Diabetes Mellitus

 

Diabetes Complications


Diabetes Complications

So what’s the big deal about diabetes? Why should anybody worry about being thirsty and having to go the bathroom all the time?  Recall from our discussion of the cause of diabetes that years of high glucose levels can cause damage to various parts of the body. This ultimately leads to major health problems and significant effect on lifestyle. Diabetes is one of the leading underlying causes of death in the United States.

Most of the complications of diabetes result from a few basic mechanisms.  Sensory nerves carry information about the body to the brain. When they are damaged through long-standing diabetes, the patient may permanently lose sensation in the affected area. Arteries carry blood (containing oxygen and nutrients) to all cells of the body. Over time, high blood glucose levels can lead to narrowing of arteries and decreased blood flow to organs and different parts of the body. Glucose in the blood and lack of insulin (or insulin response) can also directly affect some parts of the body or cause changes in blood chemistry. In this section, you will learn about many of the complications of diabetes, including specific prevention tips, possible treatments (if any), and likely outcomes. Remember that the risk of all complications is decreased with good control of blood sugar.

Heart Disease

Narrowing of the “coronary” arteries supplying blood to the heart can damage the heart muscle.  This may occur suddenly when an already-narrowed artery becomes blocked (a heart attack) or over time as low blood flow slowly destroys the heart muscle (heart failure).  Not all patients with heart disease have diabetes, but diabetes is one of its biggest risk factors.  Heart disease is the number one cause of death in patients with diabetes.

  • Prevention: Avoid other risk factors for heart disease – keep blood pressure and cholesterol under control, exercise, eat healthily, and stop smoking.  Your doctor may also order tests to detect early heart disease or prescribe a variety of medications.  Be sure to recognize the signs of a heart attack and seek immediate treatment (www.americanheart.org for more information).
  • Treatment: A heart attack can sometimes be stopped with drugs, surgery, or other special procedures.  Heart failure can be improved with some drugs, though many cases may be difficult to treat.
  • Outcome: Many heart attacks are not survivable; those that are often result in permanent damage to the heart.  Heart failure usually causes debilitating fatigue and shortness of breath.  Many patients have very restricted activities due to heart failure.

    Heart disease is the leading cause of death in patients with diabetes

Stroke (Brain Attack)

The same way that coronary artery narrowing causes a heart attack, a blockage of the arteries in the brain can cause a stroke – a sudden and often permanent injury of the brain.

  • Prevention: The risk factors for stroke are mostly the same as for heart disease.  Learn the signs of stroke so you can seek immediate treatment (see www.strokeassociation.org).
  • Treatment: Likewise, a variety of drugs, surgeries, or other procedures may be necessary, but the damage caused by stroke can be permanent.
  • Outcome: The brain controls almost every aspect of the body.  Common problems with stroke include speech difficulty and decreased voluntary movement.  A severe stroke can result in brain death.

    Stroke is a major cause of disability in diabetic patients.

Foot Infections and Loss of Limbs (Amputation)

Decreased sensation in the feet means that any slight damage to the foot (even rubbing against the inside of the shoe) is not felt, and the normal response to change position, put on a band-aid, or stay off the foot are not done.  On top of this, decreased blood flow due to artery narrowing leads to slower healing time.  Repeated abrasion can result in gaping, infected wounds that may not be detected until too late.

  • Prevention: One of the most important daily routines of the diabetic patient is visual inspection of the feet for any sign of a wound.  This must be done every day to detect cuts and scrapes before they become infected.  If you find such a wound (an especially large or deep wound or a wound that does not heal after a day or two), your doctor can recommend cushions, supports, and other devices to promote healing.
  • Treatment: Once a wound has become infected, prompt treatment is vital.  Antibiotic drugs are needed, though decreased blood flow may make them less effective.  Cleaning of the wound by a surgeon may also be necessary in more advanced cases.  In severe cases, when the infection has invaded or spread or damaged the foot, it may be necessary to amputate the foot or leg.
  • Outcome: Loss of limbs is unfortunately a common complication of diabetes.  While prosthetic legs and physical therapy may restore some function, many patients are severely and permanently disabled.  If the infection spreads even beyond the point of amputation or overwhelms the bloodstream, it can be fatal.

Diabetic patients must examine their feet daily in
seach of new wounds that can lead to infection

Kidney Disease

The kidneys are necessary for removing harmful substances from the blood and expelling them as urine.  They kidneys also help regulate blood pressure and electrolytes and stimulate production of red blood cells, which carry oxygen in the blood.  Narrowing of the arteries supplying the kidneys can lead to permanent damage and loss of these important functions.

  • Prevention: Alert your doctor if you experience a decrease in urine production or notice blood in the urine.  However, besides good blood glucose control, there are few effective ways to prevent kidney damage.
  • Treatment: There are no effective treatments for reversing kidney disease.  The management of kidney disease consists of supplementing its natural function: giving drugs to stimulate red blood cell production and regulate blood pressure and electrolytes.  In some cases the blood may need to be filtered by a machine (this is called “dialysis”) several times per week.
  • Outcome: The patient on chronic dialysis may be severely restricted by having to spend several hours a day, several days a week in a dialysis clinic.  When the blood is not adequately filtered, harmful substances can build up and damage different parts of the body, including the brain.  Electrolyte imbalances can also affect the brain, heart, and other organs.  Some of these changes can be fatal.

    Diabetic kidney disease may require 10
    hours per week or more of dialysis.

Vision Impairment and Blindness

Diabetes affects the eyes in many different ways, mostly resulting from problems with the arteries of the eyes or from direct glucose deposits in part of the eye.  Diabetic retinopathy (disease of the part of the eye that detects light) is the leading cause of blindness in patients under age 65.

  • Prevention: Most diseases of the eye are progressive, meaning that the damage to the eye increases gradually over time.  Thus, seeking treatment early can prevent or delay total blindness.  Your doctor may regularly refer you to an eye doctor; be sure to let your doctor know if you detect any change in your vision.
  • Treatment: Different specific diseases are treated in different ways.  Treatments may include medications, surgery (such as cataract replacement), or in-office laser treatment.
  • Outcome: Damage to the eye can result in partial vision loss or total blindness, creating a severe restriction to performing many regular activities.

What a diabetic patient suffering from mid- to late-stage
retinopathy might see before becoming completely blind

Other Complications

Other common complications include urinary incontinence (unable to hold urine), intestinal disruptions leading to constipation, impotence / erectile dysfunction, and many other problems.  For a complete discussion of possible complications tailored to your specific risk profile, speak with your doctor.

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