Late complications of diabetes mellitus: prevention and treatment. Treatment of complications of diabetes

Features of the development of complications in type 1 and 2 diabetes

Russian statistics of complications of diabetes, the table shows data for 2016, obtained from medical institutions.


Late complications of diabetes mellitus: prevention and treatment. Treatment of complications of diabetes Elevated blood glucose gives rise to many vascular and metabolic disorders, which in turn lead to irreversible consequences in almost all tissues of the body, including vital organs. To prevent complications of diabetes, patients are prescribed treatment to normalize glucose as early as possible. It's important to know! A novelty recommended by endocrinologists for Permanent Diabetes Control! All you need is every day... In addition to glycemia, the rate of development of complications is influenced by the level of blood pressure and hereditary factors. In some patients with insufficient glycemic control, disorders begin decades later, but the vast majority of diabetics experience them already in 5 years of illness. Type 2 disease is usually diagnosed too late, when the first problems have already begun in patients. What are the types of complications in diabetes Complications in diabetes are usually divided into 2 volume groups - acute and late. Acute conditions include conditions that develop over hours, in extreme cases, over several days. Their cause is critically low or very high sugar in the vessels. In both cases, multiple changes in metabolism and organ function begin, coma occurs, and then death. sick need immediate medical attention, restore body functions in the intensive care unit. Diabetes and high blood pressure will be a thing of the past Diabetes is the cause of almost 80% of all strokes and amputations. 7 out of 10 people die due to blockage of the arteries of the heart or brain. In almost all cases, the reason for such a terrible end is the same - high blood sugar. It is possible and necessary to knock down sugar, otherwise there is no way. But this does not cure the disease itself, but only helps to fight the effect, and not the cause of the disease. The only medicine that is officially recommended for the treatment of diabetes and is also used by endocrinologists in their work is Ji Dao Diabetes Patch. The effectiveness of the drug, calculated according to the standard method (the number of recovered patients to the total number of patients in a group of 100 people who underwent treatment) was: Normalization of sugar 95% Elimination of vein thrombosis - 70% Elimination of a strong heartbeat - 90% Getting rid of high blood pressure 92% Increase energy during the day, improve sleep at night - 97% Ji Dao Producersare not a commercial organization and are funded with state support. Therefore, now every resident has the opportunity to get the drug at a 50% discount. Late complications accumulate over decades, their cause is. The higher the average blood sugar, the more actively the disorders develop. Late complications act in the nervous tissues and in the vessels at the macro and micro levels. First of all, the work of the most vulnerable organs is disrupted: the kidneys and eyes. Ultimately, a diabetic collects a whole "bouquet" of chronic diseases: from nephropathy to diabetic foot. In children, most of the complications appear during puberty. Acute complications in diabetics Not only the diabetic, but also his relatives should be aware of the possible options for acute complications. In all cases, these are coma states. They are caused either by severe decompensation of diabetes mellitus (hyperosmolar and ketoacidotic coma), or by an overdose of hypoglycemic agents (hypoglycemic coma), or by excessive lactate formation under the influence of external causes (lactoacidotic coma). It is not always possible to recognize acute complications at the initial stage. As the severity of the condition increases, the patient's consciousness quickly fades away, he needs the help of others. hypoglycemia Hypoglycemia in healthy people is considered to be a drop in sugar below 2.6 if characteristic symptoms are present: agitation, internal trembling, hunger, headache, active sweating, inability to concentrate. If these signs are absent, 2.2 mmol / l is considered a critical threshold. In diabetes mellitus, the perception of hypoglycemia may be impaired. Patients who often endure drops in sugar do not always feel them. Conversely, with constantly elevated glucose, symptoms can be felt when sugar drops to 5. With drug therapy, glycemia is raised to a lower limit of 3.3. Mild hypoglycemias are considered to be those that the patient managed to stop on his own, regardless of the sugar level and the severity of the symptoms. Every type 1 diabetic faces them at least once a week, even if his disease is compensated. Severe hypoglycemic complications include conditions in which a diabetic needs the help of outsiders. 