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Diabetic acidosis results when diabetes is not well controlled. When carbohydrates are not being adequately metabolized, the blood fats, which "burn in the fire of the carbohydrates," are incompletely broken down, and acetone and other acidic ketone bodies pile up in the blood. Acidosis is gradual in onset and is characterized by nausea, vomiting, dehydration, and ultimately coma. This is a medical emergency requiring hospitaliza-tion and skilled medical management.

Diabetic patients should be taught to test their urine for acetone whenever they find a 4+ sugar on routine examination and to report the finding of acetone to the physician immediately.

Insulin shock may occur from an overdose of insulin or it may be brought on by unusually strenuous exercise or omission of a meal. Rapid in onset, insulin shock is characterized by weakness, hunger, sweating, and nervousness. In its more advanced stages there may be confusion, muscle incoordination, and, ultimately, unconsciousness. The treatment is simple, consisting of the prompt administration of carbohydrate or if the patient is unconscious, the administration of a newly available hormone from the alpha cells known as glucagon.

Insulin reactions, in addition to being discomforting and even alarming, are serious because following recovery there frequently is a rebound phe­nomenon with elevation of the blood sugar to a level higher than usual.

Diabetic retinitis occurs mainly among juvenile diabetics and those whose disease is poorly controlled. A common cause of impaired vision and blindness, the retinitis of diabetes is characterized by microaneurysms of the retinal arterioles, waxy exudates, and punctate hemorrhages.

Diabetic neuritis is most common among elderly diabetics. It is a pain­ful complication of long-standing diabetes, with the pain being character­istically worse at night. There also may be some function impairment of parts of the nervous system.

Renal complications occur in nearly 20 percent of diabetics. Most com­monly the kidney involvement is an atypical pyelonephritis, but there may be serious renal damage either from acute necrotizing papillitis or from intercapillary glomerulonephritis.

Diabetes may greatly complicate the course of pregnancy. Insulin dosage becomes more difficult to standardize. Nausea and vomiting fre­quently upset the dietary regimen, and during pregnancy the female diabetic is more prone to acidosis and to insulin reactions. Of greatest sig­nificance, however, is the fact that the babies of diabetic mothers tend to be large in size, thus making delivery more difficult and the complications of delivery more frequent. Premature delivery and abortions are also common.

The most serious complication of diabetes is premature atherosclerosis, presumably associated with elevated blood lipids. Cerebral thrombosis is not uncommon, and the presence of diabetes significantly increases the risk of coronary thrombosis. Approximately one-half of all diabetics die of coronary disease. Involvement of the peripheral vessels may lead to gan­grene of the foot or toe.