obsolete diabetes mellitus, insulin dependent type with hyperosmolarity, uncontrolled

Hyperosmolar Hyperglycemic State (HHS) in Diabetes Mellitus

The condition described is a serious complication of diabetes mellitus, specifically Hyperosmolar Hyperglycemic State (HHS). HHS is characterized by extremely high blood sugar levels, extreme lack of water (dehydration), decreased alertness or consciousness, and a buildup of ketones in the body.

Causes and Risk Factors

HHS mainly affects people with Type 2 diabetes, typically adults older than 65 years. The condition occurs when diabetes is not well managed, leading to persistently high blood sugar levels. Other risk factors include:

• Insulin resistance: A condition where the body's cells become less responsive to insulin, making it harder for glucose to enter the cells.
• Inadequate insulin secretion: When the pancreas does not produce enough insulin to regulate blood sugar levels.

Symptoms and Complications

The symptoms of HHS include:

• Polyuria: Excessive urine production
• Polydipsia: Excessive thirst
• Weight loss
• Blurred vision
• Decreased alertness or consciousness

If left untreated, HHS can lead to severe complications, including:

• Diabetic ketoacidosis: A life-threatening condition characterized by high levels of ketones in the blood.
• Kidney damage: Prolonged high blood sugar levels can damage the kidneys and impair their ability to filter waste from the blood.

Prevention and Management

To prevent HHS, it is essential to manage diabetes effectively through:

• Regular monitoring of blood sugar levels
• Adherence to medication regimens
• Healthy diet and exercise habits

Early recognition and treatment of HHS can significantly improve outcomes. If you or someone you know is experiencing symptoms of HHS, seek medical attention immediately.

References: [1] [2] [3] [4] [5]

Based on the search results, it appears that there are no specific references to "obsolete diabetes mellitus" in the provided context. However, I can provide information on the signs and symptoms of Type 1 diabetes with hyperosmolarity.

Type 1 diabetes is an autoimmune condition where the pancreas does not produce enough insulin. When left uncontrolled, it can lead to hyperosmolarity, a life-threatening complication characterized by severe dehydration and altered mental status.

The following are some common signs and symptoms associated with Type 1 diabetes and hyperosmolarity:

• Severe dehydration: This is a hallmark sign of hyperosmolarity, where the body loses excessive amounts of water due to high blood sugar levels.
• Altered mental status: Patients may experience lethargy, confusion, or even coma due to severe dehydration and electrolyte imbalances.
• Deep, rapid breathing (Kussmaul respirations): This is a sign of severe metabolic acidosis, which can occur in hyperosmolarity.
• Fruity-smelling breath: A sweet, fruity odor on the breath can be indicative of diabetic ketoacidosis or hyperosmolarity.
• Headache, nausea and vomiting, and stomach pain are also common symptoms associated with Type 1 diabetes and hyperosmolarity.

It's essential to note that these symptoms can occur in both Type 1 and Type 2 diabetes, but the context provided suggests a focus on Type 1 diabetes. If left uncontrolled, Type 1 diabetes can lead to severe complications, including hyperosmolarity, which requires immediate medical attention.

References:

• [3] Physical findings include profound dehydration and neurologic symptoms ranging from lethargy to coma.
• [6] Deep, rapid breathing · Fruity-smelling breath · Headache · Nausea and vomiting · Stomach pain · Change in mental status · Loss of consciousness, coma.
• [8] Signs and symptoms of DKA include dehydration, nausea, vomiting, and altered mental status. Kussmaul respirations may also be observed, which is consistent with hyperosmolarity.

Based on the search results, it appears that you are looking for diagnostic tests for a specific type of diabetes mellitus.

Diagnosis of Type 1 Diabetes

Type 1 diabetes is typically diagnosed in children and young adults, although symptoms can be less specific in adults. The following tests may be used to diagnose type 1 diabetes:

• Random Plasma Glucose (RPG) Test: This blood test measures your blood glucose level at a single point in time. It is often used to diagnose type 1 diabetes in people with clear-cut diabetes symptoms [15].
• A1C Test: While the A1C test can diagnose prediabetes and diabetes, it may not be specific enough to distinguish between type 1 and type 2 diabetes.
• Autoantibody Tests: Blood tests (e.g., autoantibody tests) may help clarify whether a patient has type 1 versus type 2 diabetes [14].

Other Diagnostic Tests

In addition to the above tests, other diagnostic tests may be used to rule out or confirm type 1 diabetes. These include:

• C-peptide Test: A C-peptide level below 200 pmol/L points to a diagnosis of type 1 diabetes, while a level above 200 pmol/L indicates that genetic testing for monogenic diabetes should be carried out [4].
• Fasting Blood Sugar Test: This measures your blood sugar after an overnight fast (not eating or drinking anything except water) [3].