4% of diabetic patients die from severe hypoglycemia. In most cases, the cause of death is not starvation of the brain (a direct consequence of a lack of glucose in the vessels), but concomitant factors: intoxication, heart rhythm disturbances, thrombosis. The frequency of severe hypoglycemia: type 1 diabetes - 0.08-0.14 cases per year per person, type 2 - 0.03-0.11 cases. Ketoacidotic coma Hyperosmolar coma The cause of this complication is also severe hyperglycemia, but metabolic disorders develop in a different way. Ketosis and acidosis in patients are absent, sugar increases sharply to 35 mmol / l and above, the osmolarity (density) of the blood increases, severe dehydration begins. Hyperosmolar coma is 10 times less common than ketoacidotic coma. Typical patient -. Risk factors - female gender, infectious diseases. A third of patients in hyperosmolar coma did not previously know that they had diabetes mellitus. This complication is quite difficult to detect at an early stage, since the diabetic only has symptoms of high blood sugar and dehydration. It is impossible to predict how metabolic disorders will develop. Fatal outcomes in hyperosmolar coma are more common than in ketoacidotic: the average mortality rate is 12-15%, if treatment was started at a severe stage - up to 60%. About hyperosmolar coma - Hyperlactacidemic coma In diabetic patients, lactates can accumulate in the blood. These are metabolic products that in healthy people are consumed in a timely manner by the liver. If for some reason this process is not possible, it develops. The complication is characterized by a high level of lactic acid in the vessels, a large anion gap. Dehydration is usually absent. When lactic acidosis enters a severe stage, all types of metabolism are disturbed, severe intoxication begins. Hyperlactacidemic (lactoacidotic) coma is the rarest and most dangerous type of coma. The complication occurs in 0.06% of diabetics, for most patients (according to various estimates, from 50 to 90%) it ends in death. In type 2 disease, the risk of lactic acidosis increases: metformin overdose; decompensation of diabetes mellitus; alcoholism; high physical activity; liver, heart, kidney or respiratory failure; anemia; elderly age. The more factors are present at the same time, the higher the likelihood of lactic acidosis. Late complications in diabetics With poorly compensated diabetes mellitus, disorders in the vessels and nerve fibers gradually develop. As a result, parts of the body and entire organs are deprived of normal nutrition, chronic diseases arise that significantly worsen the life of patients, and lead to premature death. Such diabetic complications are called late, since their development takes years, or even decades. As a rule, the first signs of disorders are diagnosed after 5 years from the onset of the disease. The better the glucose control, the later the complications of diabetes will begin. Late complications are divided into 3 large groups, each of which leads to the development of several chronic diseases: microvascular, macrovascular, neuropathy. Microvascular complications Pain in neuropathy can completely deprive a person of normal sleep, lead to severe depression. It literally exhausts the patient, in difficult cases it can only be eliminated by opioids. Sensitivity disorders lead to the fact that the diabetic does not feel minor injuries, burns, abrasions and begins treatment only when the wounds become infected. In addition, in diabetes mellitus, the restoring ability of tissues decreases. Together with angiopathy, neuropathy can lead to complex tissue damage up to necrosis. Most often, these complications develop on the soles of the feet (diabetic foot). It is impossible to predict which organ function the neuropathy will interfere with. Dizziness, arrhythmias, problems with digestion, urination, erection, sweating, and many other disorders may occur. Chronic complications
	Areas of thinned, dried, atrophied skin, outwardly similar to pigmentation or the effects of a burn.	Usually this is an exclusively cosmetic defect, itching is rarely possible.

