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
Case study: Carol is 17 years old and was diagnosed with Type 1 diabetes at the age of 7 years. Carol has had a recent hospital admission for dehydration and high blood glucose. During the admission Carol was found to be 6 weeks pregnant. Prior to the admission she had been experiencing weight loss and changes in mood.
Diabetes mellitus, habitually referred to as diabetes is caused by a decline in insulin secretion by the cells of the pancreatic islet resulting into a surge in blood glucose concentration, a condition known as hyperglycemia. Diabetes insipidus is a disorder defined by the secretion of huge quantities of highly diluted urine, this is regardless if a reduction in fluid intake. This is as a result of a deficit of anti-diuretic hormone (ADH) also known as vasopressin produced by the posterior pituitary gland. The disorder diabetes mellitus is associated by extreme reduction in weight, a higher urge for urination, also known as polyuria, higher levels of thirst (polydipsia) and an extreme craving to eat known as polyphagia. This disorder has been categorized as Type 1 or insulin dependent diabetes and Type 2 or non-insulin dependent diabetes another type is the Gestational diabetes. The Type 1 diabetes mellitus is portrayed by a deficiency of the insulin-secreting beta cells of the islets of Langerhans found in the pancreas, this leads to a shortage of insulin. The principal cause for this deficiency of beta cells is a T-cell mediated autoimmune onslaught. In children, Type1 diabetes is known as juvenile diabetes. The Type 2 diabetes mellitus is as a result of insulin resistance or diminished insulin sensitivity coupled to a reduction in insulin production.
There are three classifications of diabetes mellitus, Type 1 diabetes, Type 2 diabetes, and Gestational diabetes (GD). The symptoms and effects of all three forms of diabetes are similar and the outcome for all three types is high blood glucose level or hyperglycemia. The noticeable symptoms include increased thirst (polydipsia), increased urination (polyuria), incre...
2. Type 2 on the other hand, results from the cell’s inability to use insulin appropriately (RCT).
There are two main types of diabetes. The firsts is insulin-dependent diabetes mellitus (IDDM). In IDDM the body either doesn’t produce diabetes or produces very small amounts. The symptoms usually occur in teenagers under 20, usually around puberty. Untreated IDDM affects the metabolism of fat. Since the body can’t convert glucose into energy, it is broken down into fat and stored for energy. This also increases the amounts of ketone bodies in the blood, which interfere with respiration. The second type is called is non-insulin-dependent diabetes mellitus (NIDDM). This is when the body doesn’t make enough insulin or is unable to use it. NIDDM is the most common of all diabetes; it makes up 90 to 95 percent of all cases. Scientists believe that in some people weight gain or obesity is what triggers their diabetes because 80 percent of people with diabetes are over weight.
The symptoms for type 2 diabetes develop gradually. About 95% of those who have diabetes are inflicted with this type 2, making it the most common form of diabetes. It is mostly associated with those who have weight problems (obesity), older age (above 45 years), genetics (family history of diabetes), not enough exercise, high blood pressure, high cholesterol, high blood levels of triglycerides and certain ethnics groups. Of these, more than 80% of those diagnosed are overweight. While diabetes type 1 afflicts those in childhood or adolescence, diabetes type 2 usually afflicts those more mature of age.
This type of diabetes is caused by the pancreas not producing enough insulin, in result, they need to be insulin dependent.
Diabetes Mellitus can be characterized into two different types, Type 1 Diabetes and Type 2 Diabetes. Type 1 Diabetes is usually diagnosed in children and young adults. In this less common form of the disease, the body does not produce insulin. Insulin is a hormone that assists glucose from the bloodstream in entering the cells of the body in order to provide energy. Type 2 Diabetes is typically diagnosed in patients who are older, struggle with obesity, have a family history of diabetes, or live a sedentary lifestyle. Type 2 Diabetes is a much more common form of the disease in which the body does not create or use insulin well. In patients with both Type 1 and Type 2 Diabetes, blood glucose
Diabetes affects 18.2 million people in the United States. It is often referred to by doctors as diabetes mellitus and described as, “… a metabolic disease in which the person has high blood sugar …” (Collazo- Clavell et all. 2009), either because the insulin is inadequate or the body’s cells don’t respond well to the insulin. The health and economic consequences of diabetes are considerable. The majority of people that have diabetes live in low and middle income countries, where the prevalence of the disease is high. There are three types of diabetes that are called type 1, type 2, and gestational diabetes. Although diabetes is a disorder, it can lead to other diseases such as heart attack, kidney failure or death. A person that has diabetes has to maintain a healthy lifestyle, by eating the right diet, controlling their blood sugar level, and be optimistic.
Diabetes mellitus type 1 (also known as type 1 diabetes, or T1D; formerly insulin-dependent diabetes or juvenile diabetes) is a form of diabetes mellitus that results from the autoimmune destruction of the insulin-producing beta cells in the pancreas.
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.
Diabetes is a chronic disorder of metabolism characterized by a partial or complete deficiency of the hormone insulin. With this, there are metabolic adjustments that occur everywhere in the body. Specific to this child is Type One Diabetes. This is characterized by demolition of the pancreatic beta cells, which produce insulin. Because of this, it leads to complete insulin deficiency. Within Type One diabetes, there are two different forms. First there is immune-mediated deficiency, which typically results from an autoimmune destruction of the beta cells. The second type is called idiopathic type one, in which the cause is unknown. (Wong, Hockenberry, Wilson, 2015)
The results show that after the consumption of 600ml of water, the participants had the expected amount of glucose within their urine. This shows that none of the participants are undiagnosed / untreated diabetic. This can be induced because glucose was not found in the urine. Within diabetic, glucose would be present as the body is unable to utilize the glucose therefore removes it from its system as it is unable to retain it.
Those affected by Type I diabetes have a complete lack of insulin due to the lack of functioning beta cells. And thus, daily injections of insulin are needed. Type II Diabetes occurs when insulin is still being produced and pancreatic beta cells still present, however, it is the tissues responsible for the absorption of insulin that fail to respond efficiently or effectively to normal insulin levels. An occurrence commonly known as insulin resistance. Also common in Type I Diabetes, is the fact it presents itself as the individual matures into adulthood, leading to the pancreatic decrease in the levels of insulin being secreted. Type II diabetes is becoming more common due to increasing obesity and failure to exercise, both of which contribute to insulin
The first step to knowing if you have diabetes is to identify its symptoms. Patients frequently overlook symptoms of: “Urinating often,” “Feeling very thirsty,” “Feeling very hungry even though you are eating,” “Extreme fatigue,” “Blurry vision,” “Cuts/bruises that are slow to heal” (“Symptoms”). These “symptoms of diabetes are typical. However, some people with type 2 diabetes have symptoms so...