Diagnosis and Management of Diabetic Coma
Diabetes is any disorder of the metabolism which causes excessive thirst and the production of large volumes of urine. A coma is a state of unrousable unconsciousness. (Martin (2002)) There are two types of diabetes:
Diabetes Insipidus (DI) is a rare metabolic disorder, the symptoms of which are the production of large quantities of dilute urine and an increased thirst. It is caused by a deficiency of the pituitary hormone Anti-diuretic hormone (ADH / vasopressin) which regulates water reabsorption in the kidneys. (Martin (2002))
Diabetes Mellitus (DM) has symptoms of polyuria, wasting and glycosuria (mellitus means 'sweet urine') as well as the following tests to give a laboratory diagnosis of DM:
Venous plasma glucose >11.1 mmol / L or
Fasting venous plasma glucose > 7.0 mmol / L or
Plasma venous glucose concentration > 11.1 mmol / L two hours after taking 75 g glucose in an oral glucose tolerance test (OGTT).
There are two types of DM; insulin dependent DM (IDDM or type 1) and non-insulin dependent DM (NIDDM or type 2)
Type 1 is caused by the destruction of pancreatic b cell destruction, which can be predicted by the detection of the presence of antibodies (Abs) to islet cells, (Pitteloud, Philippe (2000)) insulin and glutamic acid dehydrogenase (GAD) (a neurotransmitter) and a decrease in b cell insulin secretion. This destruction causes a decrease in insulin production, the hormone which stimulates glucose to be stored in the muscle and liver as glycogen.
Type 1 causes an abrupt onset of severe symptoms, including a tendency to ketosis and a dependence on exogenous insulin.
Type 2 is caused by a diet high in saturated fats, a lack of exercise and obesity. This is because the constantly high glucose levels cause insulin to be produced at constantly high levels, and so the body becomes desensitized to its effect as cells in target tissues posses fewer insulin receptors. Characteristics of NIDDM are that insulin is present, symptoms are moderate (tiredness and thirst), there is no tendency to ketosis and patients are not dependent on exogenous insulin. High blood glucose is controlled by diet, possibly with diabetic drugs.
Complications of DM are:
Cataract, as excessive blood glucose binds to lens proteins.
Retinopathy (micro-angiopathy) caused by hemorrhage, etc..
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...ether the cause is glucose concentrations being too high or too low. Many causes of diabetic coma can be treated easily with hormones and fluids.
References
EMANCIPATOR K (1999) Laboratory diagnosis and Monitoring of Diabetes Mellitus, American Journal of Pathology, 112(5) PP665-674
EVERS IM, TER BRAAK EW, DE VALK HW, VAN DER SCHOOT B, JANSSEN N, VISSER GH (2002) Risk indicators Predictive For Severe Hypoglycemia During The First Trimester of Type 1 Diabetic Pregnancy, Diabetes Care, 25 (3) Pp554-559
Previous course notes, BIOM2003
MARTIN ELIZABETH A (2002) Concise Medical DictionarySixth Edition, Oxford, Oxford University Press, Pp148, 190-191, 374, 665-666, 717
MAYNE Philip D. (2001) Clinical Chemistry Sixth Edition, London, Arnold, Pp209-210
MOHSENI S (2001) Hypoglycemic Neuropathy, Acta Neuropathology, 102 (5) Pp 413-421
PITTELOUD N, PHILIPPE J (2000) Characteristics of Caucasian Type 2 Diabetic Patients During Ketoacidosis and Follow-up, Schweiz Med Wochenschr , 130, Pp576 - 582
TORTORA Gerard J, GRABOWSKI Sandra Reynolds (2000) Principles of Anatomy and Physiology Ninth Edition, New York, John Wiley & Sons Ltd., Pp 41, 964, 966, c-0, c-1
4: Evers IM, De Valk HW, Visser GHA (2004) Risk of complications of pregnancy in women with Type 1 diabetes: Nationwide prospective study in the Netherlands. British Medical Journal 328, 915-917.
Type I Diabetes are often found or developed in children and young adults. It was previously called “juvenile diabetes”. Type II diabetes are found in adults and can be seen at any age. This is non insulin dependent diabetes.
The main cause of diabetes is that the insulin produced by the pancreas is not working properly so the body has an abnormally high blood glucose level. There are two important reasons why this happens: either there is no insulin present in the body, Type 1 Diabetes, or there is insulin present but it is unable to work, Type 2 Diabetes.
