Its Complications

Childhood
Diabetes Mellitus

Prof. Dr. Saad S Al- Ani
Senior Pediatric Consultant
Head of Pediatric Dep...
Throughout the world, incidences of diabetes are on the
rise, and consequently so is diabetes amongst children

Most child...
Number of children and young adults affected by type 2
diabetes is beginning to rise
Approximately 90% of young people wit...
A figure of 17 per 100,000 children developing diabetes
each year has been reported

As metabolic syndrome, obesity and ba...
How is diabetes caused in
children
The actual causes of the diabetic condition are little
understood
Inherited genetic cha...
What symptoms do children
with diabetes exhibit
A number of symptoms may give early warning that diabetes
has developed
On...
What symptoms do children
with diabetes exhibit
(Cont.)

11/30/2013

Complications of DM Prof.Dr.Saad S Al Ani

7
How are children with diabetes
treated
The only certain method of treating diabetes in children is
insulin treatment

Beca...
How are children with diabetes
treated
Fast-acting insulin will generally be administered during the
day, and nocturnal le...
How are children with diabetes
treated
Treating type 2 diabetes in children depends entirely on how
far their condition ha...
What can the parents of children with
diabetes do
Keeping a strict eye on the blood glucose levels

Avoiding lows and high...
What can the parents of children with
diabetes do

Patients and their families alike should know that support is
available...
Childhood Diabetes
Mellitus
Complications

11/30/2013

Complications of DM Prof.Dr.Saad S Al Ani

Where
we
are?

13
Conclusions :One-fourth of girls with type 1 diabetes
scored above the cutoff for DEB and one-third reported
skipping thei...
The prevalence of type 2 diabetes mellitus and prediabetes in children

Abstract OBJECTIVE: To investigate the incident an...
J Pediatr Endocrinol Metab. 2010 Jun;23(6):589-96.
Subclinical metabolic abnormalities associated with
obesity in prepuber...
•

Korean Circ J. 2010 Mar;40(3):125-30. doi: 10.4070/kcj.2010.40.3.125. Epub 2010 Mar 24.

Left ventricular function in c...
J Res Med Sci. 2013 Feb;18(2):132-6.
Prevalence and related risk-factors of peripheral neuropathy in children with insulin...
PLoS One. 2013 Apr 10;8(4):e60057. doi: 10.1371/journal.pone.0060057. Print 2013.
Skin and soft tissue infections and asso...
Diabetologia
Diabetologia. 2013 May;56(5):995-1003. doi: 10.1007/s00125-013-2850-z. Epub 2013 Feb 7.
Diabetic ketoacidosis...
Emergency Medicine Clinics of North America
Volume 31, Issue 3,
August 2013, Pages 755–773
Pediatric Emergency Medicine
Em...
Diabetes
Mellitus

Its Complications
http://thediabeteschallenge.org/

11/30/2013

Complications of DM Prof.Dr.Saad S Al A...
11/30/2013

Complications of DM Prof.Dr.Saad S Al Ani

23
Acute

11/30/2013

Complications

Complications of DM Prof.Dr.Saad S Al Ani

24
Diabetic ketoacidosis
Diabetic ketoacidosis (DKA) is an acute and
dangerous complication of diabetes mellitus
DKA is alway...
Diabetic ketoacidosis
(cont.)

Low insulin levels cause the liver to turn fatty acid
to ketone
Elevated levels of ketone b...
Diabetic ketoacidosis
(cont.)

On presentation at hospital, the patient in DKA is
typically dehydrated, and breathing rapi...
Diabetic ketoacidosis
(cont.)

Ketoacidosis can easily become severe enough to
cause hypotension, shock, and death
Urine a...
Diabetic ketoacidosis
(cont.)

Prompt, proper treatment usually results in full
recovery

Death can result from:
Inadequat...
Hyperglycemia hyperosmolar
state
Hyperosmolar nonketotic state (HNS) is an acute
complication sharing many symptoms with D...
Hyperglycemia hyperosmolar
state
(cont.)

Blood glucose levels
above 300 mg/dl
(16 mmol/L))

11/30/2013

Water is
osmotica...
Hyperglycemia hyperosmolar
state
(cont.)

