Complications of Diabetes are of two major types:
I. Short Term Complications:
II. Long Term Complications:
1. Diabetic Ketoacidosis:
Ketoacidosis is chiefly a complication of type 1 diabetes. Before the discovery of insulin, more than 50 % of diabetic patients die’s of ketoacidosis. Nowadays, although it is preventable, but then also nearly 2% diabetic patients die of ketoacidosis. Mainly the patients are not aware for the ill-effects of the poor control of diseases. It can be prevented only education to patients regarding its symptoms and a patient with dangerous ketosis, requires an urgent treatment, must immediately walk into hospital.
Diabetic ketoacidosis occur in patients with serve insulin deficiency combined with glucagon excess. Failure to take insulin and exposure to stress are the common precipitating factors. Excessive insulin deficiency leads to lipolysis (i.e. breakdown of fats) in the adipose tissues. This leads to the liberation of free fatty acids into plasma. These free fatty acids are taken up by liver where the enzyme acetyl co-enzyme –A, oxidizes the free fatty acid into ketone bodies. Due to increased ketogenesis, the rate at which th ketone bodies can be utilized by the muscles and other tissues, ketonaemia and ketonuria occur. It urinary excretion of ketone bodies is prevented due to dehydration, then systemic metabolic ketoacidosis occurs in which the normal acid-base balance of eth body is disturbed. In order to overcome this acidic condition, the bodies then use sodium potassium and calcium. These chemicals are thus lost to the body, resulting in the development of toxic condition. This affects the brain, the central nervous system and the heart. The other symptoms of ketoacidosis include intense thirst and polyuria. Constipation, cramps and blurred vision are common. In children, there may be abdominal pain, with or without vomiting. Weakness and drowsiness are commonly present, which many increase, further to unconsciousness or to “Diabetic Coma”. This is a very serious condition and must be treated early.
Due to dehydration, the patient shows dry tongue and softy eyeballs. The patient also shows air hunger’ which is indicated by long, deep, sighing respirations. There is rapid, week pulse. The blood pressure may be lowered. There may be abdominal rigidity and tenderness. There is smell of acetone in breath.
Sometimes diabetic coma can occur in elderly paitents, with extreme hyperglycemia and dehydration but no ketoacidosis. This is known as Hyperosmolar diabetic coma.
It is treated with urgency in hospital. Intravenous therapy is required, even when the patient is able to swallow, because the fluids given by mouth may be poorly observed. The aim should be to over come with all speed:
- Ketosis, by means of unmodified insulin to allow glucose utilization.
- Infection, if present by means of antibiotic.
- Shock, acidosis, and water and electrolyte depletion, by means of proper intravenous fluids.
Moreover, persons suffering from this disorder are given alkaline containing food, so as to neutralize the effect of acid forming foods. So, our daily diet must contain alkaline-forming foods such as fresh fruits, tubers, legumes, leafy and root vegetables. Eating sensibly, in proper manner, provides necessary alkalinity to the blood and thus the perfect body health is maintained.
2 . Hyperosmolar Non Ketotic Coma:
Hyperosmolar nonketotic coma is mainly seen in patients suffering from Type II diabetes. If is caused by severe dehydration due to continuous removal of sugar in urine known as hyperglycemic dieresis. The loss of glucose in urine is a intense that the patient is unable to drink sufficient water to maintain urinary fluid loss. The usual clinical features of keto-acidosis like acetone smelling breath is absent. But there ar prominent central nervous system signs present. Blood sugar is extremely high. Plasma osmolality is also high, so 0.45 % saline should be given until the osmolality reaches to normal level. Ketoruria is milD in such patients but plasma bicarbonate and PH are reduced in them. There is high concentration of lactic acid in blood. Due to high viscosity of blood, the thrombotic and bleeding complications are present. The mortality rate in hyperosmolar non-kenotic coma is more than 50%.
Treatment consists of administration of large amount of intravenous bicarbonate. These patients are relatively sensitive to insulin, so it is best to give about half the dose of insulin usually used in diabetic ketoacidosis. Dialysis may be required in causes where sodium over load occurs due to administration of large quantities of sodium bicarbonate.
Hypoglycemia is commonly seen in patients suffering from Type 1 diabetes. It may occur when excessive amount of insulin is administered to the patient, leading to fall in blood glucose level. It may also occur if the patient misses a meal. Stress may also lead to Hypoglycemia. Hypoglycemia is commonly seemed when the insulin have its maximum effect, that is, in the morning or in the early evening. Stomach upset, leading to vomiting before the food is digesting, also lowers the blood glucose level. If the patient is physically over exerted or had drank alcohol in an empty stomach, may also exhibit reduced blood glucose level. The symptoms of Hypoglycemia are weakness, intense hunger, sweating, palpitation, headache, anxiety, irritability, cold skin, high pulse rate, diplopia and mental confusion. Patient behaves abnormally as drunk. This shows that the patient’s brain is not getting enough glucose. If the patient’s low blood glucose level continues them he may pass out and go into coma. Even if Hypoglycemia is not treated, person’s death can occur.
The low blood glucose level can be treated by administering a quickly absorbed glucose source. It includes glucose containing drunks, such as orange juice, soft drinks (not sugar free) or glucose containing tablets. Pinch of cake frosting applied on the inner surface of check can also serve the purpose. If the patient becomes unconscious, then intramuscular injections of glucogan are given. So, patient suffering from Hypoglycemia must have a glucogan kit with him. Families and friends of diabetic patient must be taught how to administer glucogan, as the patient is unable to take it in an emergency situation. Another life saving device, is medical alert bracelet, which is worn by all patients suffering from diabetes.
Foods rich in vitamins C, E and B complex are also beneficial in the treatment of low blood sugar. Moreover, patients suffering from low blood glucose should take six to eight meals per day instead of two or three large ones. Administration of food or sugar the patient is in conscious state. Otherwise, the food or liquid may go into the lungs and cause more problems. Only a small sip is given at first, to make sure that the patient can swallow without any problem.