Diagnosis and management of diabetic comaDiabetes is any metabolic disorder that causes excessive thirst and the production of large volumes of urine. Coma is a state of unconsciousness. (Martin (2002)) There are two types of diabetes: Diabetes insipidus (DI) is a rare metabolic disorder whose symptoms are the production of large amounts of dilute urine and increased thirst. It is caused by a deficiency in pituitary hormone, antidiuretic hormone (ADH/vasopressin) which regulates water reabsorption in the kidneys. (Martin (2002)) Diabetes mellitus (DM) presents with symptoms of polyuria, emaciation and glycosuria (mellitus means "sweet urine") along with the following tests to give a laboratory diagnosis of diabetes: Venous plasma glucose > 11.1 mmol/L or Fasting venous plasma glucose > 7.0 mmol/L or Venous plasma glucose concentration > 11.1 mmol/L two hours after taking 75 g of glucose during an oral glucose tolerance test glucose (OGTT). There are two types of diabetes; Insulin-dependent diabetes (IDDM or type 1) and non-insulin-dependent diabetes (NIDDM or type 2)Type 1 is caused by the destruction of pancreatic B cells, which can be predicted by detecting the presence of antibodies (Abs) against islet cells, (Pitteloud, Philippe (2000)), insulin and glutamic acid dehydrogenase (GAD) (a neurotransmitter) and a decrease in insulin secretion from B cells. This destruction causes a decrease in the production of insulin, the hormone that stimulates the storage of glucose in muscles and the liver in the form of glycogen. Type 1 causes sudden onset of severe symptoms, including a tendency toward ketosis and dependence on exogenous insulin. Type 2 is caused by a diet high in saturated fat, lack of exercise and obesity. This is because persistently high glucose levels cause insulin to be produced at persistently high levels, so the body becomes insensitive to its effects because target tissue cells have fewer insulin receptors. The characteristics of NIDDM are that insulin is present, symptoms are moderate (fatigue and thirst), there is no tendency toward ketosis, and patients are not dependent on exogenous insulin. Hyperglycemia is controlled through diet, possibly with diabetes medications. Complications of diabetes are: Cataracts, because excessive blood sugar binds to proteins in the lens. Retinopathy (micro-angiopathy) caused by hemorrhage, etc....... middle of paper ......whether the cause is that glucose concentrations are too high or too low. Many causes of diabetic coma can be easily treated with hormones and fluids.ReferencesEMANCIPATOR K (1999) Laboratory diagnosis and Monitoring of Diabetes Mellitus, American Journal of Pathology, 112(5) PP665-674EVERS IM, TER BRAAK EW, DE VALK HW, VAN DER SCHOOT B, JANSSEN N, VISSER GH (2002) Risk indicators predictive of severe hypoglycemia during the first trimester of type 1 diabetic pregnancy, Diabetes Care, 25 (3) Pp554-559Previous lecture notes, BIOM2003MARTIN ELIZABETH A (2002) Concise Medical Dictionary Sixth Edition, Oxford, Oxford University Press, Pp148, 190-191, 374, 665-666, 717MAYNE Philip D. (2001) Clinical Chemistry Sixth Edition, London, Arnold, Pp209-210MOHSENI S ( 2001) Hypoglycemic neuropathy, Acta Neuropathology, 102 (5) Pp 413-421PITTELOUD N, PHILIPPE J (2000) Characteristics of Caucasian type 2 diabetic patients during ketoacidosis and follow-up, Schweiz Med Wochenschr, 130, Pp576 - 582TORTORA Gerard J, GRABOWSKI Sandra Reynolds (2000) Principles of Anatomy and Physiology Ninth Edition, New York, John Wiley & Sons Ltd.,-1