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What Are The Acute And Chronic Complications Of Diabetes?

Acute And Chronic Complications Of Diabetes

Acute And Chronic Complications Of Diabetes

Acute untreated hyperglycaemia will ultimately result in death, either through hyperosmolar coma or through diabetic keto-acidosis. Thus, when insulin became available in 1921, two things about the life of those with diabetes drastically altered. The good news was that their life-expectancy dramatically increased. The bad news was that living with diabetes and chronic hyperglycaemia for a long time exposes a person to a burden of many complications. Thus, diabetes is now one of the leading causes of acquired blindness and renal failure. In addition, diabetes patients, particularly those with type 2 diabetes, are at an increased risk for myocardial infarction and stroke. Painful neuropathy, diabetic foot ulceration and lower extremity amputations are some of the other common complications, but diabetes complications come in many forms and guises. To aggravate all of this, many of the therapies used to treat diabetes come with side effects. The most common of these is hypoglycaemia, which can vary from mild (but annoying) to serious, with epileptic insults, coma or even death. Reducing the risk of all these complications and side effects has turned out to be the challenge of diabetes treatment in the last century. Pathogenesis of diabetes complications Despite an enormous amount of research, the exact pathogenetic mechanisms leading to the complications of diabetes are still far from clear. Initially, research was mainly focused on the harmful effects of glucose. In his pivotal 2005 Banting Lecture[1], Michael Brownlee suggested a unifying theory where the root cause of hyperglycaemic complications is the overproduction of reactive oxygen species, most notably superoxide, in the mitochondrial electron transport chain. This was supposed to be the initiating step that led t Continue reading >>

2. Learning Objectives

2. Learning Objectives

4.1. Diabetic Ketoacidosis (DKA) Diabetic ketoacidosis results from lack of insulin and it is considered a medical emergency as it has a mortality rate of approximately 5 percent, mostly because of late recognition and frequently suboptimal management. Diabetic ketoacidosis can be the first manifestation of type 1 diabetes in a previously undiagnosed patient or can occur in a patient with type 1 diabetes when insulin requirements rise during medical stress. Noncompliance with insulin administration is another common cause of DKA. Although DKA is much more common in type 1 diabetes, it can also occur in patients with type 2 diabetes who have a predominant insulin secretory defect under severe medical stress. 4.1.1. Pathophysiology Diabetes is often referred to as "starvation in the midst of plenty" and the progression of events that results from acute insulin deficiency holds this concept to be valid. Insulin deficiency leads to impaired peripheral glucose uptake. In the presence of inadequate insulin, energy stores in fat and muscle are rapidly broken down into fatty acids and amino acids, which are then transported to the liver for conversion to glucose and ketones (beta-hydroxybutyrate and acetoacetate). Counter-regulatory hormones such as glucagon, catecholamines, cortisol and growth hormone rise in an attempt to correct the perceived low glucose levels, further contributing to hyperglycemia and ketonemia. The combination of increased production of glucose and ketones with decreased utilization (due to insulin deficiency) results in high levels of these substances. Hyperglycemia causes osmotic diuresis with an ensuing reduction of intravascular volume, which in turn causes an impairment of renal blood flow and an inability to excrete glucose which worsens the hypergl Continue reading >>

Complications Of Diabetes: Acute And Chronic.

Complications Of Diabetes: Acute And Chronic.

Abstract The acute and chronic complications of diabetes account for the morbidity and mortality associated with this disease. Acute complications include diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, and hypoglycemia. Chronic hyperglycemia is central to the pathophysiology of chronic complications such as cardiovascular and peripheral vascular disease, retinopathy, nephropathy, and neuropathy. Pathophysiology and assessment of, and interventions for these complications are discussed. Continue reading >>