Indicators	% of the total number of diabetics
Indicators	1 type	type 2
neuropathy	34	19
retinopathy	27	13
Nephropathy	20	6
Hypertension	17	41
Macroangiopathy	12	6
diabetic foot	4	2
Acute complications with coma	2,1	0,1
Developmental disorders in children	0,6	—

Percentages in this table are underestimated, as already identified complications are indicated here. Early violations can be detected only with a complete examination, which not every patient can afford.

The second type of diabetes has many factors that increase the risk of complications: advanced age, obesity, impaired blood lipid composition. Therefore, scientists categorically disagree with the above statistics. They believe that the health of patients with type 1 diabetes is better controlled, while the complications of type 2 diabetes are detected at a late stage.

Type 2 disease may not manifest itself for a long time, but complications begin to develop already in the period. It takes an average of 5 years before the diagnosis of the disease. To detect diabetes earlier, during periodic medical examinations, the adult population takes a glucose test. This study will help identify existing diabetes mellitus, but not previous conditions. You can diagnose the first carbohydrate disorders with the help of, which is not included in the medical examination plan, you will have to take it on your own.

Prevention of complications - how to avoid

It is worth remembering that diabetes develops complications only with high sugar. Not a single diabetic can completely avoid hyperglycemia, but everyone can reduce their number.

For better compensation of diabetes mellitus, treatment correction is required:

Changing nutrition. Small portions, lack of fast carbohydrates, thoughtful composition and calorie content of food are a significant step towards normal sugar.
Physical exercise. Mandatory minimum - 3 lessons of 1 hour per week. Daily exercise will improve the compensation of diabetes.
Regular glycemic control. It has been established that frequent measurements of sugar increase the adherence of patients to treatment and contribute to a decrease in the level.
Do not be afraid to increase the dose of tablets within the limits allowed by the instructions. Complications due to high sugar are much more dangerous than possible side effects.
If hypoglycemic agents do not give normal glycemia, insulin is needed. The best control of diabetes mellitus is currently provided by an intensive regimen of insulin therapy with insulin analogues and.

You can completely cure the initial stage of complications. Then we are talking only about the prevention of the progression of existing disorders.

Be sure to study! Do you think lifelong pills and insulin are the only way to keep sugar under control? Not true! You can verify this yourself by starting to use ...

Late complications of diabetes include such changes in the organs that have developed in the long term from the moment the diagnosis of diabetes mellitus was established. This group of complications develops in both type 1 and type 2 diabetes. A distinctive feature is that in type 1 diabetes, complications really occur in the later stages - after 10-15 years from the onset of the disease. In type 2 diabetes, it often happens that complications come to the fore. Until then, the patient may not know that his glucose level is higher than normal. This is due to the fact that for many years type 2 diabetes can be asymptomatic, and with the development of one or another complication, the patient inevitably turns to a doctor who makes a diagnosis.

Diabetes mellitus (DM) is a global medical and social problem in all countries and continents. The disease is characterized by chronic hyperglycemia (elevated blood glucose levels) and associated changes in many organs. The disease affects, first of all, blood vessels and the heart. Patients with diabetes are at risk, almost all other diseases they have are more severe, and complications are life-threatening.

Hyperglycemia itself is not as terrible as the complications of diabetes arising from high blood sugar. Complications are the cause of disability and death of diabetics.

According to experts involved in research in this area, already in 2030, diabetes will be detected in every fifteenth inhabitant of the planet Earth.

Diabetes is a disease that is studied in detail by the science of endocrinology. After all, the reason for its development is in one of the endocrine organs - the pancreas.

The pancreas produces a hormone - insulin, the main function of which is to help cells process glucose. Most organs (heart, liver, adipose tissue) can convert glucose into the energy needed for life only with the help of insulin. These are insulin dependent organs. Only the brain does not need assistants - it is able to process glucose on its own (an insulin-independent organ).

In type 1 diabetes, damage is noted in the pancreas itself, when its special cells (beta cells), damaged by autoimmune components, do not produce insulin in the proper amount.

Type 2 diabetes is characterized by a relative lack of insulin - the pancreas produces it normally, but organs and tissues become insensitive (insulin resistant) to it.

Late Complications of Diabetes and Health Conditions

In both types of diabetes, late complications of diabetes have a significant health impact, being the most common cause of death from this pathology.