11/30/2013

Complications of DM Prof.Dr.Saad S Al Ani

32
Hyperglycemia hyperosmolar
state
(cont.)

11/30/2013

Complications of DM Prof.Dr.Saad S Al Ani

33
Hyperglycemia hyperosmolar
state
(cont.)

Urgent medical treatment is necessary, commonly
beginning with fluid volume repl...
Hypoglycemia
Hypoglycemia, or abnormally low blood glucose,
is an acute complication of several diabetes
treatments
In pat...
Hypoglycemia
(cont.)

The patient may become agitated, sweaty, weak,
and have many symptoms of sympathetic
activation of t...
Hypoglycemia
(cont.)

11/30/2013

Complications of DM Prof.Dr.Saad S Al Ani

37
Hypoglycemia
(cont.)

In most cases, hypoglycemia is treated with
sugary drinks or food
In severe cases, an injection of g...
Diabetic coma
Diabetic coma is a medical emergency in which
a person with diabetes mellitus is comatose
(unconscious) beca...
Chronic

11/30/2013

Complications

Complications of DM Prof.Dr.Saad S Al Ani

40
Microangiopathy
The damage to small blood vessels leads to a
microangiopathy, which can cause one or more
of the following...
Microangiopathy (cont.)
3. Diabetic neuropathy
usually in a 'glove and stocking' distribution
starting with the feet but p...
Macrovascular diseases
They are not common in children as in adults

Macrovascular disease leads to cardiovascular
disease...
Macrovascular diseases

(cont.)

3.Peripheral vascular disease, which contributes to
intermittent claudication (exertion-r...
Complications
and poor control
Type 1 diabetes rarely results in retinopathy and
nephropathy within the first five years, ...
Complications
and poor control
By closely controlling
Blood sugar levels
Blood pressure and cholesterol
People with diabet...
References
1. "Diabetes Complications". Diabetes.co.uk. Retrieved 22 November 2012.
2. http://emedicine.medscape.com
3.Rom...
11/30/2013

Complications of DM Prof.Dr.Saad S Al Ani

48
11/30/2013

Complications of DM Prof.Dr.Saad S Al Ani

49
Upcoming SlideShare
Loading in...5
×

Childhood diabetes mellitus and its complications

1,300

Published on

what are the complications ,presentations ,features,management,

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,300
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
93
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Childhood diabetes mellitus and its complications