Complications Of Acute And Chronic Hyperglycemia

Complications Of Acute And Chronic Hyperglycemia

From glucose homeostasis to hyperglycemia Glucose homeostasis is maintained by a complex neurohormonal system, which modulates peripheral glucose uptake, hepatic glucose production, and exogenous glucose utilization following food ingestion.1,2 This allows the maintenance of plasma glucose concentrations within normal range, with average values of around 90 mg/dl throughout a 24-hour period, postmeal concentration below 140 mg/dl, and minimal values, such as those after moderate fasting or exercise, above 55 mg/dl.1,2 Hormones implicated in glucose regulation include insulin, glucagon, amylin, glucagon-like petide-1 (GLP-1), glucose-dependent insulinotropic peptide, epinephrine, cortisol, and growth hormone.3 These hormones act on several target tissues, including muscle, liver, adipocyte, and brain to regulate glucose levels.3 Insulin is a key glucoregulatory hormone, produced by pancreatic β-cells, whose levels are low during the fasting state, whereas they increase during the postprandial phase, when insulin stimulates utilization of dietary glucose by peripheral tissues, and in the meantime represses hepatic glucose production.4 Another important hormone regulating glucose metabolism is glucagon, produced by pancreatic α-cells during fasting conditions, when it induces hepatic glucose production through the activation of glycogenolysis and, with more prolonged fasting, also stimulation of gluconeogenesis.5 A dysregulation in the mechanisms implicated in glucose homeostasis can cause acute or chronic hyperglycemia.6 Decreased/assent insulin production and/or reduced insulin sensitivity are important contributing factors to the development of hyperglycemia and they represent the underlying abnormalities of diabetes.4 Along with a decreased/absent insulin secretion, Continue reading >>

Complications Of Diabetes Mellitus

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. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. Chronic complications occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. Microangiopathy can affect all vital organs, kidneys, heart and brain, as well as eyes, nerves, lungs and locally gums and feet. Macrovascular problems can lead to cardiovascular disease including erectile dysfunction. Female infertility may be due to endocrine dysfunction with impaired signalling on a molecular level. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise which are accessible to management as they are modifiable. Non-modifiable risk factors of diabetic complications are type of diabetes, age of onset, and genetic factors, both protective and predisposing have been found. Overview[edit] Complications of diabetes mellitus are acute and chronic. Risk factors for them can be modifiable or not modifiable. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels.[1][2][3] However, (non-modifiable) risk factors such as age at diabetes onset, type of diabetes, gender and genetics play a role. Some genes appear to provide protection against diabetic complications, as seen in a subset of long-term diabetes type 1 survivors without complications .[4][5] Statistics[edit] As of 2010, there were about 675,000 diabetes-related emergency department (ED) visits in the Continue reading >>

Complications

Complications

Know the difference between acute and chronic complications. Acute complications can arise quickly. Chronic complications tend to arise over years or decades. Know the differences and you will be able to take effective precautions against both. Acute Complications Serious, life-threatening complications can arise quickly. Fortunately, such complications can go away just as quickly if you – and those closest to you — know what to do and how to do it. Acute complications arise from uncontrolled high blood sugars (hyperglycemia) and low blood sugars (hypoglycemia) caused by a mismatching of available insulin and need. In short, you either have taken too much diabetes medication or too little. Some acute complications require immediate medical attention. These emergencies include: Chronic Complications Chronic complications tend to arise over years or decades. Often, there is damage before there are symptoms so routine screening is recommended to catch and treat problems before they occur or get worse. Learn more about chronic complications. Problems include: VIGILANCE AND A HEALTHY LIFESTYLE PUT YOU IN CONTROL Self-assessment Quiz Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about Diabetes Complications, take our self assessment quiz when you have completed this section. The quiz is multiple choice. Please choose the single best answer to each question. At the end of the quiz, your score will display. If your score is over 70% correct, you are doing very well. If your score is less than 70%, you can return to this section and review the information. Continue reading >>

