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3 Most Serious Acute Complications Of Diabetes.

1. Diabetic Ketoacidosis

2. Hyperglycaemic Hyperosmolar State

3. Lactic Acidosis

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Diabetic ketoacidosisSerious complication of T1 DM.

Less common in T2 DM.

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Type 2 diabetes Ketoacidosis rare - higher portal vein

insulin levels in type 2 diabetics than in type 1 diabetics.

Keeps the formation of ketone bodies in check.

Type 2 - Hyperosmolar nonketotic state.

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Insulin/glucagon ratio is decreased.

Marked insulin deficiency. Glucagon excess.

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Effect of decreased Insulin/glucagon ratio

Decreased peripheral utilization of glucose.

Increased gluconeogenesis. Osmotic diuresis and dehydration. Dehydration is characteristic of DKA.

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Activation of the ketogenic machinery

The second major effect of decrease in the insulin:glucagon

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DKA Due to combination of insulin

deficiency and counter regulatory hormone excess (glucagon, catecholamines, cortisol, and growth hormone).

Insulin deficiency and glucagon excess - necessary for DKA to develop.

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Hyperglycemia of DKA1. Due to increased hepatic

glucose production 2. Impaired peripheral glucose

utilization.

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Hypercortisolaemia Increases protein breakdown. Provides increased amino acid

precursors for gluconeogenesis. Glucose production is thus

increased.

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Glucose utilisation in peripheral tissues Decreased

insulin deficiency insulin resistance

Blood glucose levels rise glycosuria, osmotic diuresis and

dehydration

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Insulin deficiency stimulates lipoprotein lipase.

Excessive breakdown of adipose stores

Increase in FFA. Esterified to acyl CoA.

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Lipoprotein lipase is exquisitely sensitive to inhibition by insulin.

Lipoprotein lipase stimulates the breakdown of stored triglycerides in adipose tissue.

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Ketonemia and ketonuriaLiver - Oxidation of acyl

CoA produces ketone bodies

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Systemic metabolic ketoacidosis

Plasma hydrogen ion concentration increases

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Excessive breakdown of adipose storesLarge amounts of glycerol and FFA released into the circulation.

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GlycerolPrecursor for gluconeogenesis

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Ketone bodiesStrong organic acids. Buffered by bicarbonate.

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Systemic metabolic acidosis

The rapid increase in ketone body production outstrips the bodies buffering capacity provided by bicarbonate

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Ketoacidosis is rare in type 2 diabetes Much more common in T1 DM. Higher portal vein insulin levels in T2 DM

than in type 1 diabetics. Keeps the formation of ketone bodies in

check. T2 DM - hyperosmolar nonketotic

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Hyperosmolar nonketotic stateSevere dehydration Result from osmotic diuresis

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