COMPLICATIONS OF

DIABETES
 ACUTE CHRONIC
• DIABETIC KETOACIDOSIS. • VASCULAR DISEASES.
• LACTIC ACIDOSIS. • NEUROPATHY.
• HYPEROSMOLAR • KIMMELSTIEL-WILSON SYNDROME.
NONKETOTIC COMA • COMPLICATIONS IN EYES.
• COMPLICTIONS IN PREGNANCY.
ACUTE COMPLICATIONS.
DIABETIC KETOACIDOSIS
• More common in Type 1 Diabetes.
• Confirmed by ROTHERA’S test.
• 5 ml of urine saturated with ammonium sulphate.
• Few drops of sodium nitroprusside and 2ml liquid ammonia
added along sides of the test tube.
• Purple ring indicates presence of Ketone bodies in urine.
CAUSES..

• Deficiency of Insulin causes increased lipolysis and

releasing of excess Fatty acids into circulation.
• Oxidation of FA increases Acetyl CoA.
• Enhanced Gluconeogenesis restricts TCA cycle as the
availability of OAA is less.
• This leads to accumulation of Ketone bodies.
CONSEQUENCES…
• Metabolic acidosis.
• Reduced buffers.
• Kussmaul’s respiration.
• Smell of acetone in mouth.
• Osmotic diuresis.
• Sodium loss.
• High Potassium.
• Dehydration.
• Coma in severe cases.
MANAGEMENT / TREATMENT.

• IV Insulin and Glucose to control Diabetes.

• IV bicarbonate to correct acidosis.
• Normal saline to correct water imbalance.
• Correction of Insulin induced electrolyte imbalance.
HYPEROSMOTIC NONKETOTIC COMA.
• Due to very high levels of glucose - >900 mg/dl.
• Coma results from dehydration of cerebral cells due to
hypertonicity of the ECF.
 LACTIC ACIDOSIS.
• Occurs due to-
• Overproduction-Increased rate of anaerobic glycolysis due to
hypoxia.
• Underutilization-Impairment of TCA cycle.
• Seen when Diabetes is treated with oral Anti-Diabetics and Biguanides.
• Biguanides inhibit TCA cycle and gluconeogenesis.
• Also caused by excess intake of alcohol.
CHRONIC COMPLICATIONS.
VASCULAR DISEASES.

• Atherosclerosis and Plaque formation in medium – sized vessels

which leads to Intravascular thrombosis.
• If it occurs in Cerebral vessels – Paralysis.
• If it occurs in Coronary artery – Myocardial Infarction.
• In the small vessels it is called as Microangiopathy.
• May lead to Diabetic Retinopathy and Nephropathy.
 NEUROPATHY
• Peripheral neuropathy with paresthesia is common in Diabetes
mellitus.
• Caused due to –
• Decreased glucose utilization and its diversion to sorbitol in
Schwann cells.
• Productiiion of advanced Glycation end products.
• Neuropathy may lead to risk of Foot Ulcers and Gangrene.
KIMMELSTIEL-WILSON YNDEOME
• Results from Nephrosclerosis.
• Characterised by Proteinuria and Renal failure.
• Caused by persistent hyperglycemia leading to glycation of
basement membrane proteins.
COMPLICATIONS IN EYES

• Hyperglycemia causes increased Sorbitol formation which

leads to early Cataract ovvt eye.
• Retinal microvascular abnormalities leads to Retinopathy
and Blindness.
COMPLICATIONS IN PREGNANCY
• Diabetic mothers tend to have heavier babies as Insulin is
an Anabolic hormone.
• Chances of Abortion, Premature birth and Intrauterine
death of Fetus are also more.
THANK YOU