Acute Complications Of Diabetes Mellitus

Acute Complications Of Diabetes Mellitus

1. Acute Complications of Diabetes -Reshma Ann Mathew 2. DIABETES It is a GROUP of metabolic disease characterised by chronic hyperglycemia with DISTURBANCE in the carbohydrate, fat & protein metabolism resulting from DEFECTS in insulin secretion, insulin action or both . 3. Pancreas beta cells Insulin actions Glucose entry and utilization (oxidation, storage) Glucose entry and oxidation TG synthesis Normal glucose and fat metabolism 4. Pancreas beta cells Insulin actions Glucose entry and utilization (oxidation, storage) Glucose entry and oxidation TG synthesis Metabolic consequences of insulin deficiency/resistance 5. Clinical Features of DM due to insulin lack Polyphagia (decr. leptin?) Starvation in the midst of plenty Hyperosmolar hyperglycemic syndrome (HHS) Lactic acidosis Lactic acidosis Muscle protein breakdown Acetoacetate,0H-butyrate, acetone 6. • Insulin level increases when? a) Glucose administered by mouth (food intake) b) Glucose given by IV (glucose infusion) c) No difference 7.  CLASSIFICATION 1) Type 1 2) Type 2 3) Other specific types 4) Gestational diabetes 8. DIABETIC KETOACIDOSIS • It is a MEDICAL emergency • PRINCIPALLY seen in type 1 diabetes • Mortality- • CHILDREN & ADOLESCENTS- cerebral edema • ADULTS- hypokalemia, acute respiratory distress syndrome & co-morbid conditions 9.  PATHOPHYSIOLOGY Insulin Counterregulatory hormones Glucagon, Epinephrine, Cortisol, Growth hormone NORMAL 10. EXCESS counterregulatory hormones Insulin DEFICIENCY DKA 11. Insulin Deficiency Glucose uptake Proteolysis Lipolysis Amino Acids Glycerol Free Fatty Acids Gluconeogenesis Glycogenolysis Hyperglycemia Hepatic Ketogenesis Metabolic Acidosis Osmotic diuresis Dehydration & electrolyte loss Excess counterregulatory hormones Forces H+ ions into cells Continue reading >>

Acute And Chronic Complications Of Type 2 Diabetes Mellitus In Children And Adolescents - Sciencedirect

Acute And Chronic Complications Of Type 2 Diabetes Mellitus In Children And Adolescents - Sciencedirect

Volume 369, Issue 9575 , 26 May1 June 2007, Pages 1823-1831 Acute and chronic complications of type 2 diabetes mellitus in children and adolescents Author links open overlay panel DrOritPinhas-HamielMDa Get rights and content With the increase in prevalence of type 2 diabetes mellitus in adolescents, a rise in incidence of secondary comorbiditiesincluding hypertension, hyperlipidaemia, nephropathy, and retinopathyis anticipated. Furthermore, findings of studies in young adults have suggested that the development and progression of clinical complications might be especially rapid when the onset of type 2 diabetes is early, raising the possibility of a serious public-health challenge in the next few decades. To date, reports of the epidemiology and natural history of secondary complications specifically in adolescents with type 2 diabetes have been scarce. Yet, we must begin to understand the extent of the coming challenge. To this end, we have reviewed reports on acute and long-term comorbidities associated with type 2 diabetes in young people and have looked at mounting evidence that this group could be at increased risk for development of early complications. Continue reading >>

Diabetes: Preventing Complications

Diabetes: Preventing Complications

Diabetes complications can be divided into two types: acute (sudden) and chronic (long-term). This article discusses these complications and strategies to prevent the complications from occurring in the first place. Acute complications Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) Acute complications of diabetes can occur at any time in the course of the disease. Chronic complications Cardiovascular: Heart disease, peripheral vascular disease, stroke Eye: Diabetic retinopathy, cataracts, glaucoma Nerve damage: Neuropathy Kidney damage: Nephropathy Chronic complications are responsible for most illness and death associated with diabetes. Chronic complications usually appear after several years of elevated blood sugars (hyperglycemia). Since patients with Type 2 diabetes may have elevated blood sugars for several years before being diagnosed, these patients may have signs of complications at the time of diagnosis. Basic principles of prevention of diabetes complications: Take your medications (pills and/or insulin) as prescribed by your doctor. Monitor your blood sugars closely. Follow a sensible diet. Do not skip meals. Exercise regularly. See your doctor regularly to monitor for complications. Results from untreated hyperglycemia. Blood sugars typically range from 300 to 600. Occurs mostly in patients with Type 1 diabetes (uncommon in Type 2). Occurs due to a lack of insulin. Body breaks down its own fat for energy, and ketones appear in the urine and blood. Develops over several hours. Can cause coma and even death. Typically requires hospitalization. Nausea, vomiting Abdominal pain Drowsiness, lethargy (fatigue) Deep, rapid breathing Increased thirst Fruity-smelling breath Dehydration Inadequate insulin administration (not getting Continue reading >>

