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The Laboratory Diagnosis and Management of Diabetic Coma

  • Date Submitted: 01/28/2010 09:23 AM
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Diabetes is any disorder of the metabolism which causes excessive thirst and the production of large volumes of urine.   A coma is a state of unrousable unconsciousness.   (Martin (2002))   There are two types of diabetes:

Diabetes Insipidus (DI) is a rare metabolic disorder, the symptoms of which are the production of large quantities of dilute urine and an increased thirst.   It is caused by a deficiency of the pituitary hormone Anti-diuretic hormone (ADH / vasopressin) which regulates water reabsorption in the kidneys.   (Martin (2002))

Diabetes Mellitus (DM) has symptoms of polyuria, wasting and glycosuria (mellitus means 'sweet urine') as well as the following tests to give a laboratory diagnosis of DM:

Venous plasma glucose >11.1 mmol / L or

Fasting venous plasma glucose > 7.0 mmol / L or

Plasma venous glucose concentration > 11.1 mmol / L two hours after taking 75 g glucose in an oral glucose tolerance test (OGTT).

There are two types of DM; insulin dependent DM (IDDM or type 1) and non-insulin dependent DM (NIDDM or type 2)

Type 1 is caused by the destruction of pancreatic b cell destruction, which can be predicted by the detection of the presence of antibodies (Abs) to islet cells, (Pitteloud, Philippe (2000)) insulin and glutamic acid dehydrogenase (GAD) (a neurotransmitter) and a decrease in b cell insulin secretion.   This destruction causes a decrease in insulin production, the hormone which stimulates glucose to be stored in the muscle and liver as glycogen.

Type 1 causes an abrupt onset of severe symptoms, including a tendency to ketosis and a dependence on exogenous insulin.  

Type 2 is caused by a diet high in saturated fats, a lack of exercise and obesity.   This is because the constantly high glucose levels cause...


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