Note on Obsolete Diabetes Mellitus

It appears that the term "obsolete diabetes mellitus" is not a standard medical term. However, based on the search results, it seems that you may be referring to type 1 diabetes with hyperosmolarity and uncontrolled blood sugar levels.

Please note that these tests are not mutually exclusive, and a healthcare professional would use a combination of them to diagnose type 1 diabetes accurately.

References:

[3] - Context result 3 [4] - Context result 4 [14] - Context result 14 [15] - Context result 15

Based on the search results, it appears that there are several treatment options for diabetic hyperglycemic hyperosmolar syndrome (HHS), a complication of type 2 diabetes.

Treatment Approaches

There are four main approaches to treating HHS:

• Vigorous intravenous rehydration: This involves administering fluids through a vein to correct dehydration and electrolyte imbalances [6].
• Electrolyte management: This includes managing potassium, sodium, and other electrolytes to prevent imbalances [6].
• Intravenous insulin: Insulin therapy is often used in conjunction with fluid replacement to help lower blood sugar levels [3], [7]. The recommended dosage for IV insulin is 0.1 units/kg/h [3].
• Crystalloid solutions: Prompt administration of crystalloid solutions with tonicity appropriate to the level of hyperosmolarity is crucial for treatment [4].

Insulin Therapy

Insulin therapy is a key component of HHS treatment, particularly in patients who are not responding to fluids alone. The recommended dosage for IV insulin is 0.1 units/kg/h, and it should be administered in conjunction with fluid replacement [3], [7]. In some cases, patients may require continuous intravenous insulin until ketoacidosis is resolved [9].

Other Considerations

It's worth noting that not all patients with HHS will require long-term insulin therapy. Some studies suggest that following recovery, many patients can be managed effectively with diet or oral agents alone [2]. However, this should only be determined on a case-by-case basis.

References:

[1] SN Levine (1989) - Following recovery many patients presenting with HHNS will not require long term insulin therapy and can be managed effectively with diet or oral agents. [3] OG Mustafa (2023) - Start a Fixed Rate Intravenous Insulin Infusion (FRIII) and IV fluids immediately and treat according to DKA pathway using 0.1 units/kg/h. [4] R MATZ (1999) - The linchpin of therapy is prompt, rapid administration of crystalloid solutions that have tonicity appropriate to the level of hyperosmolarity. [6] GD STONER (2017) - Treatment of HHS requires a four-pronged approach: (1) vigorous intravenous rehydration, (2) electrolyte management, (3) intravenous insulin, ... [7] Jul 18, 2024 - Although many patients with HHS respond to fluids alone, IV insulin in dosages similar to those used in DKA can facilitate correction of hyperglycemia. [9] Jan 1, 2002 - Patients with moderate to severe DKA should be treated with continuous intravenous insulin until ketoacidosis is resolved.

Based on the search results, it appears that you are looking for a differential diagnosis for a condition related to diabetes mellitus, specifically insulin-dependent type (Type 1) with hyperosmolarity and uncontrolled.

Differential Diagnosis:

• Diabetic Ketoacidosis (DKA): A metabolic complication of diabetes mellitus characterized by hyperglycemia, ketonuria, and acidosis. DKA can occur in patients with both Type 1 and Type 2 diabetes mellitus [10].
• Hyperosmolar Hyperglycemic State (HHS): A life-threatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus, characterized by severe hyperglycemia, profound dehydration, and alteration in consciousness ranging from lethargy to coma [13].
• Diabetic Coma: A rare but serious complication of uncontrolled diabetes, characterized by deep unconsciousness, often accompanied by seizures, and can be a precursor to death if not treated promptly [14].

Key Features:

• Hyperglycemia
• Dehydration
• Altered consciousness (ranging from lethargy to coma)
• Presence of ketones or hyperosmolarity

Important Considerations:

• The differential diagnosis for uncontrolled diabetes with hyperosmolarity should include both DKA and HHS, as these conditions can present similarly.
• A comprehensive clinical and biochemical evaluation is crucial in differentiating between these conditions [10].
• Timely diagnosis and effective management are key to the successful resolution of DKA and HHS.

References:

[10] Diabetic ketoacidosis and hyperosmolar hyperglycemic state are the most feared complications of uncontrolled diabetes seen in emergency medicine. [13] The hyperglycemic hyperosmolar state (HHS) is a life-threatening metabolic decompensation of diabetes which presents with severe hyperglycemia and profound dehydration, typically accompanied by alteration in consciousness ranging from lethargy to coma. [14] the classic symptoms of diabetes –Polyuria, polydipsia, weight loss •Course of autoimmune diabetes characterized by ongoing β-cell destruction •Exogenous insulin required for survival –T1D should be identified as soon as possible to avoid high morbidity due to a delay in insulin treatment 13 T1D, type 1 diabetes. ADA.