Short term complications of Diabetes

➢ Hypoglycemia: Adrenergic effect: increase apetite, being shaky, sweaty.

➢ Neuroglycopenia: Not enough sugar on the brain. The pesron can get confuse,
pass out, or even have a seizure.
➢ Hyperosmolar coma: ussualy seen in Type 2. State of severe dehydration.
➢ Ketoacidoses: meainly in Type1. Because there is not enough insuline around
the body goes into a catabolic state where there is a breakdown of tissue,
specially fatty acids onto keton bodies and the person´s blood gets acid. The
person can pass out. This is trated with rehydratation and insuline IV.
➢ Catabolic state: breadking down muscle and fatt because of the lack of insulne.
➢ Susceptible to infections: They don´t produce the antibodies appropiately to
fight infections

Long term complications of Diabetes

● Microvascular (small vasels)

Retinopathy: leading cause of blindness. It happens over time, after years
with high levels of glucosa not controled.
Nephropathy: Diabetes is the leading cause of kidney damage. It happens
slowly within the years. There are different stages until a kidney dysfunction is
developed.
Neurophaty: 60% have it. There are 2 types:
-Peripheral symptoms: numbness/tingling in the feet, cramps,
sensitivity/insensitivity to touch, loss of balance/coordination.(The person doesn’t feel
his feet), risk of amputaion >25% higher than people without diabetes.
-Autonomic symptoms: urinary incontinence, loss of sexual
response, orthostatic hypotension.
● Macrovascular
-Cardiovascular disease: Most common cause of death.

DCCT (Diabetes Control and Complication Trial)

Glycemic Targets and Individualization in Type 2 Diabetes

NIDDM: Non insulin dependant Diabetes Mellitus.
Hemoglobin A1c: Shows how the glucose levels has been in the past 3 months, and
it should be under 7%
Current glycemia targets
Now the key is Individualization.
Tighter targets: 6.0-6.5%, younger, healthier.
Looser targets: 7.5-8.0%, older, comorbidities, hypoglycemia prone

Avoidance of hypoglycemia

There is not much change in the plasma glucose when change from one drug to
another. But there is a improvement when adding a drug to an already existing
one, and the adding of more drugs improves even more because of their
mechanisms of actions are different.