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Complications of Diabetes Mellitus

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The acute complications of diabetes mellitus include the following.

Diabetic ketoacidosis, or DKA, is more common in type 1 diabetes but can also develop in type 2 diabetes during periods of severe relative insulin deficiency in the setting of metabolic stress such as infection. It presents with hyperglycemia, ketonemia, and metabolic acidosis.

The hyperosmolar hyperglycemic state, or HHS, primarily develops in type 2 diabetes and is characterized by severe hyperglycemia, high plasma osmolality, and minimal or absent ketosis.

Hypoglycemia is a complication of diabetes treatment, especially with insulin or insulin secretagogues.

Over time, sustained hyperglycemia increases the risk of infection, delays wound healing, and damages the vascular system.

Macrovascular complications affect large blood vessels and increase the risk of coronary and peripheral artery disease and stroke.

Microvascular complications include retinopathy, nephropathy, and neuropathy.

Overview

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Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia due to insulin deficiency, resistance, or both. Prolonged hyperglycemia disrupts metabolic homeostasis and leads to acute and chronic complications.

Acute Complications

Acute complications result from sudden metabolic imbalance.

Diabetic ketoacidosis (DKA) mainly appears in type 1 diabetes but may also develop in type 2 diabetes, particularly under extreme stress. It arises from severe insulin deficiency, leading to hyperglycemia, ketonemia, acidosis, and dehydration, often triggered by infection or missed insulin doses.
Hyperosmolar hyperglycemic state (HHS) arises in type 2 diabetes, with extreme hyperglycemia, high osmolality, dehydration, and minimal ketosis. Triggers often include infections, undiagnosed diabetes, or poor glucose control during an acute illness.
Hypoglycemia (glucose <70 mg/dL) frequently appears in individuals using insulin or insulin secretagogues. Symptoms include shakiness, confusion, and diaphoresis, and in severe cases, seizures or coma. It is more common in type 1 diabetes but may also develop in type 2 diabetes.

Chronic Complications

Chronic complications develop from prolonged hyperglycemia.

Macrovascular complications affect large vessels, increasing the risk of coronary artery disease, stroke, and peripheral arterial disease, leading to amputations; contributing factors include hypertension, dyslipidemia, obesity, smoking, and inactivity.
Microvascular complications involve damage to small blood vessels caused mainly by chronic hyperglycemia. This includes retinopathy, which causes vision loss, nephropathy, which leads to albuminuria and kidney failure, and neuropathy, which causes sensory loss, increasing the risk of ulcers and infections.

Other Complications

Neuropathy and vascular disease predispose to foot ulcers, infections, and amputations. Skin changes include diabetic dermopathy and acanthosis nigricans. Hyperglycemia also impairs immunity, increasing the risk of infections (UTIs, candidiasis) and delaying wound healing.

Transcript

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Diabetes Mellitus

Diabetic Ketoacidosis

Hyperosmolar Hyperglycemic State

Macrovascular Complications

Microvascular Complications