The major cause of concern i n patients with diabetes is the long-term
complications, which almost inevitably ensue over a period of time. Most
of these complications, though, could be managed very well with proper
care and a good diabetic control.
Two types of complications seen with diabetes
- Acute complications
- Chronic complications
Acute complications: problems may arise during the treatment of
diabetes, mainly of two types:
Hypoglycaemia (low blood sugar) :
This occurs most commonly in patients on insulin injections although it
may occur in people on oral medication as well. The symptoms include:
- Sweating, trembling, anxiety, hunger
- Nausea, tiredness, headache
- Confusion, sleepiness, speech difficulty, lack of concentration
- In severe cases- seizure
This usually results from an imbalance between injected insulin and
the person's normal diet. Usually this occurs before meals and during
the night. Irregular eating habits, unusual exertion and alcohol excess
may precipitate episodes.
What to do?
- Always carry a card on your person indicating your treatment and
dosage
- Carry sugar of sweets- immediately have sugar or a glucose
solution, or even jam or honey
- Occasionally injectable glucose may be required if the person is
not conscious or is unable to swallow
- Seek advice regarding dosage once the emergency is over
Diabetic Ketoacidosis :
This may occur in case insulin therapy is interrupted or due to the
stress of an infection or illness. Usually patients stop their insulin
because of nausea or vomiting, which is a mistake. The lack of insulin
causes blood glucose to rise rapidly, excessive fluid and electrolyte
loss from the body and subsequent dehydration. There are increased fatty
acids in the circulation, more nausea and vomiting and a vicious cycle
is established. The person thus has:
- Dry skin, temperature below normal
- Air hunger, 'ketone' smell on the breath
- Kidney shut-down
- Coma and if untreated - death
What to do?
Take the person to a doctor immediately for, where the management
includes the following:
- Testing the urine for ketones & blood sugar level
- Replacement of fluids lost
- Restoration of electrolyte balance
- Investigation and treatment of the underlying case
Long-term complications of Diabetes
The problems arise because of the effects the disease has on both small
and large blood vessels and include blindness due to diabetic
retinopathy, difficulty in walking, chronic ulceration of the feet,
bladder and bowel problems due to neuropathy, angina, heart failure and
gangrene due to atherosclerosis. However, the nearer the blood glucose
is to the normal levels, the fewer and less severe are the
complications.
I. Diabetic Retinopathy: This is the commonest cause of
blindness between the ages of 30 to 65 years. To detect this, a regular
check-up by an eye specialist is a must. Symptoms are worse in cases of
a long duration and early onset of disease, smoking and excessive
alcohol consumption. Treatment is in the form of retinal surgery
(photocoagulation)
II. Diabetic Neuropathy: a common complication, usually presents
with 'glove-and -Stocking' type( involving the hands and the feet) of
impaired sensation. There may be pain in the legs, worse at night,
burning sensations in the soles of the feet and a sense of numbness in
the feet. Muscles of the hands and feet may be weakened, besides
problems with passing urine, impotence, bowel disturbances.
III. Diabetic Foot: in this condition a foot ulcer presents
after a trivial trauma, or may be due to necrosis under a callus(corn).
Treatment includes antibiotics for the infection and good control of
diabetes alongwith professional foot-care. Avoidance of amateur
chiropody is a must in such cases. In severe, irretreivable cases,
amputation may have to be performed.
IV. Diabetic Nephropathy: results from long-standing,
uncontrolled disease, with a history of hypertension.This may be a cause
of premature deaths in young diabetic patients. The earliest presenting
feature is the presence of protein in urine.
Treatment is aimed at control of the disease along with control of
blood pressure, since otherwise it accelarates the process.
As stated earlier complications of diabetes involve multiple organ
systems and cause much morbidity and economic loss to the patients.
Better dianbetic control, regular check-ups and prompt intervention in
case of detection of a complication helps.
Treatment