  1. 1. Its Complications Childhood Diabetes Mellitus Prof. Dr. Saad S Al- Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan Hospital Sharjah ,UAE saadsalani@yahoo.com
  2. 2. Throughout the world, incidences of diabetes are on the rise, and consequently so is diabetes amongst children Most children are affected by type 1 diabetes in childhood 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 2
  3. 3. Number of children and young adults affected by type 2 diabetes is beginning to rise Approximately 90% of young people with diabetes suffer from type 1 and the number of patients who are children varies from place to place 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 3
  4. 4. A figure of 17 per 100,000 children developing diabetes each year has been reported As metabolic syndrome, obesity and bad diets spread, so too have the first incidences of type 2 diabetes, previously incredibly rare. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 4
  5. 5. How is diabetes caused in children The actual causes of the diabetic condition are little understood Inherited genetic characteristics are triggered by environmental factors such as diet or exercise 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 5
  6. 6. What symptoms do children with diabetes exhibit A number of symptoms may give early warning that diabetes has developed One or more of the following symptoms may be associated with diabetes: Thirst Tiredness Weight loss Frequent urination Amongst children, specific symptoms may include: Stomach aches Headaches Behavioral problems 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 6
  7. 7. What symptoms do children with diabetes exhibit (Cont.) 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 7
  8. 8. How are children with diabetes treated The only certain method of treating diabetes in children is insulin treatment Because type 1 typically means that the vast majority of islet cells have been destroyed and insufficient or zero insulin can be produced, 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 8
  9. 9. How are children with diabetes treated Fast-acting insulin will generally be administered during the day, and nocturnal levels will be controlled by a slow-acting dose Insulin pumps are also common amongst children Good glucose control is essential in the management of all diabetics’ conditions. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 9
  10. 10. How are children with diabetes treated Treating type 2 diabetes in children depends entirely on how far their condition has developed An abrupt lifestyle change incorporating a healthier diet and exercise at an early stage 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 10
  11. 11. What can the parents of children with diabetes do Keeping a strict eye on the blood glucose levels Avoiding lows and highs Activity levels need to be closely monitored 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 11
  12. 12. What can the parents of children with diabetes do Patients and their families alike should know that support is available Understanding how the disease affects the child, being adaptable and patient, are essential to successfully managing diabetes 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 12
  13. 13. Childhood Diabetes Mellitus Complications 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani Where we are? 13
  14. 14. Conclusions :One-fourth of girls with type 1 diabetes scored above the cutoff for DEB and one-third reported skipping their insulin dose entirely at least occasionally after overeating. Both DEB and insulin restriction were associated with poorer metabolic control, which may increase the risk of serious late diabetes complications. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 14
  15. 15. The prevalence of type 2 diabetes mellitus and prediabetes in children Abstract OBJECTIVE: To investigate the incident and prevalence of type 2 diabetes mellitus (T2DM) and prediabetes in obese children in the last ten years. METHODS: The clinical data of hospitalized children with newly diagnosed diabetes mellitus (DM) or obesity between October 2000 and September 2010 were Conclusions: The prevalence rates of T1DM and T2DM retrospectively studied. RESULTS: A total of 503 newly onset cases were diagnosed as DM in the past ten years, of which 31 were diagnosed as T2DM. The prevalence of T2DM in the second five-year duration increased significantly in the last 5 years. The prevalence of increased significantly compared with that in the first five-year duration (0.18‰ vs 0.05‰; P<0.01). The T2DM of type 1 diabetes mellitus (T1DM) and T2DM increased by 1.35 fold and 4.20 fold, number of cases increased more significantly than T1DM. There was a respectively in the second five-year duration. A total of 1301 obese patients received oral glucose tolerance higher prevalence of prediabetes in obese children. Childhood tests, and 29 cases were diagnosed with T2DM and 255 cases with prediabetes. Of the 255 cases of obesity predicts a higher risk of T2DM and cardiovascular prediabetes, 133 had dyslipidemia, 138 had non-alcoholic fatty liver disease and 53 had hypertension. CONCLUSIONS: The prevalence rates of T1DM and T2DM increased significantly in the last 5 years. The disease in the future. prevalence of T2DM increased more significantly than T1DM. There was a higher prevalence of prediabetes in obese children. Childhood obesity predicts a higher risk of T2DM and cardiovascular disease in the future. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 15