Long-term Complications Of Diabetes

Long-term Complications Of Diabetes

It is important to keep your blood sugar, blood pressure, and cholesterol in a healthy range. You should learn these basic steps for managing diabetes and staying as healthy as possible. Steps may include: A healthy diet Exercise Medicines You may need to check your blood sugar daily or more often. Your health care provider will also help you by ordering blood tests and other tests. All these may help you keep complications of diabetes away. You will need to check your blood sugar level at home. You will use a special device called a glucose meter to test your blood sugar. Your provider will let you know if you need to check it every day and how many times each day. Your provider will also tell you what blood sugar numbers you are trying to achieve. This is called managing your blood sugar. These goals will be set for different times during the day. To prevent heart disease and stroke, you may be asked to take medicine and change your diet and activity: Your provider may ask you to take a medicine called an ACE inhibitor or a different medicine called an ARB, for high blood pressure or kidney problems. Your provider may ask you to take a medicine called a statin to keep your cholesterol down. Your provider may ask you to take aspirin to prevent heart attacks. Ask your provider if aspirin is right for you. Regular exercise is good for people with diabetes. Talk to your provider first about what exercises are best for you and how much exercise you should do every day. DO NOT smoke. Smoking makes diabetes complications worse. If you do smoke, work with your provider to find a way to quit. To keep your feet healthy, you should: Get a foot exam by your provider at least every 6 to 12 months and learn whether you have nerve damage. Make sure you are wearing the right kinds of Continue reading >>

Acute And Chronic Complications Of Diabetes Mellitus In Older Patients

Acute And Chronic Complications Of Diabetes Mellitus In Older Patients

Volume 80, Issue 5, Supplement 1 , 16 May 1986, Pages 39-53 Acute and chronic complications of diabetes mellitus in older patients Author links open overlay panel Douglas A.GreeneM.D. Get rights and content The chronic complications of diabetes are thought to be caused by an interaction between hyperglycemia or other metabolic consequences of insulin deficiency and other poorly defined independent genetic or environmental factors. Several important biochemical sequelae to hyperglycemia are discussed. Macrovascular disease appears to be primarily age-related in diabetic patients. The clinical course, manifestations, and management of diabetic complications are significantly altered when they appear against a background of the degenerative changes of aging, greatly complicating diagnosis and management. In elderly patients, the acute complications of diabetesketoacidosis and hyperosmolar dehydrationoften occur in the context of chronic complications that greatly compound their management and increase their morbidity and mortality. Continue reading >>

Type 2 Diabetes Complications

Type 2 Diabetes Complications

With type 2 diabetes (also called type 2 diabetes mellitus), if you don’t work hard to keep your blood glucose level under control, there are short- and long-term complications to contend with. However, by watching the amount and types of food you eat (your meal plan), exercising, and taking any necessary medications, you may be able to prevent these complications. And even if you have some of the long-term, more serious complications discussed below when you’re first diagnosed, getting tight control of your blood glucose will help prevent the complications from becoming worse. (It is possible with type 2 diabetes to already have some of these complications when you’re first diagnosed. That’s because type 2 develops gradually, and you may not realize that you have high blood glucose for quite some time. Over time, high blood glucose can cause serious damage. You can learn more about that in this article on the symptoms of type 2 diabetes.) Short-term Diabetes Complications Hypoglycemia is low blood glucose (blood sugar). It is possible for your blood glucose to drop, especially if you’re taking insulin or a sulfonylurea drug (those make your body produce insulin throughout the day). With these medications, if you eat less than usual or were more active, your blood glucose may dip too much. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and too much alcohol (alcohol keeps the liver from releasing glucose). Rapid heartbeat Sweating Whiteness of skin Anxiety Numbness in fingers, toes, and lips Sleepiness Confusion Headache Slurred speech Mild cases of hypoglycemia can be treated by drinking orange juice or eating a glucose tablet—those will quickly rai Continue reading >>

Acute And Chronic Complications Of Diabetes, An Issue Of Endocrinology And Metabolism Clinics, Volume 42-4

Acute And Chronic Complications Of Diabetes, An Issue Of Endocrinology And Metabolism Clinics, Volume 42-4

