(DKA) a metabolic state resulting from a profound lack of insulin, usually found only in type 1 *diabetes mellitus but sometimes arising in people of Afro-Caribbean ethnicity with type 2 diabetes. Inability to inhibit glucose production from the liver results in *hyperglycaemia, which can be extreme and lead to severe dehydration. The concurrent failure to suppress fatty-acid production from adipose tissue results in the excess conversion of fatty acids to ketones in the liver (*ketosis) and the development of a metabolic *acidosis, which can be severe. Patients often present with vomiting (from the ketosis), which contributes to the dehydration. The condition is treated as a medical emergency with intravenous fluid and insulin; patients should be monitored in high-dependency units.
an acute mononeuropathy of the femoral nerve, usually of microvascular origin, associated with chronic poor diabetic control. Symptoms are thigh pain and progressive weakness of knee extension. Examination reveals wasting of the quadriceps muscle group and loss of the knee jerk. It may affect both legs and recovery is usually slow. Treatment is with physiotherapy and improved control of the diabetes; the condition never seems to recur in the same leg. The main *differential diagnosis is of compression of the nerve roots in the spinal canal.... diabetic amyotrophy
the combination of features, often found in the hands of long-standing diabetic subjects, consisting of *Dupuytren’s contractures, knuckle pads, *carpal tunnel syndrome, *cheiroarthropathy, and sclerosing *tenosynovitis.... diabetic hand syndrome
progressive damage to the peripheral nerves seen in some people with long-standing diabetes. It most commonly affects the legs, causing pain or numbness working up from the feet. There is no cure but drugs can sometimes be used to control the discomfort experienced, and good blood glucose control may prevent deterioration over time. See also diabetic holiday foot syndrome.... diabetic neuropathy
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