  16. 16. J Pediatr Endocrinol Metab. 2010 Jun;23(6):589-96. Subclinical metabolic abnormalities associated with obesity in prepubertal Mexican schoolchildren J Pediatr Endocrinol Metab. 2010 Jun;23(6):589-96. Subclinical metabolic abnormalities associated with obesity in prepubertal Mexican schoolchildren. Romero JB, Briones E, Palacios GC, Castelán K. Source Departamento de Pediatría, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Saltillo, Coahuila, Mexico. Abstract Childhood obesity has increased to epidemic levels and is considered a public health problem due to its association with a number of metabolic abnormalities, which are being detected at earlier stages of life. The objective was to evaluate the association between the presence of subclinical metabolic abnormalities (SMA) and obesity in a sample of pre-pubertal Mexican schoolchildren. Children of both sexes and 6 to 13 years old were questioned for signs of puberty, In this sample of Mexican schoolchildren, obesity was groups were formed: underwent anthropometric measurement and had their Body Mass Index (BMI) calculated. Twoassociated those with obesity (case group) and those withof SMA, such as hyperinsulinism and to a higher frequency normal weight paired by age and chosen randomly (control group). Fasting insulin, glucose and cholesterol were measured. 92 children were included, 46 in each group, mean age 9.9 and 9.5 years old, impaired(p = 0.97). Aglucose, and to a family history ofthe case group: Fasting insulin respectively fasting higher frequency of hyperinsulinism was found in DM > 15 mU/ml, 75% vs. 21% (case group vs. control group, respectively); fasting glucose to insulin ratio < 6, 72% vs. 24%; HOMA IR > 2.7, 83% vs. 14%; and decrease in QUICKI (< 0.3), 80% vs. 19% (p = 0.000). Hypercholesterolemia was 25% vs. 15% (p = 0.22), impaired fasting glucose 28% vs. 8% (p = 0.01), and family history of diabetes mellitus (DM) 35% vs. 9% (OR = 5.6; 95% CI = 1.5-22.2; p = 0.002). In this sample of Mexican schoolchildren, obesity was associated to a higher frequency of SMA, such as hyperinsulinism and impaired fasting glucose, and to a family history of DM. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 16
  17. 17. • Korean Circ J. 2010 Mar;40(3):125-30. doi: 10.4070/kcj.2010.40.3.125. Epub 2010 Mar 24. Left ventricular function in children and adolescents with type 1 diabetes mellitus. Kim EH, Kim YH. Source Department of Pediatrics, Keimyung University School ofin children and adolescents with Left ventricular function Medicine, Daegu, Korea. Abstract type 1 diabetes mellitus. BACKGROUND AND OBJECTIVES: Adult studies have reported that patients with diabetes mellitus (DM) show ultrastructural and functional myocardial deterioration. The aim of this study was to assess whether cardiac functional deterioration can be detected in pediatric patients with type I DM and whether or not a relatively short duration of DM and hyperglycemia influences cardiac function. SUBJECTS AND METHODS: CONCLUSION: Forty-seven children and adolescents with DM and 38 healthy subjects (control group) were enrolled. Glycosylated Patients with DM-induced complications, and left ventricular (LV) function as assessed using conventional the hemoglobin (HbA1c), DM in childhood and early adolescence rarely have insight on and unconventional echocardiography {tissue Doppler imaging (TDI) and vector velocity imaging (VVI)} were evaluated. significance of DM, and their diet is difficult to control. An alteration of RESULTS: myocardial function induced by with may begin earlier than generally thought, The conventional echocardiographic parameters,DM the exception of early peak mitral inflow velocity, the findings of pulsed wave TDI at the annular level, and regional ventricular function by VVI, were not significantly different between and groups. changes are accelerated when glycemic control is poor. We the two theseUsing the conventional and unconventional indices of systolic and diastolic function, no significant relationship was found between the duration of DM and the echocardiographic parameters. The deceleration time (DT) recommend the early institution of close p=0.016, respectively). and E'/A' had an inverse correlation with HbA1c (p=0.042 and observation of patients with diabetes for CONCLUSION: in cardiac function, in addition to other diabetic complications alterations Patients with DM in childhood and early adolescence rarely have insight on the significance of DM, and their diet is difficult to control. An alteration of myocardial function induced by DM may begin earlier than generally thought, and these changes are accelerated when glycemic control is poor. We recommend the early institution of close observation of patients with diabetes for alterations in cardiac function, in addition to other diabetic complications. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 17
