Complications of Diabetes

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