Diabetes Complications
If not controlled, diabetes can cause a host of complications that can affect nearly every organ in the body. They include:
The heart and blood vessels ,The eyes,The kidneys,The nerves,The gums and teeth,Heart Disease and Blood Vessel Disease... Complications of Diabetes are of two major types: 1. Short Term Complications, 2. Long Term Complications: |  |
Complications of Diabetes are of two major types:
I. Short Term Complications:
Diabetic Ketoacidosis
Hyperosmolar non ketotic coma
Hypoglycaemia
1. Diabetic Ketoacidosis:
Ketoacidosis is chiefly a complication of type 1 diabetes. Before the discovery of insulin, more than 50 % of diabetic patients die’s of ketoacidosis. Nowadays, although it is preventable, but then also nearly 2% diabetic patients die of ketoacidosis. Mainly the patients are not aware for the ill-effects of the poor control of diseases. It can be prevented only education to patients regarding its symptoms and a patient with dangerous ketosis, requires an urgent treatment, must immediately walk into hospital.Diabetic ketoacidosis occur in patients with serve insulin deficiency combined with glucagon excess. Failure to take insulin and exposure to stress are the common precipitating factors. Excessive insulin deficiency leads to lipolysis (i.e. breakdown of fats) in the adipose tissues. This leads to the liberation of free fatty acids into plasma. These free fatty acids are taken up by liver where the enzyme acetyl co-enzyme –A, oxidizes the free fatty acid into ketone bodies. Due to increased ketogenesis, the rate at which th ketone bodies can be utilized by the muscles and other tissues, ketonaemia and ketonuria occur. It urinary excretion of ketone bodies is prevented due to dehydration, then systemic metabolic ketoacidosis occurs in which the normal acid-base balance of eth body is disturbed. In order to overcome this acidic condition, the bodies then use sodium potassium and calcium. These chemicals are thus lost to the body, resulting in the development of toxic condition. This affects the brain, the central nervous system and the heart. The other symptoms of ketoacidosis include intense thirst and polyuria. Constipation, cramps and blurred vision are common. In children, there may be abdominal pain, with or without vomiting. Weakness and drowsiness are commonly present, which many increase, further to unconsciousness or to “Diabetic Coma”. This is a very serious condition and must be treated early.Due to dehydration, the patient shows dry tongue and softy eyeballs. The patient also shows air hunger’ which is indicated by long, deep, sighing respirations. There is rapid, week pulse. The blood pressure may be lowered. There may be abdominal rigidity and tenderness. There is smell of acetone in breath.Sometimes diabetic coma can occur in elderly paitents, with extreme hyperglycemia and dehydration but no ketoacidosis. This is known as Hyperosmolar diabetic coma.
Treating Ketoacidosis
It is treated with urgency in hospital. Intravenous therapy is required, even when the patient is able to swallow, because the fluids given by mouth may be poorly observed. The aim should be to over come with all speed:
Ketosis, by means of unmodified insulin to allow glucose utilization.
Infection, if present by means of antibiotic.
Shock, acidosis, and water and electrolyte depletion, by means of proper intravenous fluids.
Moreover, persons suffering from this disorder are given alkaline containing food, so as to neutralize the effect of acid forming foods. So, our daily diet must contain alkaline-forming foods such as fresh fruits, tubers, legumes, leafy and root vegetables. Eating sensibly, in proper manner, provides necessary alkalinity to the blood and thus the perfect body health is maintained.
2 . Hyperosmolar Non Ketotic Coma:
Hyperosmolar nonketotic coma is mainly seen in patients suffering from Type II diabetes. If is caused by severe dehydration due to continuous removal of sugar in urine known as hyperglycemic dieresis. The loss of glucose in urine is a intense that the patient is unable to drink sufficient water to maintain urinary fluid loss. The usual clinical features of keto-acidosis like acetone smelling breath is absent. But there ar prominent central nervous system signs present. Blood sugar is extremely high. Plasma osmolality is also high, so 0.45 % saline should be given until the osmolality reaches to normal level. Ketoruria is milD in such patients but plasma bicarbonate and PH are reduced in them. There is high concentration of lactic acid in blood. Due to high viscosity of blood, the thrombotic and bleeding complications are present. The mortality rate in hyperosmolar non-kenotic coma is more than 50%.
Treatment consists of administration of large amount of intravenous bicarbonate. These patients are relatively sensitive to insulin, so it is best to give about half the dose of insulin usually used in diabetic ketoacidosis. Dialysis may be required in causes where sodium over load occurs due to administration of large quantities of sodium bicarbonate.
