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Complications of Diabetes
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Diabetes or high blood glucose levels themselves give few or any symptoms at all. The major damage to the whole body is associated with persistently high glucose levels and the damage done by this to various body organs and systems.
Diabetes can turn into a dreadful monster if not controlled. But if sugar levels are kept under control, a diabetic may perhaps never have even slightest of discomfort due to diabetes. The complications of Diabetes may be either because of persistent increase in blood glucose levels as a result of uncontrolled Diabetes ( called chronic complications) or may be the result of acute lowering of blood glucose, or extremely high blood glucose or ketone levels, (called acute complications ).
ACUTE COMPLICATIONS
Diabetes may be a cause for Acute complications which arise from extremely high or low levels of glucose. These complications require urgent medical treatment in the Emergency department of a hospital or an ICU.
Acute lowering of blood glucose ( below 50 mg /dl) due to overdose of insulin or glucose lowering medication, kidney or liver disease, or skipping meals.....
Also see HYPOGLYCEMIA Unawareness, due to autonomic neuropathy, the diabetic person does not have any symptoms even when glusoe levels are critically low.
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Ketoacidosis is a metabolic abnormality usually seen patients on insulin (Type I), can cause severe pain in stomach, vommitting, with a characterstic fruity odour of breath.....
Hyperosmolar state When blood glucose levels are extremely high ( above 600 mgs/dl) blood literally thickens...
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 Complete or partial blockage of coronary arteries supplying blood to heart may cause death of portion of heart muscles, causing heart failure, irregular heart beats and other serious complications.
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Stroke is caused by blockage of arteries supplying blood to parts of the brain, symptoms may vary from difficulty in speech, weakness in legs or hands, sudden emotional changes to seizures and coma......
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CHRONIC COMPLICATIONS
Chronic complications are caused by persistently high blood glucose levels and the damage done to various organs and tissues due to diabetes. Most of the complications of Diabetes are due to formation of Advanced Glycation End products AGE; When the glucose levels are persistently raised all the cells of body are immersed in a sugary syrup ( like Jalebi / or gulab Jamun in syrup), this affects the synthesis of proteins, as proteins are structural elements of the cells, cells formed with a defective structure are not able to function properly ( like a house built with defective and fragile bricks).
Due to persistently raised levels of Glucose, cells forming the inner lining of blood vessel (endothelial cells) are not able to function properly and may cause clotting of blood and formation of thrombuses which disrupt blood supply to vital organs like heart, brain or kidneys.
 Deposition of calcium and other substances in walls of blood vessels cause blockages in blood flow to vital organs like heart, brain etc.. resulting in decreased effeciency and damage to these organs... |
Decreased blood supply to heart and constant damage to muscles of heart makes them inefficient and causes pain, breathlesness and chest discomfort with exertion to varying degrees...
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Blockage of large blood vessels supplying blood to different parts of brain may cause acute emergencies like paralysis or death, Smaller arteries supplying blood to some parts of brain may also get damaged over time in Diabetes leading to microinfartcs- death of small areas of the brain. Click to read more...
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Kidneys are vital to our existence as they secrete the waste products from our body together with urine, In uncontrolled Diabetes the structure of kidneys change making them nonfunctional..glomeruli , the functioning unit of kidneys are damaged...click to read more..
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Light is percieved by the light sensitive part of eye called retina.. this gets damaged in uncontrolled Diabetes leading to Blindness. Other eye problems like Glaucoma and cataract are also more frequent and of more severe nature in Diabetes.click to read more..
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Lack of insulin and long standing Diabetes causes damage to nerves, all kinds of nerves may get affected in Diabetes, including those of Central Nervous system ( Brain) or Peripheral nervous system- innervating hands, legs and other organs of the body, symptoms range from pain, numbness, burning and pricking to loss of function, impotence and even death. Click to read more..
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Diabetic Foot is a Constellation of Problems affecting the Foot in Diabetics, Damage to Nerves and Blood vessels lead to formation of non healing wounds which may even require amputation of the leg for treatment. Click here to read more..
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Complications of Diabetes -
Chronic Complications of Diabetes
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Written by Dr Rajesh Kesari MD
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Wednesday, 26 August 2009 05:10 |
Angina
Heart is also an organ and requires blood for its own functioning, Coronary arteries supply blood to different portions of heart. Cardiac muscles rythmically contract and relax causing the pumping action. When arteries supplying blood to heart itself get clogged due to atherosclerosis, heart muscles do not recieve adequate blood and together with it oxygen, thus causing undue fatigue of the muscles- this condition is termed as Coronary Artery Disease, when this happens for a long time the muscles may get permanently damage and may not work efficiently leading to 'Heart failure'. Causes and Symptoms
While walking, lifting weight, climbing, upstairs, while thinking, under any emotional stress or even after eating the requirement of oxygenated blood increases and heart has to pump more, in order to do this 'extra' work heart muscles themselves require 'extra' blood, when they do not get that - pain or heaviness in chest is felt, initially it may be relieved with rest but as blockages increase it may require medication for relief. Such pain or discomfort is called 'Angina' . Important thing is that in diabetics with autonomic neuropathy this pain may not be percieved (silent Angina)and the person would continue to overburden the fatigued heart. If any such symptoms are noted 2 tabs of Sorbitrate ( Isosorbide dinitrate ) should immediately be kept under the tongue as they dilate the blood vessels of heart and allow more blood to flow to heart.
