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The leading cause of hyperglycemia in type 2 diabetes is the failure of insulin to suppress glucose production by glycolysis and gluconeogenesis due to insulin resistance. [39] Insulin normally inhibits glycogenolysis, but fails to do so in a condition of insulin resistance, resulting in increased glucose production. [ 40 ]
Hyponatremia or hyponatraemia is a low concentration of sodium in the blood. [4] It is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe hyponatremia being below 120 mEq/L. [3] [8] Symptoms can be absent, mild or severe.
In severe or acute hypoosmolar hyponatremia, swelling of brain cells causes various neurological abnormalities, which in severe or acute cases can result in convulsions, coma, and death. The symptoms of chronic syndrome of inappropriate antidiuresis are more vague, and may include cognitive impairment, gait abnormalities, or osteoporosis. [2]
More severe hyponatremia (levels less than 120 mEq/L), particularly if it develops rapidly (defined as occurring over less than 48 hours), can cause confusion, seizures and even lead to death ...
This leads to excessive urination (more specifically an osmotic diuresis), which, in turn, leads to volume depletion and hemoconcentration that causes a further increase in blood glucose level. Ketosis is absent because the presence of some insulin inhibits hormone-sensitive lipase -mediated fat tissue breakdown .
In addition to the endogenous renal glucose produced by the kidneys. The condition of high circulating concentrations of ketone bodies and hyperglycemia leads to osmotic diuresis, characterized by the excessive presence of glucose and ketones in the urine. Consequently, osmotic diuresis causes dehydration and electrolyte loss. [10] [9] [8] [11 ...
The low GFR causes a lowered rate of osmole excretion, and an increase in the amount of water reabsorbed; thus, hyponatremia occurs when the amount of water intake exceeds the renal water excretion capacity. [2] Medications, such as thiazides and antidepressants, may exacerbate symptoms of hyponatremia. [2]
Hypoosmolar hyponatremia is a condition where hyponatremia is associated with a low plasma osmolality. [1] The term "hypotonic hyponatremia" is also sometimes used. [2] When the plasma osmolarity is low, the extracellular fluid volume status may be in one of three states: low volume, normal volume, or high volume.