Clinical manifestations of diabetes depends on the phase of the disease. Symptomatic diabetes is characterized by the appearance of thirst, polyuria, nocturnal and daytime urinary incontinence, increased appetite, weight loss, diminished work capacity, sluggishness, and irritability.
At this stage of diabetes mellitus revealed persistent hyperglycemia and glucosuria. Typically, the initial period of illness (year) is characterized by labile over relatively low need for insulin. The period is characterized by degenerative changes in the high insulin demand, sometimes a relative insulin resistance
Clinical condition characterized by lack of metabolic compensation of clinical symptoms and normalization of metabolic processes. If you do not complain of clinical compensation and clinical symptoms of diabetes mellitus with persistent metabolic disorders of carbohydrate and fat metabolism. Allocate a lighter degree of decompensation (without ketoacidosis) and ketoatsidoticheskuyu decompensation, threatening the development of diabetic coma.
The cause of diabetic coma may be different:
Late diagnosis of diabetes
violation of the diet
insulin
addition of concomitant diseases, and stressful situations.
The most common clinical and metabolic variant of diabetic coma in children is hyperketonemicheskaya.
For stage I, characterized by coma, drowsiness, lethargy, confusion, increasing thirst, polyuria, loss of appetite, nausea, vomiting, acetone smell from mouth.
For stage II is characterized by more profound impairment of consciousness (sopor), lower blood pressure, peripheral vascular tone, polyuria, alternated oligouriey, vomiting, muscular hypotonia, deep breathing, noisy, hyporeflexia.
Stage III is characterized by coma, complete loss of consciousness, cyanosis, vascular collapse, anuria, edema, abnormal breathing character.
In diabetes mellitus in children can occur giperlaktatsidemicheskaya coma, it features upcoming early dyspnoea, accompanied by complaints of chest pain in the lumbar region and of the heart. Characterized by sharp decompensated metabolic acidosis and a relatively low degree of glycemia. The third option may be diabetic coma hyperosmolar coma, characterized by restlessness, seizures, hyperthermia, high levels of glucose, the growth of sodium in the blood serum, increased levels of total protein, residual nitrogen, urea, and the absence of ketoacidosis, severe degidrotatsiey.
During diabetes may be disrupted development of hypoglycemic states and hypoglycemic coma against violations of the diet, excessive stress, excessive doses of insulin. Hypoglycemic state is characterized by fatigue, dizziness, anxiety, sweating, paleness, muscle weakness, trembling hands, feeling of hunger. With the development of hypoglycemic coma, there is complete loss of consciousness, seizures.
The basic principles of treatment of diabetes is diet therapy, the use of various preparations of insulin and dietary compliance. For the duration of insulin distinguish very short, short and extended (prolonged) action. There is also a mixed insulins in which the pre-mixed insulin short-and longer-acting. Insulin dose is calculated individually depending on the level of glycemia, food intake and physical activity.