In type 1 diabetes, complications associated with damage to small vessels are more often detected, while in type 2 diabetes, complications associated with damage to large vessels are most frequent.

Most often, large-caliber vessels suffer from diabetes, this condition is called diabetic macroangiopathy. This is due to long-term hyperglycemia, which inevitably leads to atherosclerotic vascular damage - cholesterol plaques are deposited on the walls of the vessels, the walls of the vessels thicken, become rigid. The lumen of the vessels narrows, which leads to hypoxia (oxygen starvation) of organs and tissues, strokes and heart attacks.

Clinically, macroangiopathy in diabetes is manifested by coronary heart disease, atherosclerosis of the vessels of the brain and extremities, arterial hypertension. Moreover, the course of these diseases does not differ from those in people with normal blood glucose levels.

Only the incidence of cardiovascular disease in people with diabetes has incredibly high rates. Thus, the risk of developing coronary heart disease in people with type 2 diabetes is 6 times higher than in people without hyperglycemia.

High blood pressure is observed in 20% of patients with type 1 diabetes and in 75% of patients with type 2.

Heart attacks and strokes are the most common cause of death in type 2 diabetes. A feature of the course of a heart attack in diabetes mellitus is its painless form. This is noted in about 30% of cases and is probably associated with simultaneous nerve damage in diabetes.

Diabetic neuropathy

The nervous system is affected in 30% of cases in type 1 and type 2 diabetes. The cause of damage in the nerves is hyperglycemia: microangiopathy in the vessels that feed the nerve trunks leads to disruption of their normal nutrition. High blood glucose leads to the accumulation of free radicals, which have a damaging effect on nerve tissue.

Diabetic neuropathy has two forms:

touch form.

It is characterized by a violation of sensitivity and motor function. Patients complain of unusual sensations that appear in the limbs: "crawling", "cotton legs", loss of sensation like "gloves" and "stocking", "foreign legs". There may be pain in the limbs, which disappear after walking. More often, pain occurs at night, and even the touch of bed linen can cause them. Over time, the pain syndrome may disappear, which is associated with the death of small nerves.

vegetative form.

From the side of the cardiovascular system: tachycardia at rest, fainting, heart attack without pain. From the gastrointestinal tract: violation of the contractile function of the stomach with slow or too rapid evacuation of the contents, reflux of gastric contents into the esophagus, diarrhea. From the genitourinary system: violation of the tone of the bladder, which leads to frequent inflammatory diseases, erectile dysfunction in men.

It is characterized by an increase in pressure inside the vessels of the renal glomeruli and the loss of protein in the urine due to a violation of the filtration function. And arterial hypertension present in DM exacerbates the situation.

As diabetes mellitus progresses, the death of the renal glomeruli and the replacement of the renal tissue with connective tissue (glomerulosclerosis) occurs. The outcome of diabetic nephropathy is chronic renal failure. This complication is more common in type 2 diabetes and in 15% of cases is the cause of death in this group of patients.

diabetic foot

Diabetic foot syndrome develops due to damage to the nerves, blood vessels, soft tissues and bones. This complication most often leads to the need to amputate the foot.

Complication can manifest itself in the following forms:

neuropathic form.

This complication of diabetes is characterized by nerve damage, the patient loses sensitivity, and the skin and soft tissues of the foot undergo atrophy. Parts of the foot that are exposed to friction thicken due to the growth of the stratum corneum (hyperkeratosis). Sensory impairment leads to the fact that the patient does not notice the damage. Wearing tight shoes, inaccurate pedicure can lead to the appearance of small wounds and cracks, which subsequently become inflamed when the infection joins and lead to long-term non-healing ulcers. Further, bones and ligaments are involved in the process, osteoporosis, osteolysis (melting of bone tissue) occurs, Charcot's joint is formed (destruction of the joint due to impaired sensitivity). Figuratively, such a foot is called a "bag of bones."

Ischemic.

