Complications of Diabetes Mellitus


By Dr Ali Omar

The complications of Diabetes mellitus are divided into Acute and chronic.

Acute Complications of Diabetes

  1. Diabetic ketoacidosis (DKA)

This is a major medical emergency seen especially in people with type 1 diabetes. The patient usually develops inter-current infections leading to loss of appetite so they think at this time they don’t need the insulin so much.

It is characterised by biochemical features Hyperglycemia, hyperkeratonemia (high ketone bodies) and metabolic acidosis.

Hyperglycemia causes profound osmotic diuresis leading to dehydration and electrolyte loss especially sodium and potassium. Ketones also accumulate in the blood due to increased lipolysis. All patients are usually depleted of potassium even though it might not show in the blood works.

Symptoms include polydipsia, polyuria, nausea, vomiting, blurring of vision and weakness. Signs picked by your Doctor are dehydration, hypotension, tachycardia, kussmaul breathing, sickly sweet smell of acetone, confusion, drowsiness and even coma.

Besides the blood sugar level in the investigation, urine analysis to show presence or absence of Ketones is important. UECs to check potassium is also important.

Intravenous soluble insulin and fluids is extremely important in managing DKA. Potassium replacement should be done too.

  1. Hyperosmolar Hyperglycemic state (HHS)

It is characterised by severe Hyperglycemia can be more than 50mmol/l without hyperkeratonemia or acidosis.

Common in elderly patient with previous history of undiagnosed diabetes.

Severe dehydration and hence fluids and half dose of insulin of the DKA is essential in the management.

  1. Hypoglycemia

Low blood glucose level of less than 3.5mmol/l. It occurs mainly in patients using Insulin. In those who have used insulin for many years, symptoms may develop when sugar level is below 2.5mmol/l due to cerebral adaption.

Signs and symptoms include sweating, trembling, tachycardia, hunger, anxiety, confusion and speech difficulty. In most cases the patient recognises the symptoms except during sleep.

Management depends on severity, ability to swallow and level of consciousness. Jam and honey may be effective. For those who are unable to swallow, Intravenous glucose 30-50ml of 20-50% dextrose or 1mg of intramuscular glucagon.

Chronic complications of Diabetes

Divided into Macro-vascular and Micro-vascular/Neuropathic.

Macro-vascular complications

Coronary circulation – Myocardial ischemia/infarct.

Cerebral – Transient ischemic attack and stroke.

Peripheral – claudication and ischemia.

Micro-vascular complications

Diabetic retinopathy leading to impaired vision and blindness in 30-65 years of age. Optimum glycemic control is essential in prevention.

Diabetic nephropathy leading to renal failure. Optimum glycemic control is essential in prevention.

Diabetic neuropathy leading to peripheral sensory loss and muscle weakness.

Diabetic foot – foot ulceration from trauma in the presence of neuropathy and infection. Control of sugars, treat infection and control of edema if present.

For the main article on diabetes mellitus Read here

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