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What Are The Acute Complications Of Diabetes Mellitus?

Acute Complications Of Diabetes Mellitus

Acute Complications Of Diabetes Mellitus

mild hypoglycemia would be indicated by a bs of moderate hypoglycemia would be indicated by a bs of -10 to 15 grams of carbs (oj, regular soda, milk, life saver) how would you treat moderate hypoglycemia what pt teaching should be done regarding sick day managment -if disorientation, unconsciousness, or seizure occur what should be done after giving the pt tx for severe hypoglycemia -follow up with snack or protien and complex carb this condition is a consequence of severe insulin deficiency with a bs of >300 -acidosis caused by an accumulation of ketone bodies (substance in the blood as a result of faulty carbohydrate metabolism) -change in diet, insulin, or exercise regimen -tachycardia / hypotension (from dehydration) why will the pt have kussmal breathing and / or hyperapnea in dka -pt is trying to offload acids theu breathing what ph level would you expect to find in a pt with dka what bs would you expect to find in a pt with dka what would the bun and creatinine levels do if the pt has dka -levels will decrease as the pt is rehydrated what will osmolarity levels do if the pt has dka you can / will see ketonuria in a pt with dka what would be involved in the management of dka -fluid replacement (ns to restore volume) -bicarbonate administration (only given for severe acidosis) -within the 1st hour 1 liter of .9ns to restore volume (run at 200 to 250 ml/h) -as bs reaches 250, .5% d5w / .45ns given (to prevent cerebral edema) -monitor urine output during fluid replacement insulin therapy is started slowly, why is this -bringing it down to quickly will cause problems with cerebral functions) hhnk (hyperglycemic hyperosmolar nonketotic syndrome) what bs levels would you expect to see in hhnk 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

Acute And Chronic Complications

Access the latest recommendations, journal articles, webcasts and patient literature on the microvacular and macrovacular complications of diabetes. 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 >>

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 >>

Mksap Primer: Acute Complications Of Diabetes Mellitus

Mksap Primer: Acute Complications Of Diabetes Mellitus

MKSAP primer: Acute complications of diabetes mellitus The major acute complications of diabetes are the hyperglycemic and hypoglycemic emergencies. The major acute complications of diabetes are the hyperglycemic and hypoglycemic emergencies. Hyperglycemic emergencies include diabetic ketoacidosis, mainly in patients with type 1 disease, and hyperglycemic hyperosmolar syndrome (HHS), primarily in patients with type 2 disease. If untreated, these conditions can result in severe sequelae and require urgent medical attention. In this illustration of type 1 diabetes, the insulin emanating from the pancreas becomes less prominent and ultimately disappears. Diabetic ketoacidosis is often the presenting manifestation of this disease. Illustration by Jim Dowdalls/Photo Researchers Inc. Diabetic ketoacidosis (DKA) is the most life-threatening acute complication of diabetes, and is often the presenting manifestation of type 1 diabetes. In patients with established type 1 disease, DKA may occur during superimposed acute infections, such as influenza, pneumonia or gastroenteritis, especially in patients who do not follow sick day rules; in patients on insulin pumps when insulin infusion is technically interrupted; or in patients who are noncompliant. Noncompliance is generally a problem in teenagers and in substance abusers. In almost all cases, DKA is preventable by a well-educated patient who is compliant with glucose monitoring and understands the need for increased insulin doses during stress. DKA may occur in patients with type 2 disease during severe medical stress, such as with overwhelming infection or myocardial infarction. The syndrome of DKA indicates profound insulin deficiency, in combination with excess circulating concentrations of counter-regulatory factors, especi 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 >>

