Intensive management of diabetes is needed in all except,
Autonomic neuropathy causing hypotension [Ref Harrison 16th/e p. 21731 Diabetes is managed in two ways i) Intensive management ii) Conventional diabetes management Intensive management Multiple insulin injections are administered each clay,. Conventional management Twice daily insulin injections are administered each day. Indications fur intensive diabetes management Otherwise healthy adult with type I or type 2 diabetesdeg. Purposeful therapeutic attempt to avoid or lessen micro vascular complicationsdeg. All pregnant women with diabetes, all women with diabetes who are planning pregnancydeg. Management of labile diabetes0. Availability of health care professionals with appropriate expeisedeg. Patients who have kidney transplantation for diabetic nephropathydeg. Why is intensive management avoided in diabetes with autonomic neuropathy ???. Remember that hypoglycemia due to insulin ingestion is an impoant and dangerous side effect of diabetes therapy (especially in Diabetes type I) Diabetic patients who are on insulin are at an ongoing risk of hypoglycemia due to overingestion of insulin. Severe hypoglycemia can cause serious complications, but founately the patient quickly recognizes the symptoms of hypoglycemia before such serous levels are attained and abos the episodes of hypoglycemia by eating. Symptoms of hypoglycemia are produced due to the release of counterregulatory hormones. This is a physiological response. An intact autonomic nervous system is necessary for this counterragulatoty hormonal responses. So if the autonomic nervous system is not functioning properly patient cannot produce counterregulatory hormonal response, Thus he will not be able to experience hypoglycemia (hypoglycemic unawareness) and thus will not he able to abo the episodes of hypoglycemia. Thus hypoglycemia will reach dangerous levels jeopardizing the life of the patient. "Advanced adrenergic neuropathy as evidenced by ohostatic hypotension, generally leads to decreased epinephrine secretion after hypoglycemia. Patients with recurrent hypoglycemia unawareness or a history of hypoglycemia related accidents (like ohostatic hypotension) should probably not be treated with intensive insulin therapy". Diabetic mellitus with acute M.I. Some student argue that intensive management of diabetes should not he done here because intensive management does not prevent macrovascular complication. Please read the option carefully - It is diabetes mellitus with acute M.I. - Intensive diabetes management is definitely needed in patients with diabetes and acute M.I. Acute MI with diabetes is managed in setting and intensive diabetes management is difinitevely required in these cases. Most of the critical care units and organizations recommend intensive management of hyperglycemia in all cases of acute M.I. irrespective of their diabetes status.
Autonomic neuropathy causing hypotension
Pregnancy
Post kidney transplant in diabetic nephropathy
DM with acute MI