Special Features Of Hyperosmolar Nonketotic Coma

Many properties elucidated above for diabetic ketoacidosis are also true for hyperosmolar non-ketotic diabetic coma and will not be repeated. The hyperosmolar coma corresponds to extreme hyperglycemia with a high level of dehydration and appears very frequently in elderly patients with type 2 diabetes (Table 8) (11). Mortality is higher than in diabetic ketoacidosis. Since there is only relative insulin deficiency, the liver is still seeing enough insulin to prevent severe ketoacidosis....

Hypoglycemia Risk

Elderly diabetic patients treated with glucose-lowering drugs are at particular risk for iatrogenic hypoglycemia. Multiple factors contribute to this risk, including declining renal function, polypharmacy and frailty-associated anorexia 37,38 . In addition, cognitive impairment may alter the behavioral response to hypoglycemia and predispose to errors in medication use. It is unclear if hypoglycemia counter-regulation is impaired as a function of aging, but type 2 patients with long-standing...

Initial Bolus Of Insulin

The German diabetes association recommends in their latest guideline, to begin the insulin therapy with an intravenous initial bolus of 10 to 20 IE 11,20 . The insulin therapy should not be started without concomitant volume substitution, because a rapid decrease in blood glucose without fluid expansion can lead to intracellular edema 17 . In accordance with the concept outlined above, it is sensible to choose a lower dose of initial insulin, e.g., 2 to 15 IE 13 . The question of if and in...

Sexual Functioning

Impaired sexual functioning is a well-recognized complication of type 2 diabetes in men and women. The prevalence of erectile dysfunction ED in the overall population between the ages of 40 and 70 years is 52 , while the prevalence in men with diabetes is as high as 75 92-95 . Moreover, diabetic men develop ED at an earlier age than men without diabetes 2 . In women, type 2 diabetes has been shown to impact sexual desire, orgasmic capacity, lubrication, sexual satisfaction, sexual activity, and...