3. Hypoglycemia:
Hypoglycemia is commonly seen in patients suffering from Type 1 diabetes. It may occur when excessive amount of insulin is administered to the patient, leading to fall in blood glucose level. It may also occur if the patient misses a meal. Stress may also lead to Hypoglycemia. Hypoglycemia is commonly seemed when the insulin have its maximum effect, that is, in the morning or in the early evening. Stomach upset, leading to vomiting before the food is digesting, also lowers the blood glucose level. If the patient is physically over exerted or had drank alcohol in an empty stomach, may also exhibit reduced blood glucose level. The symptoms of Hypoglycemia are weakness, intense hunger, sweating, palpitation, headache, anxiety, irritability, cold skin, high pulse rate, diplopia and mental confusion. Patient behaves abnormally as drunk. This shows that the patient’s brain is not getting enough glucose. If the patient’s low blood glucose level continues them he may pass out and go into coma. Even if Hypoglycemia is not treated, person’s death can occur.The low blood glucose level can be treated by administering a quickly absorbed glucose source. It includes glucose containing drunks, such as orange juice, soft drinks (not sugar free) or glucose containing tablets. Pinch of cake frosting applied on the inner surface of check can also serve the purpose. If the patient becomes unconscious, then intramuscular injections of glucogan are given. So, patient suffering from Hypoglycemia must have a glucogan kit with him. Families and friends of diabetic patient must be taught how to administer glucogan, as the patient is unable to take it in an emergency situation. Another life saving device, is medical alert bracelet, which is worn by all patients suffering from diabetes.
Foods rich in vitamins C, E and B complex are also beneficial in the treatment of low blood sugar. Moreover, patients suffering from low blood glucose should take six to eight meals per day instead of two or three large ones. Administration of food or sugar the patient is in conscious state. Otherwise, the food or liquid may go into the lungs and cause more problems. Only a small sip is given at first, to make sure that the patient can swallow without any problem.
II. Long Term Complications:
Arterio Sclerosis
Diabetic nephropathy
Diabetic retinopathy
Diabetic microangiopathy
Diabetic neuropathy
Injections
Heart Disease and Stroke 1. Arteriosclerosis
It is seen in patients of both Type 1 and Type 2 Diabetes mellitus Arteriosclerosis of the extremities is a disease of blood vessels characterized by narrowing and hardening of the arteries that supply the legs and feet. It results in diminished blood flour which can lead to injury of nerves and other tissues. Commonly the effect is seen in the legs and feet. Pain occurs in the legs while walking and is relieved with rest. Numbness of legs or feet may occur while at rest. There may be cold feet or leg. Muscle pain may be felt in thighs or calves. There may be loss of hair on the legs and change in colour of the legs. Pulse is weak or absent in the limb. Arteriosclerosis is commonly associated with ulceration, calcification and thrombosis. Calcium deposits in the walls of the arteries leads to narrowing and stiffness of arteries.
It is commonly seen in patients above 50 years of age. The ill effects of accelerated atherosclerosis in diabetes are early onset of coronary artery diseases, silent myocardial infarction, cerebral stroke and gangrene of the extremities is 100 times more common in diabetes than in non-diabetes.
Treatment consists of self care and relief of symptoms.
Self care consists of-
Exercise must be balanced with rest.
Stop smoking, as smoking constricts arteries and increases the chances of forming clots.
Foot care is very important in diabetes, wearing shoes that fit properly. Keeping the feet as clean as possible use of bed-socks rather than hot water bottles. Attention must be given to any cuts, scraps or injury, as the tissues heal slowly and are prone to infection.
Symptoms can be relieved by giving medication such as pain relieves, blood thinners etc. Surgery is performed only in severe cases. Amputation is required when there is toxic absorption from necrotic tissue and secondly infection which may kill the patient unless the limb is amputated.
2. Diabetic Nephropathy
Kidney damage from diabetes is called diabetic nephropathy. It is also known as Diabetic glumerulosclerosis. In this a particular type of renal lesion is seen which may be diffuse or nodular. The diffuse lesion occurs mainly due to generalized thickening of the basement membrane of glomerular capillaries. The nodular lesion is in the form of rounded masses of hyaline material which are superimposed upon the diffuse lesion. These lesions are known as kimmelsteil Wilson bodies. Initially, Diabetic nephropathy that is, diseased small blood vessels in the kidney leads to leakage of protein in the urine. As the disease progresses, the kidney stops cleaning and filtering blood. This leads to accumulation of toxic waste products in the blood. So, patient is kept on dialysis machine, which serves the purpose of filtering and cleaning the blood. Kidney transplantation is done if the patient is not willing to go under dialysis.
The Nephropathy in diabetic patient can be controlled by treating the raised blood sugar levels and by controlling high blood pressure. So, Angiotension receptor blockers (ARBs) are used to treat high blood pressure which further controls the kidney damage in diabetic individuals.
3 . Diabetic Retinopathy
Retinopathy is the commonest long term complication of diabetes. It is leading cause of blindness. These are diseased small blood vessels in the back of the eye which causes the leakage of protein and blood in the retina. Disease in these small blood vessels may also cause the formation of Micro aneurysms. They appear as minute, discrete, circular, dark red spots near to the retinal vessels. They look like ting hemorrhages. These are also formation of new, brittle blood vessels. Sudden bleeding from the new and brittle blood vessels can lead to retinal scarring and retinal detachment, thus impairing the vision. Soft exudates are seen. But the hard exudates are more common and are characteristic feature of Diabetic Retinopathy. They are yellow in colour, have irregular, sharply defined edges and may vary in size from small specks to large circular patches.
