Complications diabetes mellitus - late, acute vascular, chronic complications and treatment



Vascular complications in diabetes mellitusdiabetes, is a disease with the potential for serious chronic complications. If its normal for there is a strong likelihood that the patient will be able to lead a normal life, complications, all ends, indeed, in tears - coma. It can be:

All three have one name - hyperglycemic coma.


Acute complications

They represent a serious threat to patients ' lives. These include hyperglycemic and hypoglycemic coma. Most often, the condition of hypoglycemia develops on the background of the rapid decrease in the quantity glucose blood-related cardiovascular complications. Diabetic ketoacidosis, called a condition in which see sharp decompensation metabolic processes, because of the progressive shortage insulin. Its manifestation is characterized by a rapid increase in ketone bodies, blood glucose observe the development of metabolic acidosis.

Not without metabolic disorders. It proceeds in several phases:

Decompensation metabolism
• Ketoacids - a progressive disorder of metabolism, observed intoxication, depression of consciousness. In the analysis of urine, there has been a sharp presence of acetone
• Precoma is more strongly pronounced state of depression of consciousness. There may be stupor
• Coma severe metabolic disorders, the patient is unconscious. There is a threat to the life of the patient.

most Often, these cardiovascular complications result of refusal of admission medications or inaccuracy in the appointment of the insulin dose.

As a serious consequence of the exacerbation of diabetes is giperosmoljarnaja coma. It is due to high concentration in the blood vysokoosmotichnyh compounds of sodium, glucose. Initially see the development of intracellular dehydration, which leads to dehydration. In this case the worst is that dehydration in the first place exposed to the brain. The most susceptible to this type to diabetic patients 2 elderly.

Treatment when giperwolemicescoy and giperosmolarnaya Komax quite similar. But there are also serious differences. In the first place to make an accurate diagnosis by a doctor, after receiving data about the analysis of blood and urine. It can be noted that in the latter case, when you exhale, there is no smell of acetone.


Typical mistakes made in the treatment

complications of diabetesthe Most common of these is error in determining the severity of the patient with acute vascular complications. In particular, this concerns cases where moderate decompensation of diabetes, accompanied by ketonuria and ketosis is estimated as ketoacidosis. Unlike the past, when ketosis the condition of the patient is not highly heavy, it is regarded as average. This can be seen not only on tests, but also by external signs:

• Clear consciousness
• No clinical signs of marked dehydration
• there is No hypovolemia
• the parameters that determine acid-base status are within the limit values or are normal.

Is inappropriate in this case to rehydration and insulin therapy in mode, designed for the treatment of diabetic ketoacidosis ketoatsidoticheskaya coma. Ketosis when you see the lack of a clinically relevant hypovolemia and centralization of circulation. Therefore, patients permitted the introduction of insulin under skin.

Despite the state of the patient, especially if he refuses to eat or drink, do not stop taking insulin. In the case where the temperature rises above 37.5 one degree, 25% increased daily dose of insulin. When diagnosing the patient ketoatsidoticheskaya coma or diabetic ketoacidosis, insulin should be given only intravenously.

should Not be used in the treatment of ketoacidosis to the use of large (50 or more units) doses of insulin, as this can lead to brain swelling. The most likely to develop this type of complications are children and the elderly. Mortality during development is 70%.