Complications of Diabetes Mellitus > 4 to 6 oz of fruit juice or regular soda

>6- 10 hard candies

Acute Complications: > 2 to 3 teaspoons of sugar of honey

 Hypoglycemia  Retest blood glucose after 15 minutes and re

 Diabetic Ketoacidosis
 Hyperglycemic Hyperosmolar Nonketotic
Syndrome (HHNS)
Chronic Complications:
A. Macrovascular Complications
a. Coronary Artery Disease
b. Cerebrovascular Disease
c. Peripheral Vascular Disease
B. Microvascular Complications
a. Retinopathy
b. Neuropathy
c. Nephropathy
Acute Complication: Hypoglycemia
 Abnormally low blood glucose levels
 Blood glucose: 60 mg/dL or less
May be due to:
1. too much glycemic agents
2 too little food
3. excessive physical exercise
treat if it is less than 70 mg/ dL or if blood
glucose test is impossible
 Re treat patient if symptoms persist longer
than 15 minutes after initial treatment.
 Protein - rich and starch - rich snacks are
served after treatment unless patient plans to
eat regular meal in 30 minutes.
B. If unconscious:
 Injection Glucagon - 1 mg subcutaneously or
intramuscularly.
 Injection 25 to 50 ml of 50% Dextrose in Water
(D5W) intravenously.
 It will take about 20 minutes for patient to
regain consciousness after glucagon injection
 Concentrated source of CHO followed by a
snack must be given to the patient on awakening
to prevent recurrence of hypoglycemia.
Acute Complication: Ketoacidosis
• Caused by absence or markedly inadequate amount of
insulin.
• Occurs Commonly to DM Type

Manifestations: 3 Main Clinical Features are:

A. Adrenergic symptoms
a. Hyperglycemia (blood glucose 300-800 mg/dL)
a. Sweating b. Dehydration and electrolyte loss
b. Tremor
c. Tachycardia Manifestations:
d. Palpitations  Polyuria
e. Nervousness  Polydipsia
f. Hunger  Blurred vision
 Weakness and headache
Manifestations:
 Orthostatic hypotension
B. Central Nervous System symptoms:
 With electrolyte imbalance, additional
symptoms develop
a. Inability to concentrate
b. Headache
Management:
Lightheadedness
d. Confusion  Treat hyperglycemia - Insulin
e. Memory lapses  Rehydration
f. Numbness of lips and tongue  Reversing Acidosis
g. Emotional changes  Restore electrolytes
h. Irrational behavior
i. Double vision
j. Drowsiness
k. Slurred speech
l. Impaired coordination Acute Complication: HHNS

In severe cases, patient may develop:
a. Disoriented behavior
b. Seizures
C. Loss of consciousness
Management: Hypoglycemia
A. If Conscious: Any of these given orally:
>3 or 4 commercially prepared glucose tablets
• Hyperosmolarity and hyperglycemia predominate, with
alterations of the sensorium.
• Ketosis is absent or may be minimally present
• Biochemical defect is LACK of INSULIN
• Persistent hyperglycemia leads to osmotic diuresis
which results to losses of water and electrolytes
Manifestations: HHNS
 Increased glucose levels - 600 mg/ dL or even
more
 Normal pH with BUN and Creatinine levels
elevated
  Hypotension /
 Profound dehydration 1 kidney filtration decreases and CHON from the blood
 Tachycardia is excreted in the urine.
 Variable neurologic signs /
CHON has fluid attracting properties and the pressure in
Note: with HHNS the blood and the kidneys are increased
 Serum osmolarity is >310 mOsm/Kg /
 (without acidosis) Blood pressure increases
/
 Serum sodium level >140 mEq/L
Kidneys fail to compensate (prolonged)
 Mortality rate is HIGH because most of the
/
patients affected are old
Nephropathy
Management: similar to DKA
Manifestations:
 Fluid replacement
 Albumin in urine
 Correction of fluids and electrolytes
 Increased serum BUN and Creatinine
 Administration of insulin

MACRO Vascular Complications

Macrovascular Complications:
Management:
 High glucose levels in the blood are likely to  Control of blood glucose
cause formation of plagues.
 Management of hypertension
 Blood vessel wall thickens, sclerosed and
 Low protein low sodium diet
become occluded by plague that adheres to the
 Prevention of UTI at early stages
blood vessels.
HEMODIALYSIS - to those with ESRD
3 Main Types of Macrovascular Complications:
Coronary Artery Disease
Peripheral Neuropathy
 Involves the peripheral, autonomic and spinal
 Cerebrovascular Disease
nerves
 Peripheral Vascular Disease
 Caused by chronic elevation of blood glucose
 Myocardial Infarction is common
levels
 Often involves the nerves of the lower
 Coronary Artery Disease accounts for 50 to 60
extremity, affecting the body symmetrically and
% of all deaths in Diabetes
proceeding proximally.
 Nerve fibers are damaged and are mainly
Cardiomyopathy
involved.
 In diabetes, the heart is exposed to an increased
 Paresthesia is a common symptom
supply of fatty acids and of glucose.
 The increase in substrate supply is accompanied
Note: the most common cause of hospitalization for DM
by systemic and myocardial insulin resistance.
patients is due to the complications of the lower
 This extreme metabolic environment influences extremities, specifically the foot (DM Foot)
energy substrate metabolism and directly affects,
myocyte survival, together with cardiac structure Filament test
and contractility
 Echocardiographic studies have shown that, in  Done to test sensation in sole of the foot with the
diabetes, the heart hypertrophies and stiffens use of monofilament.
 Diabetes also causes abnormal intracellular  Failure to feel in 4 out of 10 sites means (+)
calcium ion cyding, resulting in slowed myocyte peripheral neuropathy
contraction and relaxation
Management:
Management:
 Topical analgesics
 Modified Nutritional Therapy
 Weight loss and Exercises  Tricyclic Antidepressants
 Glucose monitoring and control
 Medication to control hyperglycemia,  Anti-seizure drugs
hypertension and hyperlipidemia
 Life style modifications - no smoking, no  Narcotic analgesics are least preferred
drinking
 Micro Vascular Complications  SURGERY: in case of gangrene with loss of
 Diabetic Nephropathy impulses

 25% of DM patients exhibit nephropathy After a Limb Amputation:

which usually develops after 10 years of
having the DM. • Phantom Limb Sensation - or Phantom pain sensation
could be present
Pathophysiology

Increased blood glucose