Approximately 20% of the ketoacidosis episodes occur with the first manifestation of diabetes, being more common in smaller children

(< 4 years) and affecting 10/100 thousand children. However, the frequency of ketoacidosis in patients with previously established

diagnosis is 1-10% patient/year, with greater risk for patients with poor metabolic control, and in 75% of the cases it derives from

infectious processes and inadequate treatment.

Rates of ketoacidosis are higher in DM1 (13.4 per 1000 individuals per year) than DM2 (3.3 per 1000 individuals per year).

It is a hospitalization that requires ICU care, and special attention from inpatients, with variable mortality rates (0.18 to 0.31%). However,

in developing countries with unreliable health resources, these rates are higher, sometimes reaching 5.0% of the cases. The main

cause of death is cerebral edema, which occurs in 0.3 to 1% of ketoacidosis cases and is responsible for 57 to 87% of deaths.

As diabetes is better controlled, hypoglycemia can become more frequent. It affects mainly insulin users, but it can also occur with

patients using oral hypoglycemiants.

Frequent and/or prolonged severe hypoglycemia might cause important neurologic complications, and it still is a frequent cause of

hospitalizations for individuals with diabetes.  However, with the current resources available, the need for hospital treatment will practically

disappear, as long as there is a greater dissemination of education about this subject (preventive measures and, when they are not

efficient, healing measures, such as the use of Glucagon).

Diabetes is the main cause of acquired blindness. Individuals with diabetes have a six times greater chance of becoming blind than

non-diabetic people, but in the age group below 44 years the risk is 25 times higher.

Diabetic retinopathy accounts for 90% of blindness cases in individuals with DM1 and for one third of blindness cases in DM2.

Glaucoma, cataract and senile macular degeneration are the most frequent causes of blindness in DM2.

After 10 years with diabetes, 50% of individuals with DM1 and approximately 15% of individuals with DM2 develop proliferative

retinopathy. Without any treatment, 25 to 50% of the patients with proliferative retinopathy become blind within 5 years. Fortunately,

recent studies show that, with DM1 intensive treatment (3 to 4 doses of insulin per day, with an equal number of measurements of

capillary glycemia), it is possible to reach a reduction of 76% in the appearance and 54% in the progression of retinopathy.

Practically half of the amputations of lower limbs is due to badly controlled diabetes. Peripheral neuropathy, vascular disease and

infection are the predisponent causes of these amputations. Individuals with diabetes have 16 times more chance to end up suffering

an amputation of a lower limb than non-diabetic individuals.  However, once again in the age group below 44 years, the relative risk is

even higher (28 times).

With DM1 intensive treatment, it is possible to achieve a 69% reduction in the appearance of neuropathy, which certainly will contribute

to lower the number of amputations.

Half of the individuals with diabetes also present arterial hypertension, which increases its frequency with age and time with diabetes.

The frequency of hypertension in individuals with diabetes is two to three times higher than in non-diabetic individuals of the same age.

High blood pressure is an important factor that helps develop retinopathy, nephropathy, brain vascular disease, and coronary diseases.

Renal and genitourinary tract infections occur with more frequency in individuals with diabetes. Generally speaking, the infections seem

to be more common in individuals with diabetes than in non-diabetic individuals.

Children of pregnant women with pre-existing diabetes have higher rates of congenital malformations and intrauterine anoxia.

Gestational diabetes (which appears during pregnancy) is probably not linked to an increase in congenital malformation, but it is

associated to an increase in perinatal mortality.

Diabetes is the 2nd cause of end stage renal disease. Approximately one third of patients in hemodialysis are individuals with diabetes.

As a group, individuals with diabetes have 17 times more chance of developing end stage renal disease than non-diabetic individuals

in the same age group.

However, in the 0 – 44 years range the relative risk is 44 times higher. After 15 years with diabetes, approximately one third of individuals

with DM1 and one fifth of individuals with DM2 present nephropathy.

The nephropathy begins with the urinary excretion of minimal amounts of albumin (microalbuminuria) and evolves to macroalbuminuria,

when the progressive loss of renal function starts.

With the intensive treatment of DM1 (explained above) it is currently possible to achieve a 54% reduction in nephropathy.