  18. 18. J Res Med Sci. 2013 Feb;18(2):132-6. Prevalence and related risk-factors of peripheral neuropathy in children with insulin-dependent diabetes mellitus. Hasani N, Khosrawi S, Hashemipour M, Haghighatiyan M, Javdan Z, Taheri MH, Kelishadi R, Amini M, Barekatein R. Source Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran. Abstract BACKGROUND: Diabetes mellitus (DM) is a common metabolic disorder that can cause various complications including, peripheral neuropathy (PNP). Some possible risk-factors such as blood glucose level, hyperglycemia, duration of diabetes, and lipid profiles are assumed to be important in diabetic PNP incidence. The aim of this study is to evaluate the prevalence and possible risk-factors of PNP in children with insulin dependent DM. MATERIALS AND METHODS: Among diabetic children, 146 patients (up to 18-years old) were evaluated in this cross-sectional study. All patients were examined for signs and symptoms of neuropathy and nerve conduction studies were performed. Blood level of glucose and lipid profiles were also tested. The relation between variables was compared by independent t-test and logistic regression test. RESULTS: The mean age of diabetic children was 11.9 3.3 years whereas mean diabetes duration was 3.8 2.9 years. PNP was detected in 40 patients (27.4%) that 62.5% of them have subclinical and 37.5% have clinical neuropathy. According to logistic regression analysis, duration ofdiabetes was the most important factor in prevalence of PNP (5.7 3.5 and 3.1 2.5 years in patients with and without neuropathy respectively, P < 0.001, 95% confidence interval [1.15-1.54]). CONCLUSION: As most of the patients had subclinical PN, neurological assessment is recommended to detect subclinical neuropathy in asymptomatic type 1 diabetic children and it seems that the best way to prevent this complication is still rigid blood glucose control and periodic evaluations. Prevalence and related risk-factors of peripheral neuropathy in children with insulin-dependent diabetes mellitus CONCLUSION: As most of the patients had subclinical PN, neurological assessment is recommended to detect subclinical neuropathy in asymptomatic type 1 diabetic children and it seems that the best way to prevent this complication is still rigid blood glucose control and periodic evaluations. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 18
  19. 19. PLoS One. 2013 Apr 10;8(4):e60057. doi: 10.1371/journal.pone.0060057. Print 2013. Skin and soft tissue infections and associated complications among commercially insured patients aged 0-64 years with and without diabetes in the U.S. Suaya JA, Eisenberg DF, Fang C, Miller LG. Source GlaxoSmithKlineVaccines, Philadelphia, Pennsylvania, United States of America. Jose.2.Suaya@GSK.com Abstract INTRODUCTION: Skin and soft tissue infections (SSTIs) are common infections occurring in ambulatory and inpatient settings. The extent ofcomplications associated with these infections by diabetes status is not well established. METHODS: Using a very large repository database, we examined medical and pharmacy claims of individuals aged 0-64 between 2005 and 2010 enrolled in U.S. health plans. Diabetes, SSTIs, and SSTI-associated complications were identified by ICD-9 codes. SSTIs were stratified by clinical category and setting of initial diagnosis. RESULTS: We identified 2,227,401 SSTI episodes, 10% of which occurred in diabetic individuals. Most SSTIs were initially diagnosed in ambulatory settings independent from diabetes status. Abscess/cellulitis was the more common SSTI group in diabetic and nondiabetic individuals (66% and 59%, respectively). There were differences in the frequencies of SSTI categories between diabetic and non-diabetic individuals (p<0.01). Among SSTIs diagnosed in ambulatory settings, the SSTI-associated complication rate was over five times higher in people with diabetes than in people withoutdiabetes (4.9% vs. 0.8%, p<0.01) and SSTI-associated hospitalizations were 4.9% and 1.1% in patients with and without diabetes, respectively. Among SSTIs diagnosed in the inpatient setting, bacteremia/endocarditis/septicemia/sepsis was the most common associated complication occurring in 25% and 16% of SSTIs in patients with and without diabetes, respectively (p<0.01). CONCLUSIONS: Among persons with SSTIs, we found SSTI-associated complications were five times higher and SSTI-associated hospitalizations were four times higher, in patients with diabetes compared to those without diabetes. SSTI prevention efforts in individuals with diabetes may have significant impact on morbidity and healthcare resource utilization. Skin and soft tissue infections and associated complications among commercially insured patients aged 0-64 years with and without diabetes in the U.S. CNCLUSIONS Among persons with SSTIs, we found SSTI-associated complications were five times higher and SSTI-associated hospitalizations were four times higher, in patients with diabetes compared to those without diabetes. SSTI prevention efforts in individuals with diabetes may have significant impact on morbidity and healthcare resource utilization 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 19
