Complications of diabetes
Acute complications of diabetes
Acute complications of diabetes pose a serious threat to life.Acute complications include hyperglycemic and hypoglycemic coma.Most often develops state of hypoglycemia, which occurs at a rapid decrease in blood glucose.Hyperglycemic coma (due to excessive increase in blood sugar) is divided into ketoatsidoticheskaya, hyperosmolar and giperlaktatsidemicheskuyu (lactic acid).
Ketoacidosis and ketoatsidoticheskaya coma
Diabetic ketoacidosis - an acute metabolic disorders as a result of progressive insulin deficiency, which manifests a sharp increase in glucose and ketone bodies in the blood, as well as the development of metabolic acidosis (a shift of blood pH in the acid side as a result ofaccumulation of toxic products of metabolism in the blood).
Metabolic disorders in the development of ketoacidosis occurs in several stages.The first stage - metabolic disorders - manifested by the presence of signs of excessive levels of blood sugar and sugar in the urine (norma
In most cases, the state of ketoacidosis is caused by the treatment regime change in the form of a long pass or complete abolition of the unauthorized reception of preparations.Most of the people with diabetes as received in the absence of appetite, fever, of nausea and vomiting.Quite often, a break in the reception tablets saharoponizhayuschih drugs is several months or even years.Second place among the causes of ketoacidosis occupy acute inflammatory diseases, exacerbation of chronic and infectious diseases.There may be a combination of the two.Also cause ketoacidosis can develop errors in the treatment of insulin preparations, such as the lack of its dosage or administering the drug unusable.As a cause and a consequence of ketoacidosis can be myocardial infarction and stroke.The development of ketoacidosis possibly during pregnancy when there is an increase in insulin requirements and the appearance of the relative stability of the tissue to it.Ketoacidosis occurs when stress such as shock, sepsis, trauma, surgery.
main role in the development of ketoacidosis belongs sharp deficiency of insulin.The result is a decrease in glucose entering the cell and, consequently, it increases the blood level.If any of the cells utilization of glucose energy shortage develops in the tissues.This causes an increase in blood flow ejection of hormones such as glucagon, cortisol, adrenaline.These hormones have an effect opposite to insulin, ie. E., They cause amplification of the formation of glucose in the liver.The resulting glucose enters the blood, whereby its level is increased even further.Hyperglycemia leads to the fact that the liquid enters the cell from the bloodstream.If you exceed a certain threshold glucose enters into the urine, t. E. Develop glucosuria.However, it comes into the urine water and electrolytes (sodium, potassium, calcium, fluoride, chloride).As a result of developing dehydration, severe electrolyte disorders, marked thickening of the blood, leading to the formation of blood clots.As a result of severe dehydration and reduction of circulating blood volume in vessels decreases the intensity of renal and cerebral blood flow, resulting in insufficient intake of oxygen to these organs.
vyzyvaetsnizhenie Reduced renal blood flow amount of urine, which leads to a rapid increase in blood glucose."Oxygen starvation" tissues causes a metabolic disorder, resulting in the body accumulates excessive amounts of lactic acid - lactate.The excess of this substance promotes blood pH shift to the acid side.Furthermore, the activation of the splitting fat in adipose tissue.As a result, the content of free fatty acid increases in the blood which enter the liver in excess.Free fatty acid in this case are the main source of energy.As a result of numerous chemical transformations of ketone bodies are produced (acetic acid, acetone).The amount of ketone bodies in the blood increases rapidly, which is connected not only with an increase in their formation, but the fact that their reduced excretion of urine.Ketone bodies, as well as lactate, promote blood pH shift to the acid side.The symptom is that the state of respiratory failure, as well as the appearance of pain in the abdomen.Also in diabetic ketoacidosis heart function is disturbed, there are the digestive system disorders, as well as many others, leading to cerebral edema.First of all when metabolic disorders affect the central nervous system, which is manifested by progressive impairment of consciousness.
