HYPOGLYCEMIA, HYPEROSMOLAR, SOMOGYI PHENOMENON OTHER DIABETIC COMPLICATIONS

摘要

A variety of unusual complications may be encountered when treating diabetic patients. Technicians with understanding of the clinical signs and ability to monitor and care for these cases are essential for positive outcomes. Hypoglycemia - Hypoglycemia is one of the most common side effects of insulin therapy. Hypoglycemia in this case may be symptomatic or asymptomatic. Hypoglycemia may occur after increasing the dose of insulin, if duration of action overlaps into the next insulin dose, with strenuous exercise, with decreased appetite, anorexia, or vomiting after eating. In some cases the bottle of insulin was not properly mixed, or was almost empty, allowing a concentrated dose of insulin to be administered, or the patient may regain some abilityto produce its own insulin again. In any case some form of insulin overdose occurs. In these cases, profound hypoglycemia occurs before diabetogenic hormone response can be initiated to compensate. Symptomatic signs include nervousness, anxiety, vocalization, papillary dilation, lethargy, weakness, ataxia (owner may say the pet is "wobbly" or walking drunk), muscle tremors, seizures, coma, and death. Severity of signs is dependent on severity of hypoglycemia and the rate of decrease of blood glucose. Clinically hypoglycemia is described as a blood glucose level <60 mg/dl. Signs may become apparent at levels higher or much lower than this. With asymptomatic hypoglycemia, signs are either not present or so subtle that owners do not notice them. It mostoften will be found incidentally, while checking routine labwork, or if the patient is being seen for another problem, or during a serial blood glucose curve. A low (<350 umol/1) fructosamine level may also indicate problems with chronic hypoglycemia.