  20. 20. Diabetologia Diabetologia. 2013 May;56(5):995-1003. doi: 10.1007/s00125-013-2850-z. Epub 2013 Feb 7. Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels. Fredheim S, Johannesen J, Johansen A, Lyngsøe L, Rida H, Andersen ML, Lauridsen MH, Hertz B, Birkebæk NH, Olsen B, Mortensen HB, Svensson J; Danish Society for Diabetes in Childhood and Adolescence. Source Department of Paediatrics, Herlev Hospital, Arkaden, Turkisvej 14, DK 2730 Herlev, Denmark. sirifredheim@dadlnet.dk Abstract AIMS/HYPOTHESIS: We investigated the long-term impact of diabetic ketoacidosis (DKA) at onset on metabolic regulation and residual beta cell function in a Danish population with type 1 diabetes. METHODS: The study is based on data from DanDiabKids, a Danish national diabetes register for children. The register provides clinical and biochemical data on patients with type 1 diabetes diagnosed in 1996-2009 and then followed-up until 1 January 2012. Repeatedmeasurement models were used as statistical methods. RESULTS: The study population comprised 2,964 children <18 years. The prevalence of DKA at diagnosis was 17.9%. Of the total subjects, 8.3% had mild, 7.9% had moderate and 1.7% had severe DKA. DKA (moderate and severe) was associated with increased HbA1c (%) levels (0.24; 95% CI 0.11, 0.36; p = 0.0003) and increased insulin dose-adjusted HbA1c (IDAA1c, 0.51; 95% CI 0.31, 0.70; p < 0.0001) during follow-up, after adjustment for covariates. Children without a family history of diabetes were more likely to present with DKA (19.2% vs 8.8%, p < 0.0001); however, thesechildren had a lower HbA1c (%) level over time (-0.35; 95% CI 0.46, -0.24; p < 0.0001). Continuous subcutaneous insulin infusion (CSII) was associated with a long-term reduction in HbA1c, changing the effect of DKA, after adjustment for covariates (p < 0.0001). CONCLUSIONS/INTERPRETATION: DKA at diagnosis was associated with poor long-term metabolic regulation and residual beta cell function as assessed by HbA1c and IDAA1c, respectively; however, CSII treatment was associated with improvement in glycaemic regulation and residual beta cell function, changing the effect of DKA at onset in our population. Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels CONCLUSIONS/INTERPRETATION: DKA at diagnosis was associated with poor long-term metabolic regulation and residual beta cell function as assessed by HbA1c and IDAA1c, respectively; however, CSII treatment was associated with improvement in glycaemic regulation and residual beta cell function, changing the effect of DKA at onset in our population. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 20
  21. 21. Emergency Medicine Clinics of North America Volume 31, Issue 3, August 2013, Pages 755–773 Pediatric Emergency Medicine Emerg Med Clin North Am. 2013 Aug;31(3):755-73. doi: 10.1016/j.emc.2013.05.004. Epub 2013 Jul 6. Diabetic ketoacidosis in the pediatric emergency department. Olivieri L, Chasm R. Diabetic ketoacidosis in the pediatric emergency department Source Department of Emergency Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Abstract Despite many advances, the incidence of pediatric-onset diabetes and diabetic ketoacidosis (DKA) is increasing. Diabetes mellitus is 1 of the most common chronic pediatric illnesses and, along with DKA, is associated with significant cost and morbidity. DKA a patient has prolongedstate hallmarked by dehydration andif when is a complicated metabolic or multiple courses of DKA or electrolyte disturbances. Treatmentcerebralfluid resuscitation with can be DKA is complicatedconstant monitoring for the results insulin andDKA is by involves edema, cerebral edema. When electrolyte replacement under devastating. recognized and treated immediately, the prognosis is excellent. However, when a patient has prolonged or multiple courses of DKA or if DKA is complicated by cerebral edema, the results can be devastating. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 21
  22. 22. Diabetes Mellitus Its Complications http://thediabeteschallenge.org/ 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 22
  23. 23. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 23
  24. 24. Acute 11/30/2013 Complications Complications of DM Prof.Dr.Saad S Al Ani 24
  25. 25. Diabetic ketoacidosis Diabetic ketoacidosis (DKA) is an acute and dangerous complication of diabetes mellitus DKA is always a medical emergency and requires medical attention Ketoacidosis is much more common in type 1 diabetes than type 2 http://eatingacademy.com 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 25
  26. 26. Diabetic ketoacidosis (cont.) Low insulin levels cause the liver to turn fatty acid to ketone Elevated levels of ketone bodies in the blood decrease the blood's pH, leading to DKA 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 26
  27. 27. Diabetic ketoacidosis (cont.) On presentation at hospital, the patient in DKA is typically dehydrated, and breathing rapidly and deeply Abdominal pain is common and may be severe The level of consciousness is typically normal until late in the process, when lethargy may progress to coma 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 27
  28. 28. Diabetic ketoacidosis (cont.) Ketoacidosis can easily become severe enough to cause hypotension, shock, and death Urine analysis will reveal: Significant levels of ketone bodies 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 28
  29. 29. Diabetic ketoacidosis (cont.) Prompt, proper treatment usually results in full recovery Death can result from: Inadequate or delayed treatment Complications (e.g., brain edema). 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 29