Development ketoatsidoticheskaya coma preceded by three stages: ketosis, ketoacidosis, precoma.Each phase as we approach the coma is characterized by a worsening of metabolic disorders, resulting in a greater inhibition of consciousness.Ketoatsidoticheskaya coma develops in most cases for several days.ketosis stage is characterized by the following features: dry mucous membranes and skin progressive nature;It appears thirst;It increases the amount of urine, growing weakness;reduced appetite and body weight;there is a headache, and increased sleepiness.Others may note the presence of a weak breath smell of acetone.For detection of ketosis is necessary to analyze urine, wherein the violation detected ketones.With the progression of metabolic disorders develop ketoacidosis stage.It manifests the appearance of signs of excessive loss of body fluids: dry mucous membranes, tongue, skin, muscle tone and reduced skin turgor, there is a tendency to lower blood pressure, there is a rapid heartbeat, decreased urine output.In most cases of intoxication resulting nausea and vomiting.With the progression of ketoacidosis vomiting becomes more frequent, exacerbating the body's dehydration.Usually vomit krovjanisto have a brown tint.The rhythm of breathing is disturbed.A more clearly defined by the smell of acetone in the breath.There is expansion of blood capillaries, which leads to the appearance of diabetic blush.Quite often there are abdominal pain without clear localization, there is muscle tension anterior abdominal wall.These symptoms are the result of irritation of the peritoneum, and the solar plexus ketone bodies, a small hemorrhage in the peritoneum, as well as violations of motor activity of the intestine.Stage precoma different progression of impaired consciousness, worsening dehydration and intoxication.If left untreated, there is the progression of damage to the central nervous system that ends with the development of coma.Coma is characterized by a complete lack of consciousness.There was a sharp smell of acetone breath broken, her face pale, appears on the cheeks blush.Characteristic signs of dehydration: dry mucous membranes, tongue, and skin.Tissue turgor reduced, as well as the muscle tone and eyeballs.Blood pressure is reduced, rapid pulse, weak.Reflexes and all kinds of reduced or absent sensitivity that depends on the depth of coma.
Treatment of such a state is held exclusively in a intensive care unit.
state in which the celebrated high blood compounds such as sodium and glucose, called hyperosmotic.As a result of inadequate intake of these substances into the cells appear quite severe pressure difference between extra- and intracellular fluid.As a result, first developing excessive fluid loss cells that subsequently leads to total dehydration.Dehydration exposed primarily brain cells.The greatest risk of hyperosmolarity condition occurs in diabetes mellitus type II, mostly elderly streets.
Development hyperosmolar coma provokes dehydration and lack of insulin.Dehydration, in turn, provoke conditions such as vomiting, diarrhea, acute pancreatitis or cholecystitis, blood loss, prolonged use of diuretics, renal dysfunction, and others. By enhancing insulin deficiency in diabetes lead a variety of injury, surgery, long-term use of hormonaldrugs.
appearance of signs hyperosmolar coma is slow - a few days or weeks.Initially, there is a growing signs of diabetes, such as thirst, weight loss and an increase in urine.At the same time there are muscle twitches, which are constantly enhanced and transformed into spasms of local or generalized nature.Disorders of consciousness can be observed in the first days of the disease.First, these disorders are manifested in a decrease in the orientation of the surrounding area.Constantly progressing, impaired consciousness may go into a coma, which precedes the appearance of hallucinations and delirium.Hyperosmolar coma is characterized by symptoms of nervous system are very diverse and are manifested convulsions, paresis and paralysis, speech disorders, the appearance of involuntary movements of the eyeballs, signs of meningitis.Usually, the combination of these features is regarded as acute ischemic stroke.Externally, you can identify displays pronounced dehydration: dry skin and visible mucous membranes;skin turgor, muscle tone, and the tone of the eyeballs are reduced;marked pointed facial features.Breathing becomes shallow, frequent.Odor of acetone is no breath.There is a decrease in blood pressure, rapid pulse.Quite often, the body temperature rises to high numbers.Typically, the final step is the development of shock, the cause of which is pronounced circulatory disorders.
Treatment of this type of coma is also carried out in the conditions of intensive care unit.
