Diabetes Lecture 3

Course Overview

• Course no 3: Acute Complications of Diabetes

Agenda

• Acute Metabolic Complications of Diabetes:

  • Definition

  • Pathogenesis

  • Diagnosis

  • Treatment

• Specific Conditions:

  • Diabetic Ketoacidosis (DKA)

  • Hyperosmolar Hyperglycemic State (HHS)

  • Lactic Acidosis

  • Hypoglycemia in Diabetes

Diabetic Ketoacidosis (DKA)

Definition

• DKA is characterized by a triad of conditions:

  • Uncontrolled hyperglycemia

  • Metabolic acidosis

  • Increased body ketone concentration

Precipitating Factors

• DKA can occur in:

  • Type 1 Diabetes (absolute insulin deficiency):

    • Inaugural DKA

    • Discontinuation of insulin therapy (intentional, healthcare access issues)

    • Acute illnesses (e.g., trauma, stroke, infections)

  • Type 2 Diabetes (relative insulin deficiency):

    • Associated with acute illness

Pathogenesis

• Factors leading to DKA include:

  • Physical illness or stress: Infection or trauma

  • Insulin omission: Lack of insulin delivery, such as pump failures or intentional omission

  • Hormonal activity: Elevated counter-regulatory hormones (e.g., glucagon, cortisol)

  • Metabolic processes:

    • Increased lipolysis and ketogenesis

    • Hyperglycemia due to gluconeogenesis

    • Resulting dehydration and acidosis due to ketones

Clinical Diagnosis

• Symptoms may include:

  • Hyperglycemia symptoms: Polyuria, polydipsia

  • Signs of ketoacidosis: Kussmaul respirations, acetone breath, abdominal pain

  • Signs of dehydration: Poor skin turgor, hypotension, tachycardia

Diagnostic Criteria for DKA

Laboratory Findings

• Potential findings in DKA:

  • Hyperkalemia due to shifts of potassium in acidosis

  • Increased blood urea nitrogen due to hemoconcentration

  • Leukocytosis may indicate infection

  • Hyperlipidemia due to insulin deficiency

Treatment Objectives

• Goals of DKA Treatment:

  • Reduce blood glucose levels

  • Correct electrolyte imbalances

  • Suppress ketogenesis

  • Restore circulatory volume

  • Correct acidosis

  • Identify and treat underlying precipitating factors

Hypoglycemia in Diabetes

Definition of Hypoglycemia

• Whipple’s Triad for diagnosis:

  • Symptoms/signs of hypoglycemia

  • Low plasma glucose concentration (≤ 70 mg/dl for diabetics)

  • Resolution of symptoms after glucose elevation

Pathophysiology

• Causes include:

  • Excess insulin or insufficient carbohydrate intake

  • Increased glucose use (e.g., exercise)

  • Endogenous factors in diabetes (decreased glucagon response)

Clinical Classification of Hypoglycemia

• Types by severity:

  • Mild: Autonomic symptoms, self-treatment possible

  • Moderate: Autonomic and neuroglycopenic symptoms, self-treatment possible

  • Severe: Requires assistance for treatment

Diagnosis and Treatment

• Diagnosis: Confirmed by Whipple’s triad

• Treatment when Conscious:

  • Intake of 15-20g of fast-acting sugar

  • Re-check blood glucose after 15 minutes

  • Once stabilized, offer a balanced snack to prevent recurrence

• Severe Hypoglycemia:

  • Administer glucagon or IV glucose if unconscious

Key Takeaways

• Timely recognition and management of both DKA and hypoglycemia is critical to prevent severe complications and improve patient outcomes.