According to Lewis and associates, DM is a chronic disease that affects multiple body systems. For the purpose of this paper, only DM type 2 will be discussed based on the assumption that a majority of patients aged 60 years or older have this type. The primary defects of this disease consist of insulin resistance, decreased insulin production, inappropriate glucose production by the liver, and alterations in production of adipokines. Insulin resistance is the result of defects in the body’s insulin receptors. This finding predates all cases of DM type 2 and the development of impaired glucose tolerance. In insulin resistance, beta cells in the pancreas are stimulated to increase insulin production to compensate for the lack of response by the insulin receptors. Gradually, the beta cells begin to fail to secrete enough insulin to meet the body’s demands resulting in hyperglycemia. As a result of increased glucose in the liver, the liver begins to malfunction and release glucose at inappropriate times, thereby worsening hyperglycemia. Adding to the problem, glucose and fat metabolism is altered in adipose tissue, which is generally abundant in those with DM type 2. (Lewis et al., 2011)
The pathophysiology of diabetes mellitus in is related to the insulin hormone. Insulin is secreted by cells in the pancreas and is responsible for regulating the level of glucose in the bloodstream. It also aids the body in breaking down the glucose to be used as energy. When someone suffers from diabetes, however, the body does not break down the glucose in the blood as a result of abnormal insulin metabolism. When there are elevated levels of glucose in the blood, it is known as hyperglycemia. If the levels continue to remain high over an extended period of time, damage can be done to the kidneys, cardiovascular systems; you can get eye disorders, or even cause nerve damage. When the glucose levels are low in one’s body, it is called hypoglycemia. A person begins to feel very jittery, and possibly dizzy. If that occurs over a period of time, the person can possibly faint. Diabetes mellitus occurs in three different forms - type 1, type 2, and gestational.
A. One condition is known as hyperglycemia, which means that the blood glucose gets too
HbA1c has been suggested as a useful test for diabetes screening and diagnosis because it does not require fasting, it has less intraindividual variability, and it may better predict diabetes-related complications (Kramer, Araneta, & Barrett-Connor, 2010). Since fasting is not required for HbA1c testing the test can be done at any time, which makes diagnosing diabetes on the same day possib...
When looking at the common signs and symptoms of the disease, we understand that the symptoms are more readily recognizable in children than in adults. In Type I, we typically see a variety of symptoms shown by the child. Common symptoms within the Type I disease are typically related to the child’s low blood sugar. When this happens the child experiences, in most case, abdominal pain**, weight loss, thirst**, nausea, blurry eyes**, sweaty**, dry skin, and fatigue**. (Wong, Hockenberry, Wilson, 2015)
Diabetes type 1 occur when the immune system destroys the beta cells, they are responsible to create insulin and are located
Diabetes is a disease that affects the body’s ability to produce or respond to insulin, a hormone that allows blood glucose (blood sugar) to enter the cells of the body and be used for energy. Diabetes falls into two main categories: type 1, or juvenile diabetes, which usually occurs during childhood or adolescence, and type 2, or adult-onset diabetes, the most common form of the disease, usually occurring after age 40. Type 1 results from the body’s immune system attacking the insulin-producing cells in the pancreas. The onset of juvenile diabetes is much higher in the winter than in the summer. This association has been repeatedly confirmed in diabetes research. Type 2 is characterized by “insulin resistance,” or an inability of the cells to use insulin, sometimes accompanied by a deficiency in insulin production. There is also sometimes a third type of diabetes considered. It is gestational diabetes, which occurs when the body is not able to properly use insulin during pregnancy. Type 2 diabetes encompasses nine out of 10 diabetic cases. Diabetes is the fifth-deadliest disease in the United States, and it has no cure. The total annual economic cost of diabetes in 2002 was estimated to be $132 billion, or one out of every 10 health care dollars spent in the United States. Diabetes risk factors can fall into three major categories: family history, obesity, and impaired glucose tolerance. Minority groups and elderly are at the greatest risk of developing diabetes.
There are many symptoms of type one diabetes. They include drinking irritability, excessive urination, extreme weight loss, feeling very hungry or tired, sores that don’t heal and blurry eyesight. The cause of type one diabetes is unknown, although genetic tendency and childhood infections are two possibilities. The pancreas undergoes a change and cells that normally produce insulin are destroyed. This may be a result of the body’s own immune system believing the pancreas is a foreign organ. Also, type one diabetes often appears at times of physical stress and during illness when the body produces extra ...
When the blood sugar levels aren’t normal, it’s a disease called diabetes. Diabetes (diabetes mellitus) is a deficiency of the hormone insulin or the inhibition of its action with the cells. The insulin acts like a bridge between the glucose and the cells. In the US there are about 16 million people who suffer from diabetes. It is the seventh most common cause of all deaths. Diabetes is most common in Native American females over 45 years of age.
So what is a diabetic emergency? A diabetic emergency occurs when there is a severe imbalance between the amount of insulin and sugar in the body. There are two conditions that may result in a diabetic emergency. 1. Not enough insulin. This causes a high level of sugar or hyperglycemia. This can lead to a diabetic coma. 2. Too much insulin. This causes a low level of sugar or hypoglycemia. This may lead to insulin shock. Regardless, both conditions require the person to seek medical attention.
LaFleur Brooks, M. (2010). Exploring Medical Language, A Student – Directed Approach, 7th Edition, St. Louis: Mosby Elsevier.
“Diabetes mellitus (sometimes called "sugar diabetes") is a condition that occurs when the body can't use glucose (a type of sugar) normally. Glucose is the main source of energy for the body's cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. Insulin helps glucose enter the cells” (Diabetes Mellitus).