The document discusses acute and late complications of diabetes mellitus. Acute complications include diabetic ketoacidosis (DKA), insulin shock, and hyperglycemic hyperosmolar nonketotic coma. Late complications involve damage to organs over time and include retinopathy, neuropathy, and nephropathy. Treatment of diabetic nephropathy focuses on blood pressure control using ACE inhibitors or ARBs to slow disease progression.

1. DIABETIC NEPHROPATHY

2. ACUTE COMPLICATIONS OF
DIABETES MILLETUS
• DIABETIC KETO-ACIDOSIS (DKA)
• INSULIN SHOCK
• HYPERGLYCEMIC, HYPEROSMOLAR,
NONKETOTIC (HHONK) COMA
• SOMOGYI EFFECT

3. D.K.A.
PATHOPHYSIOLOGY
NO INSULIN
OSMOTIC
DEHYDRATION MARKED HYPERGLYCEMIA
GLUCOSURIA LIPOLYSIS
CELLULAR
HUNGER
OSMOTIC
DIURESIS WEIGHT
LOSS KETOACIDOSIS
POLYPHAGIA
POLYURIA
POLYDIPSIA

4. D.K.A.
S/SX:
• S/SX OF DM +
• KETONURIA
• METABOLIC ACIDOSIS
• KUSSMAUL’S RESPIRATION
• ACETONE BREATH
• DHN
• FLUSHED FACE
• TACHYCARDIA
• CIRCULATORY COLLAPSE COMA DEATH

5. COMPLICATIONS OF DIABETES
• Acute:
DKA
Hypoglycemia
• Late-onset:
Retinopathy
Neuropathy
Nephropathy
Ischemic heart disease & stroke

6. Treatment of Diabetic Nephropathy
• End stage renal disease is a major cause of death and
disability among diabetics
• Blood pressure reduction is an important initial step
in slowing the progression of diabetic nephropathy
• Randomized, blinded outcomes trials that
demonstrate a clear renoprotective benefit of ACE
inhibitors in diabetes have been conducted only in
type 1 diabetics
• Three recently completed randomized blinded trials
address the previously unanswered questions of
whether ARBs delay the progression of diabetic
nephropathy (RENAAL, IDNT) or reduce proteinuria
(IRMA II) in patients with type 2 diabetes
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