Acute and Chronic Complications of Diabetes, An Issue of Endocrinology and Metabolism Clinics, Volume 42-4 Personal information is secured with SSL technology. This issue of Endocrinology Clinics brings the reader up to date on the important advances in research surrounding acute diabetic complications. Guest edited by Leonid Poretsky and Eliana Liao, the topics covered include retinopathy, neuropathy, gastrointestinal complications, diabetic foot, dental complications, dermatologic complications, and more. "A concise, well structured and extensively referenced compilation of 13 reviews around the theme of acute and chronic complications of diabetes, it offers a collection of succinct discourses that will enthral during the three months between this and the next publication....The physical size of the book is pleasing and it is comfortable in the hand. Each review is of just the right length to provide both enlightenment and education. On average each of the 13 reviews is of 20 to 40 pages in length, so the imparting of knowledge is lean, succinct and brisk. But paradoxically each provides a leisurely read that enables the clinician to ensure a rounded update on pertinent areas in the field....I can recommend this book as an investment that will provide months of quiet, enjoyable contemplation of the fascinating interplay between the conditions associated with diabetes and pathophysiology of diabetes itself." Continue reading >>

Diabetes Complications

Diabetes Complications

Diabetes control is vital to prevent several acute and chronic complications. Acute complications include diabetic ketoacidosis, hyperosmolar coma, infections, hypoglycaemic episodes etc. Some of the chronic or long term complications include eye, kidney and nerve damage. Several other problems and lifestyle habits are responsible for worsening diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Some of the common long term complications of diabetes and their pathophysiology include:– Weight loss – this is seen due to los of glucose and calories in urine. Poor wound healing, gum and other infections – this occurs due to increased blood glucose providing a good source of nutrition to microbes and due to a diminished immunity. Heart disease - this occurs due to changes in the large blood vessels leading to coronary, cerebral, and peripheral artery diseases, atherosclerosis, dyslipidemia etc. Damage to the large blood vessels is called macrovascular damage. Diabetic retinopathy or eye damage – this occurs due to damage of the fine blood vessels of the retina in the eye due to long term exposure to high blood sugar. Kidney damage – similar damage to small and large blood vessels of the kidneys. Initially there is proteinuria or increased outflow of protein and may lead to end stage renal disease (ESRD). Nerve damage – this can affect the arms and legs and is called stocking-glove numbness/tingling. It can also affect autonomic functions leading to impotence, erectile dysfunction, difficulty in digestion or gastroparesis etc. Diabetic foot – this occurs due to peripheral nerve damage as well as blood vessel affliction due to long term diabetes. Little trauma, sores and blisters go unnoticed d Continue reading >>

Diabetes Mellitus Chronic Complications

Diabetes Mellitus Chronic Complications

Chronic Complications of Diabetes Mellitus refer to the clinico-patholgoical consequences that develop over years in individuals with Type I and Type II Diabetes Mellitus (DM). These complications have been categorized into those centering around the microvasculature and macrovasculature although a variety of non-vascular sequelae also exist. Microvascular complications are almost certainly the result of chronic hyperglycemia and are less likely to occur in those with excellent glycemic control. In contrast, macrovascular Complications appear to have a more complex etiology and occur even in those with careful glycemic control. Microvascular Complications: Macrovascular Complications: The macrovascular chronic complications of DM include an increased risk of cardiovascular, cerebrovascular, and peripheral artery disease. *As mentioned the precise etiopathogenesis of these macrovascular complications is poorly understood and does not correlate well with levels of hyperglycemia. Whatever the ultimate etiology, the vasculature of patients with DM display acceleration of atherosclerosis and hyaline arteriosclerosis above and beyond other patients with otherwise similar risk factors. These pathological changes are associated with increased risk for developing ischemic heart disease, stroke, and hypertension. In addition, patients with chronic DM display significantly increased risk of pathologies in the lower extremities, especially ulcers and gangrene. Reduced blood flow to the legs, due to Peripheral Artery disease is certainly plays a role, although diabetic neuropathy and poor wound healing (see below) likely contribute. Non-vascular Complications Infection Susceptibility and poor wound healing is observed in patients with chronic DM and likely arise due to subtle defect Continue reading >>

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