Lactic acidosis and coma giperlaktatsidemicheskaya
Lactic acidosis - a condition shift the pH of the internal environment of the body to the acid side, which arises as a result of the increased content of lactic acid in the blood.The development of lactic acidosis can be triggered by a variety of diseases and conditions that are accompanied by a reduced supply of oxygen to the tissues of the body, as well as an increase in the intensity of education and decrease utilization of lactic acid.The more frequent the development of lactic acidosis in patients with diabetes mellitus due to the fact that it contributes to the state of chronic oxygen starvation of tissues.In addition, quite often patients with diabetes mellitus type II, especially the elderly, have multiple comorbidities.The most common such diseases are the pathology of the cardiovascular system, which is characterized by a state of chronic hypoxia.
Lactic acidosis initially manifested fatigue, increasing weakness, drowsiness, nausea, vomiting.These symptoms resemble decompensation diabetes.The main symptom that may cause suspicion in relation to lactic acidosis, is the appearance of muscle pains that are caused by the accumulation of lactic acid in them.Severe violation of condition may develop within a few hours.Usually his symptoms are respiratory failure, peripheral vascular expansion, a sharp decrease in blood pressure, cardiac arrhythmia, confusion, stupor or coma.The cause of death is when lactic acidosis, usually acute heart failure or respiratory arrest.
treatment is carried out in the intensive care unit.
Hypoglycemia and hypoglycemic coma
Hypoglycemia most difficult course of diabetes in people who are receiving treatment with insulin or with oral antidiabetic agents.Hypoglycemia - a syndrome caused by abnormally low blood glucose levels.Hypoglycemia can be mild when it is possible to adjust the intake of sufficient amounts of carbohydrates.In the case of severe hypoglycemia observed loss of consciousness, requiring intravenous glucose.Very often the state of hypoglycemia occurs in elderly people suffering from type II diabetes mellitus and treated with hypoglycemic drugs glibenclamide group purpose.Quite often these people have hypoglycemia periodically repeated.An extreme manifestation of a hypoglycemic state is hypoglycemic coma.It is defined as the acute occurs, life-threatening, a condition caused by a rapid and marked decrease in blood glucose levels, which is, in turn, the development of energy starvation of organism cells, swelling of the brain tissue, and in advanced cases - death of bark oreven the brain.Usually hypoglycemia in diabetes occurs when a rapid decrease in glucose levels to the lower limit of normal - 3.3 mmol / l.However, symptoms of hypoglycemia may develop even when the blood sugar level of 4.6 mmol / l.In such cases there is a distinct difference in the blood sugar level within a short period of time.
primary cause of hypoglycemia is an excess of insulin in the body relative to the amount of carbohydrates coming from food or from other sources (glucose production by the liver), as well as the accelerated utilization of carbohydrates during intensive muscle work.The development of hypoglycemia provoke the following factors: excessive physical activity, alcohol consumption, disturbance of diet in the form of improper eating regime or insufficient carbohydrate content in it, as well as an overdose of insulin or antidiabetic drugs tablets.Hypoglycaemia contributes to the first trimester of pregnancy, childbirth, chronic hepatitis, steatosis in diabetes, renal disease with renal failure, failure of the adrenal cortex and thyroid, as well as taking certain medications, such as salicylates.
Lowering blood glucose levels mainly reflect the state of the central nervous system.By reducing the level of glucose in the blood below the physiological level decreases as it enters the brain cells, leading to their energy starvation.This condition is called neyroglikopenii.It manifests itself in different stages of a variety of neurological disorders, which will eventually lead to loss of consciousness and the development of coma.The individual structures of the central nervous system have different sensitivities to energy starvation.Initially hypoglycemia gray matter affected cells located in the cerebral cortex, as they have the highest intensity of metabolic processes.This fact explains the appearance of symptoms neyroglikopenii for any more or less marked decrease in blood glucose levels.The least sensitive to hypoglycemia have centers such as respiratory and vasomotor.This explains the fact that respiration, vascular tone and cardiac activity for a long time maintained even in cases where long-term hypoglycemia leads to irreversible loss of the cerebral cortex.Art.