Complications of diabetes
Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise.
[8] DKA results from significantly low insulin levels due to various factors including undiagnosed diabetes (people who did not know they have diabetes), missed or delayed doses, insufficient insulin administration, or undergoing physiological stress (e.g. infection, surgery, Stroke, or trauma).
[9][10] Due to insulin absence, it simply triggers the release of counter-regulatory hormones resulting in serious health complications.
This release prompts excessive free fatty acids (FFAs) production as a result of the adipose tissue exhibiting heightened activity of hormone-sensitive lipase.
[15][8] The expected result of the treatment tackles the deeper causes; which are dehydration, acidosis, and hyperglycemia, and initiates a reversal of the ketosis process.
Patients' education and awareness of managing a sick day is a key element, as recognizing symptoms, and knowing when to contact a healthcare provider.
[18][8] If the fluid is not replaced, by mouth or intravenously, will ultimately result in dehydration (which in HHS typically becomes worse than DKA).
This is because the presence of a small quantity of insulin suppresses the release of counterregulatory hormones and limits the production of ketones.
[13][17] Rising obesity rates and the greater consumption of high-carbohydrate beverages have both played a role in the increased incidence of HHS.
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.
In severe cases, an injection of glucagon (a hormone with effects largely opposite to those of insulin) or an intravenous infusion of dextrose is used for treatment, but usually only if the person is unconscious.
The benefits of strict control of blood glucose were confirmed in longer-term follow-up by the DCCT EDIC study group.
[53] The situation regarding glycaemic control and complications in type 2 diabetes is less clear cut than for type 1, though there is evidence from the United Kingdom Prospective Diabetes Study Group that strict blood glucose control is beneficial for both microvascular and macrovascular complications.
In follow-up studies from the same group significant relative risk reductions emerged for myocardial infarction (15%, P=0.014) and all-cause mortality (12%, P=0.007).
[55] Research from 2007 suggested that in type 1 diabetics, the continuing autoimmune disease which initially destroyed the beta cells of the pancreas may also cause neuropathy,[56] and nephropathy.
[57] In 2008 it was even suggested to treat retinopathy with drugs to suppress the abnormal immune response rather than by blood sugar control.
[70] Different studies indicated possible role of thiamin supplementation on the prevention or reversal of early stage diabetic nephropathy,[71][72] as well as significant improvement on lipid profile.
[76] In clinical trials, homocysteine concentrations were effectively reduced within 4 to 6 weeks of oral supplementation of folic acid.
van Etten et al., found that a single dose of folic acid might help in reducing the risk of vascular complications and enhancing endothelial function in adults with type 2 diabetes by improving nitric oxide status.
[82] Based on observational studies among healthy individuals, antioxidant concentrations were found to be inversely correlated with several biomarkers of insulin resistance or glucose intolerance.
[2] Many observational and clinical studies have been conducted to investigate the role of vitamins on diabetic complications,[74] In the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, vitamin supplementations were associated with 24% reduction on the risk of diabetes[clarification needed], observed during 20 years of follow-up.