  30. 30. Hyperglycemia hyperosmolar state Hyperosmolar nonketotic state (HNS) is an acute complication sharing many symptoms with DKA, but an entirely different origin and different treatment. It is more common in type 2 diabetes than type 1 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 30
  31. 31. Hyperglycemia hyperosmolar state (cont.) Blood glucose levels above 300 mg/dl (16 mmol/L)) 11/30/2013 Water is osmotically drawn out of cells into the blood Complications of DM Prof.Dr.Saad S Al Ani Kidneys eventually begin to dump glucose into the urine 31
  32. 32. Hyperglycemia hyperosmolar state (cont.) 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 32
  33. 33. Hyperglycemia hyperosmolar state (cont.) 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 33
  34. 34. Hyperglycemia hyperosmolar state (cont.) Urgent medical treatment is necessary, commonly beginning with fluid volume replacement. Lethargy may ultimately progress to a coma 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 34
  35. 35. Hypoglycemia Hypoglycemia, or abnormally low blood glucose, is an acute complication of several diabetes treatments In patients with diabetes, this may be caused by several factors such as: Too much or incorrectly timed insulin Too much or incorrectly timed exercise Not enough food 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 35
  36. 36. Hypoglycemia (cont.) The patient may become agitated, sweaty, weak, and have many symptoms of sympathetic activation of the autonomic nervous system resulting in feelings akin to dread and immobilized panic. Consciousness can be altered or even lost in extreme cases, leading to coma, seizures, or even brain damage and death 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 36
  37. 37. Hypoglycemia (cont.) 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 37
  38. 38. Hypoglycemia (cont.) In most cases, hypoglycemia is treated with sugary drinks or food In severe cases, an injection of glucagon or an intravenous infusion of dextrose is used for treatment, but usually only if the person is unconscious 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 38
  39. 39. Diabetic coma Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of the acute complications of diabetes: 1.Severe diabetic hypoglycemia 2.Diabetic ketoacidosis 3.Hyperosmolar nonketotic coma 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 39
  40. 40. Chronic 11/30/2013 Complications Complications of DM Prof.Dr.Saad S Al Ani 40
  41. 41. Microangiopathy The damage to small blood vessels leads to a microangiopathy, which can cause one or more of the following: 1.Diabetic cardiomyopathy leading to diastolic dysfunction and eventually heart failure. 2.Diabetic nephropathy can lead to chronic renal failure, eventually requiring dialysis. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 41
  42. 42. Microangiopathy (cont.) 3. Diabetic neuropathy usually in a 'glove and stocking' distribution starting with the feet but potentially in other nerves, later often fingers and hands 4.Diabetic retinopathy can lead to severe vision loss or blindness. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 42
  43. 43. Macrovascular diseases They are not common in children as in adults Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor: 1.Coronary artery disease, leading to angina or myocardial infarction ("heart attack") 2.Diabetic myonecrosis ('muscle wasting') 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 43
  44. 44. Macrovascular diseases (cont.) 3.Peripheral vascular disease, which contributes to intermittent claudication (exertion-related leg and foot pain) as well as diabetic foot 4.Stroke (mainly the ischemic type) 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 44
  45. 45. Complications and poor control Type 1 diabetes rarely results in retinopathy and nephropathy within the first five years, but kidney damage and eye diseases have been found to be more common amongst those with poor control. Risks of diabetes complications climb once HbA1c levels exceed 9%, and again increase significantly above 12%.. Type 2 diabetes may often result in vascular complications such as heart attacks, stroke and problems with circulation 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 45
  46. 46. Complications and poor control By closely controlling Blood sugar levels Blood pressure and cholesterol People with diabetes can help lower their risk of diabetes complications. A lifestyle involving: a good diet regular exercise no smoking Can also help to reverse diabetes complication risks. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 46
  47. 47. References 1. "Diabetes Complications". Diabetes.co.uk. Retrieved 22 November 2012. 2. http://emedicine.medscape.com 3.Romero JB. Subclinical metabolic abnormalities associated with obesity in prepubertal Mexican schoolchildren. J Pediatr Endocrinol Metab. 2010 Jun;23(6):589-96. 1. http://www.nlm.nih.gov 2. http://www.cdc.gov/diabetes 3. http://www.uptodate.com 4. http://care.diabetesjournals.org 5. http://www.global-sci.org/cjcp 6. http://www.degruyter.com/view/j/jpem 7. http://www.koreancircj.kr 8. http://journals.mui.ac.ir/jrms 9. http://www.plosone.org , 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 47
  48. 48. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 48
  49. 49. 11/30/2013 Complications of DM Prof.Dr.Saad S Al Ani 49
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×