As a result of atherosclerosis of the vessels of the extremities. It is characterized by a violation of blood circulation in the foot. The feet become cold, "intermittent" lameness is characteristic, the pulse on the vessels of the foot is weak or not palpable. Acronecroses occur - the death of soft tissues at the fingertips.

Neuroischemic.

With this form, the signs of the neuropathic form of the diabetic foot are combined with the signs of the ischemic.

The main task of physicians is to inform the patient about the possible complications of diabetes and teach him the basic preventive measures aimed at preventing their development.

General medical supervision is important for everyone, but people with diabetes should be especially attentive to their health. Many common comorbidities (ARI, pneumonia, gastritis, colitis) pose particular challenges for people with diabetes, as the disease can get out of control very quickly. Fever, dehydration, infection, and stress can cause your blood glucose levels to rise quickly. This can lead to ketoacidosis.

Feet care

If you have diabetes, you need to take good care of your feet. Poor circulation in the foot can lead to serious complications. If the circulation is disturbed, numbness and pain in the legs appear when walking, or at rest, or during sleep, the legs are cold, pale blue or swollen, cuts on the legs do not heal well.

To take care of your feet:

wash your feet daily using warm (not hot) water and mild soap;
dry your feet thoroughly, especially between the toes;
check for cracks, dry skin or cuts on the legs;
use an emollient cream to keep the skin smooth;
cut toenails only in a straight line;
wear comfortable shoes. Make sure that there are no sand or pebbles in the shoes;
wear clean socks daily.

You cannot do:

soar legs;
apply cream on cuts or between fingers;
use sharp objects to cut the skin on the legs;
use home remedies to remove corns;
walk barefoot;
use compresses or heating pads.

If you find abrasions, cuts, wounds on your legs, you should immediately consult a doctor!

Eye Care

Eye care is a very important component of overall medical care. People with diabetes have a much higher risk of eye damage than normal people. Be sure to have your eyes checked regularly by an optometrist. If you have diabetes, you need to check your eyes annually, preferably every six months. Prevention of complications of diabetes mellitus is based mainly on self-control. If you want to be healthy, then be sure to follow all medical recommendations.

To prevent complications of sugar, it is necessary to adhere to certain rules:

Continue insulin therapy at the same doses, never skip insulin injections. The need for insulin during illness not only persists, but also increases. In this case, the dose of insulin should not be reduced, even if the need for food decreases, since a stressful situation (illness) leads to an increase in blood sugar levels.
If you have type 2 diabetes, then continue using diabetic tablets.
Check your blood glucose and urine ketones. Hyperglycemia (more than 13 mmol / l) requires an increase in the dose of insulin;
Contact an endocrinologist immediately if the disease lasts more than a day (vomiting, abdominal pain, rapid breathing).

Follow the diet.
Check your blood glucose levels regularly with .
With hyperglycemia over 13 mmol / l, be sure to take a urine test for the presence of ketone bodies.
Monitor the level of cholesterol and triglycerides in the blood (at least once every 6-8 months).
Get rid of bad habits (smoking, alcohol).
Carefully take care of your feet, skin, eyes.

Handbook for a diabetic Svetlana Valerievna Dubrovskaya

Prevention of complications of diabetes

In order to prevent the occurrence of complications of diabetes, the patient must comply with all doctor's prescriptions, follow a strict diet, as well as limit physical activity and monitor their mental state. In some cases, doctors recommend that their patients periodically undergo a course of physiotherapy.

Physiotherapy has a beneficial effect in uncomplicated diabetes mellitus, accompanied by angiopathy or neuropathy (in the absence of ketoacidosis). The appointment of such procedures is associated with the need to stimulate the activity of the pancreas, improve blood circulation and increase the overall tone of the patient's body.

Sinusoidal modulated currents (SMT) cause a gradual decrease in blood glucose levels, stabilize lipid metabolism and prevent the formation of angiopathy of varying severity. The full course of therapy usually consists of 10 to 15 procedures.