Besides, Retinopathy-diabetics are also prone to cataract and Glaucoma.
Treatment of Retinopathy consists of use of laser which destroys and prevents the recurrence of small aneurysms and brittle blood vessels. It has been estimated that after 10 years of diabetes, about 50% of patients develop few degree of diabetic retinopathy. And about 15 years of the disease, approximately 8-% of the patients develop diabetes. The chance to develop retinopathy is enhanced because of the poor control of blood pressure and blood glucose level. Natural, uncooked foods are the best diet for complications. So, patients must have fresh fruits, green vegetables, dairy products, etc in their dietary regimens. Vitamin A is the best used for improving vision. Vitamin A is available in carrot, cabbage, soyabeans, green peas, raw spinach, dates, etc. Exercises are performed to relax and strengthen the eye muscles. Such as moving the eyes gently up and down, from side to side and circular motion (clockwise and anti clockwise), helps in preventing the eye complications. Regular eye Check ups are recommended.
4 . Diabetic Microangiopathy:
It is characterized by basement membrane thickening of small blood vessels and capillaries of various organs and tissues such as the skin, eye, skeletal, muscle, kidney, etc. Similar type of basement membrane thickening many also be seen in nonvascular tissues such as Peripheral nerves, renal tubules etc. Diabetic microangiopathy mainly occurs due to recurrent hyperglycemia.
5 . Diabetic Neuropathy:
It involves temporary or permanent damage to nerve tissue. Nerve tissue gets injured mainly due to decreased blood flow and rise in blood glucose levels. Approximately 50% of patients, suffering from diabetes from last 10-20 years, develop Diabetic neuropathy. Some patients develop nerve damage earlier while few patients do not develop nerve damage.
Diabetic neuropathy affects all parts of the nervous system but peripheral nerves are most commonly affected. It affects cranial nerves or the nerves from spinal chord or their branches. Nerve injury normally develops in stage. In earlier stages, tingling sensation or intermittent pain in noted particularly in the extremities such as feet. But in later stage, the pain is continuous and severe. At last, a painless neuropathy develops, that in there is loss of pain sensation in an area. The increases the chance of severe tissue injury because pain does not alerts the patients to injury. Therefore, the common symptoms of diabetic neuropathy are Numbress, Tingling, Decreased sensation to a body part, Diarrhoea, Constipation, Loss of bladder control, Impotence, Facial drooping, Drooping eyelid, Drooping mouth, Vision changes, Weakness, Speech impairment, etc. These symptoms usually develop gradually over years.
Treatment consists of good control of blood glucose level in order to prevent its progression. In order to reduce the symptoms, topical treatment with Capsaicin is done. Oral medicines take amitryptlyline and carbamazepine is used successfully. Analgesics (Pain killers) are not of much benefit in the treatment of painful neuropathy. Regular foot examination must be done. If any food infection or injury goes unnoticed for much longer time then amputation may be required.
6 . Infections
Diabetics have increased susceptibility to various infections, such as tuberculosis, pneumonias, pyelonephritis, carbuncles and diabetic ulcers. This may be due to poor blood supply, reduced cellular immunity or hyperglycemia.
7 . Heart Disease And Stroke
Patients with diabetes are four times more prone to develop Heart disease than those who do not have diabetes. They may suffer from Heart Attack, Chest Pain or Angina, High Blood Pressure, Stroke, etc. Patient with diabetes may develop silent Heart Attacks that is heart attacks that take place without showing any particulars symptoms. It is because in diabetics there is damaged nerve, so the patient does not feel any chest pain, and thus is not aware of the oncoming heart attack.
Risk factors for heart disease are mainly obesity, Sedentary life style, High blood pressure, High Cholesterol levels, Cigarette smoking, Family history of coronary heart disease before 55 years of age, etc.
Chest Pain or Angina is approximately seen in 3% to 5% of the United State Population. In this condition there is pain or discomfort in the chest because the blood flow to the heart in partially or completely blocked. Situations such as exercise heavy meals and stress which require increased blood flow, to the heart may lead to Angina. It is very common in the male gender. The pain lasts for 1-15 minutes. Pain may spread to shoulder, arm, jaw, neck back or other areas. It is usually relieved with rest or nitroglycerin. If the chest pain or heaviness lasts longer than 15 minutes, then patient is taken to hospital.
Important steps in natural treatment of diabetes related heart disease are regular exercise, quitting smoking, losing weight in the person in overweight. Patient must eat apples, as it posses heart stimulating properties. Fruits such as Pineapple, Fresh grapes, orange, and coconut water provide tonicity to the heart. Patient must have diet which is low in sodium and calories. High quality foods such as whole grains, seeds, vegetables, must be consumed. Sweets, Chocolates, canned syrups, soft drinks, squashes, must be avoided. Salt and sugar amounts are restricted and the patient should avoid tea, coffee, alcohol and tobacco.
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