If you have a way to control the "stimulators" of these changes it will be possible for you to minimize the damage that such changes can cause. So it is with diabetes mellitus. The body cells are used to only so much glucose in the system. If there is too much or too little, changes take place in cell function, size, and structure. There are three series of changes that occur with the person who has diabetes: acute changes, intermediate changes, and chronic changes. Acute changes, or complications, are diabetic ketoacidosis, hypoglycemia, and hyperglycemic hyperosmolar nonketotic syndrome. Intermediate complications are those involving illness, surgery, pregnancy, and travel. Chronic complications involve the nerves (neuropathy), the kidneys (nephropathy), the eyes (retinopathy), and the large blood vessels (macroangiopathy). Chronic complications are noticeable by pain, numbness, inability to see, inability to go to the bathroom, and so on. Retinopathy, nephropathy, and perhaps neuropathy have some association, directly or indirectly, with small blood vessels. Hyperglycemic Hyperosmolar Nonketotic Syndrome This syndrome is a subtle but quite severe hyperglycemic episode in which the acid does not develop but dehydration is very acute. (This condition is called a syndrome rather than a coma, because the majority of these people are diagnosed before they ever reach the state of coma.) Blood,glucose levels may be in the neighborhood of 800-2,000 mg/dl (44-110 mmol). Osmolarity is the level of water concentration, or dehydration, of the body. The higher it is, the worse the outcome for the person involved. Dehydration must be attended to first; insulin is then given in carefully prescribed doses, as individuals with this condition are very insulin sensitive.In diabetic ketoacidosis there are ketones in the blood and urine. In hyperglycemic hyperosmolar nonketotic syndrome, there are few, if any, ketones in the blood and urine, because the person is making just enough insulin to suppress ketogenesis (the making of new ketones). The large amount of fluid lost also means the loss of much potassium. Replacement of potassium is done during the acute state and usually for some time afterward. The more potassium lost and the greater the state of dehydration, the more seriously ill the person.