The combination of SMT with electrophoresis is most often prescribed for type II diabetes, simultaneously with the active substance (maninil, adebit, etc.). In some cases, the doctor may recommend electrophoresis with nicotinic acid, which stimulates the functioning of the pancreas, and also helps to increase the lumen of small and large blood vessels.

For general strengthening electrophoresis, magnesium preparations are used (which contribute to a gradual decrease in blood pressure and eliminate hypercholesterolemia), potassium (which have an anticonvulsant effect and improve liver function), copper (in order to prevent the development of angiopathy and simultaneously reduce blood glucose levels), heparin (as a prophylactic against retinopathy), prozerin with galantamine (to improve the functioning of muscles and the nervous system, to prevent atrophy of muscle fibers).

All of the above drugs should be prescribed by a specialist, self-medication in such cases can lead to the development of severe side effects. The doctor also determines the duration of the individual procedure and the entire course of therapy.

High frequency ultrasound (UHF) stimulates the liver and pancreas, preventing some of the complications of diabetes. Usually a full course of treatment includes 13-15 procedures. In addition, the effect of ultrasound on the body has a gradual hypoglycemic effect and prevents the development of lipodystrophy in the areas of the body used for injections.

Ultraviolet irradiation (UVR) improves metabolism in the body, ensures the full absorption of calcium and phosphorus compounds, prevents the destruction of bone tissue, lowers blood glucose levels and stimulates the formation of a natural skin barrier that protects internal tissues from the penetration of pathogenic microorganisms.

Hyperbaric Oxygen Therapy (HBO) is an oxygen treatment using a local increase in pressure. This type of prevention of complications of diabetes prevents oxygen deficiency, helps to avoid the progression of neuropathy and diabetic foot. Usually a full course of therapy includes 10 to 15 procedures. Claustrophobia is a contraindication to such manipulations (since during treatment the patient must be in a pressure chamber, which is a closed space).

Electrosleep is prescribed in the presence of concomitant diabetes diseases - hypertension and coronary heart disease. Therapeutic procedures help to avoid the development of hypertensive crises and eliminate pain.

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In diabetes, there are two groups of complications: acute and chronic. Acute complications of DM develop within hours or days, chronic ones - within a few months, but more often years or even decades. Therefore, chronic complications of diabetes are also called "late".

Acute complications of diabetes mellitus.

Acute complications of diabetes include ketoacidotic, hyperosmolar (hyperglycemic) and lactic acid coma. Hypoglycemic coma, which can complicate hypoglycemic therapy for diabetes, is considered separately. Laboratory signs of diabetic coma are given in Table. 6.

Ketoacidotic coma ranks first in prevalence among acute complications of endocrine diseases and is typical for type 1 diabetes. Mortality in this coma reaches 6-10%, and in children with type 1 diabetes it is the most common cause of death. Rapidly progressing insulin deficiency leads to the development of coma.

Predisposing factors are:

prescribing too low doses of insulin during treatment;

violation of the regimen of insulin therapy (missing injections, expired insulin preparation);

a sharp increase in the need for insulin, which occurs with infectious diseases, injuries and operations, stress, concomitant endocrine disorders with hyperproduction of contrainsular hormones (thyrotoxicosis, acromegaly, pheochromocytoma, Cushing's disease), pregnancy;

Mechanisms of damage in ketoacidotic coma associated with intoxication with ketone bodies, metabolic acidosis, hypovolemia, hypoxia and dehydration of cells.

Ketone bodies, especially acetone, actively interact with the lipid components of cell membranes, and also inhibit the normal functioning of many intracellular enzymes. In particular, phospholipid-rich CNS structures are affected.

In severe cases, hypovolemia leads to a decrease in renal blood flow, which is accompanied by a weakening of glomerular filtration and a drop in diuresis (oliguria). This entails an increase in azotemia and an aggravation of acidosis due to a weakening of the excretion of nitrogenous waste products and secreted H + ions by the kidneys. Azotemia and acidosis cause disturbances in all organ systems, while the greatest threat to life is associated with suppression of the functions of the central nervous system that regulate blood circulation and respiration.