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 >>

Diabetes Complications

Diabetes Complications

Complications caused by diabetes People with diabetes must routinely monitor and regulate their blood sugar. No matter how careful you may be, there’s still a possibility that a problem might arise. There are two types of complications you may experience: acute and chronic. Acute complications require emergency care. Examples include hypoglycemia and ketoacidosis. If left untreated, these conditions can cause: seizures loss of consciousness death Chronic complications occur when diabetes isn’t managed properly. Diabetes causes high blood sugar levels. If not controlled well over time, high blood sugar levels can damage various organs, including the: eyes kidneys heart skin Unmanaged diabetes can also cause nerve damage. People with diabetes can experience sudden drops in their blood sugar. Skipping a meal or taking too much insulin or other medications that increase insulin levels in the body are common causes. People who are on other diabetes medications that do not increase insulin levels are not at risk for hypoglycemia. Symptoms can include: blurry vision rapid heartbeat headache shaking dizziness If your blood sugar gets too low, you can experience fainting, seizures, or coma. This is a complication of diabetes that occurs when your body cannot use sugar, or glucose, as a fuel source because your body has no insulin or not enough insulin. If your cells are starved for energy, your body begins to break down fat. Potentially toxic acids called ketone bodies, which are byproducts of fat breakdown, build up in the body. This can lead to: dehydration abdominal pain breathing problems Diabetes can damage blood vessels in the eyes and cause various problems. Possible eye conditions may include: Cataracts Cataracts are two to five times more likely to develop in people Continue reading >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

Natural History Of Diabetic Nephropathy In Persons With Insulin The 1982 publication of The Prevention and Treatment of FiveComplications of Diabetes: A Guide for Primary Care Practitionerswas an initial attempt to provide straightforward and practicalinformation that primary care practitioners could immediately applyin their practice in the diagnosis and prevention of complicationsof diabetes. In the eight years since that publication wasreleased, over 200,000 copies have been distributed. The emphasison early application of currently available preventive measures ortreatments has resulted in the widespread use of the document. The scope of the present revised edition has been broadened tocover nine complications of diabetes, and the recommendations forthe previous five. We anticipate continued widespread use of thisguide in assisting practitioners in the care of their patients withdiabetes. The recommendations are clear, practical, and based uponscientific evidence, and they can be generally implemented in anoffice practice. We believe that they are conceptually consistentwith the American Medical Association's new emphasis on practiceparameters. Although this publication is meant to provide freestanding andpractical assistance in an office practice, the most appropriateuse is in continuing education programs and workshops. In thesesettings, the practical application of the recommendations can bediscussed and barriers to their application in individual practicesovercome. We congratulate the Centers for Disease Control in its efforts to updatethis guide and wish it the same success as the previous edition. This publication is designed to help the primary carepractitioner in the day-to-day management of patients withdiabetes. The recommendations relate to the preventio Continue reading >>

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 >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

Autophagy and Diabetes Complications Complications of diabetes represent the major causes of morbidity and mortality that are associated with this chronic metabolic disorder84. Specifically, cardiovascular disease is the leading cause of mortality in subjects with diabetes, which represents the major cause of end stage renal disease, blindness and limb amputations in developed and many developing societies. Broadly speaking, diabetes complications can be categorized as macrovascular, which are those affecting large and medium size blood vessels and microvascular complications, which involve small blood vessels such as small arterioles. Macrovascular complications include accelerated atherosclerosis, leading to increased coronary artery disease, increased cerebrovascular disease and stroke, and increased peripheral arterial disease that contributes to critical limb ischemia. There is also strong evidence that diabetes leads to direct adverse effects in the heart that leads to diabetic cardiomyopathy85. Microvascular impairment leads to the complications of diabetic retinopathy, diabetic nephropathy and diabetic neuropathy. The pathogenesis of these diverse complications of diabetes is complex, is only partially understood and has been the subject of many reviews. Only recently has attention turned to the potential contribution of changes in autophagy due to the complications of diabetes. As reviewed in other chapters, autophagy may serve a protective role in cells where it promotes cellular survival by removing damaged organelles such as mitochondria. Therefore in these contexts, a decrease in autophagy could contribute to cellular dysfunction that occurs on the basis of accumulation of dysfunctional organelles or irreversibly damaged cellular substructures. Conversely, Continue reading >>

