Acute complications in juvenile diabetes mellitus.

Summary 1. During the 10-year-period 1942–1952, 218 diabetic patients were hospitalized on altogether 500 occasions at the Medical Department of Crown Princess Lovisa's Children's Hospital in Stockholm. Ninety-six (44.0 per cent) were admitted on one occasion only and the remainder on more than one occasion. Fresh, previously untreated diabetes was present on 142 occasions (28.4 per cent). The rest of the series consisted of patients suffering from previously diagnosed and treated diabetes. Diabetic coma occurred 24 times in the former group and 34 times in the latter. The total coma incidence in the whole series amounted to 11.6 per cent. The mortality was 4.1 per cent (9 patients), of which 3.7 per cent was from diabetic coma. 2. Hypoglycaemia necessitated hospitalization on 48 occasions (13.4 per cent) in the diabetic patients treated with insulin. Acute infections without coma were present on 93 occasions and in connexion with coma on 24 occasions (Tables 2–3). 3. In the 58 instances of diabetic coma, essential differences were found in a comparison between the 24 cases in the fresh, previously untreated diabetics and the 34 cases in the old insulin-treated patients. In the former group there was a larger number of severe cases and the mean total dose of insulin required to inhibit the coma was larger due to the presence of insulin-resistant cases. The final stabilizing dose was, on the other hand, considerably lower in this group (Table 4). The mortality was higher among the coma cases in the previously untreated diabetics than among the coma cases in insulin-treated patients. The deaths amounted to 5 (20.8 per cent) in the former group and 3 (8.8 per cent) in the latter. The factors precipitating coma in the respective groups are discussed. Infectious factors were found to be more common in insulin-treated coma patients than in those with fresh untreated diabetes and coma. 4. A comparison of the age distribution among the fresh cases of diabetes with and without coma showed a predominance of the younger age groups in the patients with coma (Fig. 2). Symptoms of diabetes before hospitalization had been present in the cases with fresh diabetes and coma for approximately half the time (mean duration 17.5 days) of that in the patients with fresh diabetes without coma but with acetonuria (mean duration 33.1 days). In the fresh cases with neither coma nor acetonuria, the duration was still longer (mean 59.5 days). 5. The mean initial blood sugar level was higher in the fresh cases with coma than in the fresh cases without coma. Exceptions were noted: a few patients with coma and a blood sugar level below 200 mg per cent, and a few cases without coma and a blood sugar level above 1 000 mg per cent (Fig. 3). 6. The most important principles for the treatment of diabetic coma are discussed, i.e., individualized doses of insulin, administration of fluids up to maximally 10–15 per cent of the body weight per 24 hours, a moderate supply of alkali during the first 3–6 hours, followed by glucose in 5–10 per cent solution, also containing sodium, chloride, lactate, potassium and phosphate (Butler's solution); Fig. 4. 7. Three cases of temporary insulin resistance are described, Figs. 5–7. Two cases occurred in association with diabetic coma; the third patient showed no signs of coma.