Symptoms of ketoacidosis are loss of appetite, nausea, vomiting, abdominal pain, then blurred vision, confusion and loss of consciousness, inhibition of reflexes, a drop in blood pressure, the appearance of Kussmaul breathing (rare, deep, noisy), symptoms of dehydration (decrease in tissue turgor, soft eyeballs), fruity (with a noticeable admixture of acetone) smell of exhaled air.

Laboratory signs of ketoacidotic coma are given in Table. 6. Hyperglycemia is noteworthy, but not maximal, an increase in ketone bodies and acidosis. Hyperlipidemia and hypercholesterolemia are also characteristic, indicating active lipolysis.

Hyperosmolar (hyperglycemic) coma more common in older people with mild to moderate type 2 diabetes. In 30% of patients, it is the first manifestation of DM2, i.e. in almost 1/3 of patients with hyperosmolar coma, the diagnosis of diabetes is made for the first time only at the time of coma development. This leads to the fact that the mortality in hyperosmolar coma reaches 30%, while in the "more expected" ketoacidotic coma in persons observed for type 1 diabetes, mortality is no more than 10%, i.e. 3 times less.

Cause of hyperosmolar coma- caused by insulin resistance, the relative deficiency of insulin, the amount of which in the body is sufficient to prevent the processes of enhanced lipolysis and ketogenesis, but not enough to counteract increasing hyperglycemia. Most often, coma occurs as a result of an increase in the need for insulin due to an increase in the action of endogenous contra-insular hormones in the context of a developing “acute phase response” (infectious diseases, mechanical injuries and operations, burns and frostbite, acute pancreatitis, myocardial infarction, etc.) or when concomitant endocrine disorders (thyrotoxicosis, acromegaly, pheochromocytoma, Cushing's disease).

Cases of the development of hyperosmolar coma are described when it is impossible to quench thirst in lonely bedridden elderly patients, as well as when using concentrated glucose solutions (prescribed for parenteral nutrition) in individuals with initially unrecognized diabetes.

Mechanisms of damage in hyperosmolar coma are associated with dehydration of all tissues due to hyperosmolality of blood plasma (> 350 mosmol / kg) against the background of pronounced hyperglycemia (> 40 mmol / l) and a decrease in blood volume.

Dehydration of brain structures with a sharp drop in intracranial pressure leads to a general depression of the central nervous system, which manifests itself in the form of neurological disorders, an increasing disorder of consciousness, turning into its loss, i.e. in a coma. Hemocoagulation disorders associated with hypovolemia can provoke the development of DIC, arterial (myocardial infarction, stroke) and venous (especially often in the basin of the inferior vena cava) thrombosis.

Symptoms of hyperosmolar coma. Thirst, polyuria, polydipsia, weight loss, and weakness increase over several days or weeks. The mechanism of these symptoms is the same as in ketoacidotic coma and is associated with hyperglycemia, osmotic diuresis, progressive dehydration, and electrolyte loss. However, dehydration in hyperosmolar coma reaches a much greater degree, and therefore the cardiovascular disorders caused by hypovolemia in these patients are more pronounced. characteristic laboratory signs: very high glucose concentration and plasma osmolality, no ketoacidosis, normal pH.

Lactic coma.

In its pure form, lactacidemic coma in diabetes is much less common than ketoacidosis and hyperosmolar coma. The accumulation of lactate in an amount exceeding the body's ability to utilize it in the liver and kidneys (more than 3400 mmol / day) leads to lactic acidosis, in which the content of lactic acid increases to 2 mmol / l or more.

Predisposing factors for lactacidemic coma:

any conditions accompanied by severe tissue hypoxia - shock, blood loss, severe heart and lung failure. At the same time, glycolysis is activated compensatory, leading to the accumulation of lactic acid;

severe damage to the liver and kidneys, i.e. organs in which lactic acid is metabolized;

any conditions that cause acidosis with pH values<7,2 (при рН<7,2 подавляется распад лактата в печени и почках).