial pH <7.30, serum HCO3 < 18 mEq/L, elevated serum AG, ketonuria and ketonemia (acetone halitosis).
Precipitating events: Main one is infection (35%). Could be med non-compliance, psych, intercurrent illness/pregnancy, no identified event.
Low insulin and high glucagon
K+ abnormalities: Translocational hyperkalemia (ECF hypertonicity, insulin deficiency, metabolic acidosis), 250-350 mEq total body K+ deficit, K+ therapy required.
Others: cerebral edema, MODS, Aspiration pneumonia, prerenal AKI.
Symptoms: polyuria, polydipsia, dyspnea, N/V, abdominal pain,. These all develop in 24 hrs. Note: N/V, dyspnea, and Ab pain are all symptoms of metabolic acidosis.
Hyperglycemia hyperosmolar state (HHS): Metabolic emergency in T2DM. It has the same precipitating events as DKA (infection is the most common). Arterial pH > 7.30, plasma glucose > 600, serum ism > 325, Serum HC30, >18, serum AG is normal
Symptoms: polyuria, confusion, lethargy, obtundation, coma. Symptoms develop n5-21 days.
These patients have more insulin than DKA patients -> no ketoacidosis.
Cataract formation: Sorbitol synthesis (see acute) consumes NADPH -> depletion of glutathione in the lens -> oxidative damage to the lens -> cataract formation.
Immunity : Decreased innate and acquired immunity.
Stage 1 : prediabetic
Stage 2: diabetic nephropathy
Carotid artery occlusive disease
Coronary artery disease
Peripheral vascular disease
Compare the water and electrolyte deficits in DKA vs HHS.