Acute Complications in Diabetes Mellitus

Previously I explained how is the metabolic stress in our body caused in Diabetes. Today we see the acute stage complications in Diabetes caused due to this metabolic stress. When I say acute stage complications it is immediate reaction of the body to high blood sugar or lack or increase of insulin/ drugs. In this case scenario the body gives no time and can sometimes go straight into coma. There have been cases where coma is bypassed into sudden death as well. The acute complications of diabetes mellitus are Hyperglycemic Hyperosmolar Non- Ketotic Syndrome , Hypoglycemia, and Diabetic Ketoacidosis. Let us go through the pathophysiology of each separately.

1. Diabetic Ketoacidosis - This is seen mainly in diabetes type I (complete lack of insulin secretion) or sometimes even type II (insulin resistance induced or inadequate insulin secretion). It is a fatal complication and can directly lead to death if undiagnosed or untreated. As I had previously mentioned ketoacidosis is a stage when the body breaks down fatty acids in the absence of glucose. Since the breakdown of fats is an anaerobic activity it is incomplete which leaves behind ketone bodies in the blood. Ketonic accumulation in the system leads to high acidity of the blood. Ketoacidosis leads to vomiting, dehydration due to the excessive urination and water accumulation in the blood vessels, ketone bodies also have an effect of disorientation of the brain leading to a state of confusion. There exist abdominal pain and a palpable abdomen, excessive thirst and deep labored breathing. The other symptoms are fruity odored breath and urine (ketone bodies smell fruity). Therapy requires immediate intravenous hydration and insulin dosage to prevent more ketone formation.

2. Hyperglycemic Hyperosmolar Non-Ketotic Syndrome - Although the name is too long it simply means dehydration of the body tissue without any ketone formation. Like the Ketoacidosis the high blood glucose level reaches a point (> 600mg/dl) where osmosis leads to the water in the cells (tissue) to come out into the blood vessels just so that the solute : solvent ratio is maintained on both ends. However due to extremely high glucose levels in the blood the water shift from the cells to the blood is quite high leading to extreme dehydration, polyuria. This leads to disordered mental functioning, confusion, tremors, and could also go into coma or death. Ketone formation is inhibited due to some insulin presence.

3. Hypoglycemia - One of the most dreaded conditions in diabetes is low blood glucose levels. Due to inaccurate insulin therapy or over dose of diabetic drugs the blood glucose level may hit an all time low. This leaves no glucose in the blood to be metabolized for energy. Due to lowered levels in the blood of glucose the body is depleted of any energy source. The brain takes the first hit where a state of dizziness sets in and leads to coma or unconsciousness.

Treating acute complications of diabetes is extremely important especially with the paucity of time given by the body. When the nutritional and pharmacological therapy of diabetes mellitus are balanced with each other this stage will not be experienced. Next post would be on the chronic complications of diabetes. Let me know through comments of your experiences with the disorder or contact me to know more about it.

Wish you wellness.
Neha Wasnik, R.D

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