Le complicanze acute del diabete mellito di tipo I e di di tipo 2 possono andare incontro a tre gravi complicanze metaboliche acute:
chetoacidosicoma
iperosmolare non chetosico
ipoglicemia
La cheatocidosi caratterizza generalmente il diabete di tipi I, il coma iperosmolare il diabete di tipo 2.
1. Il diabete mellito tipo 1 è uno stato di deficit assoluto
o relativo di insulina che conduce ad una elevazione cronica delle concentrazioni di glucosio nel sangue (iperglicemia).
E’una malattia cronica autoimmune nella quale si verifica una progressiva distruzione delle cellule beta del pancreas endocrino.
2.Il diabete mellito di tipo 2, un tempo noto come diabete non insulino-dipendente dell’adulto, rappresenta un gruppo eterogeneo di disordini caratterizzati da gravi variabili d’insulino-resistenza, con aumentata produzione epatica e riduzione dell’uptake periferico di glucosio, oltre che da alterata secrezione insulinica
CHETOACIDOSI
La chetoacidosi è uno scompenso metabolico acuto dovuto a deficit grave di insulina, con un tasso di mortalità del 1-2% nei centri bene attrezzati.
Può essere la prima manifestazione clinica del DM di
tipo 1, o può insorgere nel corso del suo trattamento per cause intercorrenti (stress, infezioni, infarto miocardico, interventi chirurgici) che precipitano un equilibrio stabile, o per la sospensione dell’assunzione di insulina multiniettiva o per la rottura o disconnessione del set di infusione del dispositivo per la somministrazione continua.
COMA IPEROSMOLARE
Coma ipersmolare o stato iperglicemico iperosmolare non chetosico è una complicazione relativamente rara che compare preferenzialmente nei pazienti con DM di tipo 2.
Si ritiene che il momento scatenante sia un ridotto apporto esogeno di liquidi. La diuresi osmotica determina uno stato di disidratazione che non viene compensato. L’ipovolemia
(riduzione del volume di sangue circolante) che ne consegue porta una progressiva riduzione del filtrato glomerulare, che peggiora l’iperglicemia perché non è più possibile l’escrezione renale di glucosio. Il quadro clinico è caratterizzato da:
grave iperglicemia
iperosmolarità plasmatica e disidratazione in assenza di chetoacidosi
COMA IPOGLICEMICO
Il coma ipoglicemico dovrebbe essere sospettato in tutti i pazienti con alterazioni dello stato di coscienza. Episodi ipoglicemici che possono progredire verso il coma ipoglicemico sono una delle complicanze acute più frequenti nei pazienti diabetici in terapia insulinica.
Le informazioni contenute in questo sito non devono in alcun modo sostituire il rapporto medico-paziente; si raccomanda di chiedere il parere del proprio medico prima di mettere in pratica qualsiasi consiglio o indicazione riportata.
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