Repeated mild to moderate episodes may result in a chronic cerebellar ataxia.
Repeated severe attacks may result in a mixed myclopathy/peripheral neuropathy which is distinguished from motor neuron disease by the presence of sensory signs.
Two types of encephalopathy develop as a consequence of hyperglycaemia:
Diabetic ketoacidotic coma Accumulation of acetone and ketone bodies in blood results in acidosis. Hyperventilation ensues with a reduction in Pco2 and HC03. Osmotic diuresis due to hyperglycaemia results in dehydration.
The neurological presentation is that of confusion progression to coma and, if untreated, death.
Diabetic hyperosmolar non-ketotic coma This results from the hyperosmolar effect of severe hyperglycaemia. Reduction of the intracellular compartment results. Involuntary movements, seizures and hemiparesis may occur. Vascular thrombosis is not uncommon. Ketoacidosis is mild or does not occur.
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