Diabetes Mellitus Acute Complications

Diabetes Mellitus Acute Complications

Acute complications of Type I or Type II Diabetes Mellitus (DM) can arise over hours to days in individuals and result from absolute or relative insufficiency of insulin. Acute complications are highly serious and in the absence of treatment can rapidly result in death. The basic etiology of these acute complications is an inability to properly metabolize glucose, resulting in hyperglycemia. However, disease tends to manifest along a spectrum with the ends being termed "Diabetic Ketoacidosis" (DKA) and "Hyperglycemic Hyperosmolar State" (HHS), discussed separately below. Pathogenesis Diabetic Ketoacidosis (DKA) is typically associated with Type I DM although it can occur in some patients with Type II DM as well. The pathogenesis of DKA requires both an absolute insufficiency of insulin along with excess of other hormones which boost blood glucose concentration such as glucagon, cortisol, circulating catecholamines, or growth hormone. This endocrine environment results in an inability of the body's tissues to import and metabolize glucose, resulting in hyperglycemia. In addition, alterations in adipose tissue metabolism result in adipocytes metabolizing and exporting fatty acids which upon reaching the metabolically-altered liver are converted into ketoacids. Therefore, DKA results in both hyperglycemia and ketosis. Clinical Consequences Hyperglycemia associated with DKA results in polyuria and ultimately volume depletion which may lead to hypotension and associated tachycardia. Release of large amounts of ketoacids give the patient's breath a characteristic fruity odor and can affect acid-base homeostasis, resulting in metabolic acidosis. Intense abdominal pain, nausea, and vomiting are also associated with DKA. If not treated promptly, patients with DKA can progress to Continue reading >>

Diabetes Symptoms, (type 1 And Type 2)

Diabetes Symptoms, (type 1 And Type 2)

Diabetes type 1 and type 2 definition and facts Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. Insulin produced by the pancreas lowers blood glucose. Absence or insufficient production of insulin, or an inability of the body to properly use insulin causes diabetes. The two types of diabetes are referred to as type 1 and type 2. Former names for these conditions were insulin-dependent and non-insulin-dependent diabetes, or juvenile onset and adult onset diabetes. Symptoms of type 1 and type 2 diabetes include increased urine output, excessive thirst, weight loss, hunger, fatigue, skin problems slow healing wounds, yeast infections, and tingling or numbness in the feet or toes. Some of the risk factors for getting diabetes include being overweight or obese, leading a sedentary lifestyle, a family history of diabetes, hypertension (high blood pressure), and low levels of the "good" cholesterol (HDL) and elevated levels of triglycerides in the blood. If you think you may have prediabetes or diabetes contact a health-care professional. Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or its action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with "sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine. Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food Continue reading >>

Acute Complications Of Diabetes Mellitus

Acute Complications Of Diabetes Mellitus

Sort Diabetic Ketoacidosis: Collaborative Care • Continuous cardiac monitoring • Start a large bore intravenous line • Administer fluid replacement • Place an indwelling urinary catheter • Monitor serum electrolyte and glucose levels • Replace potassium before administering insulin • Administer Regular Insulin infusion starting at 0.1 units/kg/hour • Monitor blood glucose levels frequently (Q 1 hr) - Blood glucose should fall at a rate of 30 to 50 mg/dL per hour • Monitor fluid status Hyperosmolar Hyperglycemic Syndrome: treatments • Treatments - Fluid replacement • IV 0.9% Sodium Chloride followed by 0.45% Sodium Chloride • Dextrose may be added to IV fluids when blood glucose is 250 mg/dl to prevent hypoglycemia - IV Regular insulin via an infusion pump (in dosages similar to those used in DKA) - Monitor fluid and electrolyte status. • Hypokalemia not as significant as with DKA. Continue reading >>

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