Heart Failure
Poorly controlled Diabetes with persistently high blood glucose levels cause damage to the muscles of heart. They slowly loose their functional capability and are not able to pump the required amount of Blood leading to a condition called heart failure.
Causes and Symptoms
As the muscles of heart contract they push out the blood from the respective chamber, when they relax that chamber again gets filled with blood. In diabetics the characterstic failure is that of the relaxing muscles,the chambers of heart do not get filled up sufficiently and hence do not pump sufficient blood. Damage to the muscles may be compounded by coronary artery disease which may further decrease their fuctioning.
Symptoms of Heart failure may be breathlesness after exertion or swelling in feet, initially breathlesness may occur after a sufficiently long period of exertion, like walking, climbing stairs , lifting weight etc.But as disease progresses breathlesness beguns earlier , a stage may be reached when patients find it difficult to breath even while sitting or standing.
The functioning capacity of heart is assessed by Echocardiography, a non invasive technique similar to ultrasound.
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Last Updated on Saturday, 02 January 2010 15:20 |
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Complications of Diabetes -
Chronic Complications of Diabetes
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Written by Dr Rajesh Kesari MD
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Tuesday, 25 August 2009 07:24 |
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Diabetic Foot is a complex condition of the foot caused due to many simultaneously occuring complications of Diabetes. It finally leads to formation of wounds or ulcers in the affected legs which may not heal quikcly or even require amputation of the affected part. The two important complications are Diabetic Neuropathy and Peripheral Vascular disease. Neuropathy affects the nerves carrying sensation of pain, touch and pressure from he feet to brain as well as supplying the blood vessels , increasing or decreasing blood flow in parts of the legs.Blood vessels may become constricted due to atherosclerosis and calcification leading to decreased blood flow to soles and other part of feet.
Role of microtrauma
Small or even microscopic trauma to the soles or even sometimes severe burns may go unnoticed by the patient whose nerves carrying sensation of pain have been damaged due to diabetes, unknowingly the damage persists and forms into a wound when it becomes visible.Healing of wounds require increased blood supply to the affected area to bring nutrients for repair of the damaged tissue. Clogged blood vessels of the legs are unable to cope up and such wounds do not heal easily, they get infected, if high blood sugar levels persist body is not able to fight off the bacterias and the infection may spread to bones as well, healing of such wounds may take months even in normal persons. Subsequently the tissue which is not getting sufficinet blood supply and has been infected Dies and ghas to be cut off this is called amputation.
Autonomic Neuropathy
In Charcots Foot' the nerves of Autonomic Nervous System are damaged- they unnecessarily increase the blood flow to lges leading to excessive dissolution of calcium from bones of the foot which makes them weak, such bones easily get deformed, fractured and infected, again leading to the same vicious cycle and amputations and deformity of the foot.
Footcare
Proper footcare is very essential for avoiding this devastating complication of Diabetes. Choice of footwear is very important, shoes should be comfortable without any areas of excessive pressure, insoles or custom made shoes should be used if theres any difficulty in finding adequate footwear.Feet should be inspected daily , if there are any cracks, wounds etc. they should be taken care of. A Diabetologist or foot specialist must inspect the feet and conduct testing to ascertain the status of nerves.
Treatment of Diabetic Foot
If foot infections do happen they require good nursing, cleaning and dressing- preferably done in clean settings by a professional, rest and antibiotics are also helpful. Non healing wounds may be helped by Hyperbaric Oxygenation, in which the affected part is kept under pressurised oxygen, this promotes healing. Laser therapy involving exposure of the affected wound to low power laser is also very effective.Blood Sugar should be strictly controlled in any infection.
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Last Updated on Monday, 08 February 2010 09:12 |
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Complications of Diabetes -
Chronic Complications of Diabetes
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Written by Dr Rajesh Kesari MD
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Tuesday, 25 August 2009 06:05 |
Diabetic Retinopathy  Retina is he light percieving part of the eye, Uncontrolled longstanding Diabetes damages the blood vessels supplying the  delicate nerves of the Retina, the vessels may start leaking causing swelling and in the retina, subsequent bleeding from these vesels and their occlusion stops blood flow to parts of Retina leading to loss of perception of light in the affected part.When sufficient area of retina gets affected total Blindness may ensue. Symptoms of Diabetic retinopathy may range from decreased vision to haziness of vision or presence of dark floating patches in the field of vision. Continuing damage may significantly decrease the perception of light causing total blindness. Laser treatment for RetinopathyHigh power Lasers are used to coagulate (clot) the bleeding blood vessels, With help of the same lasers a range of scattered microscopic spots are made ( burnt) in some parts of retina which do not signifcantly affect the vision, but these spots decrease the requirement of blood in the whole of the eye and help in the healing of vital parts of retina and decrease the loss of vision. Glaucoma in DiabetesDiabetes may also cause Glaucoma, in this condition the fluid made in the anterior chambers ( The part of eyes in front of pupils which we can see) is not evacuated properly and continues to put pressure on the nerves carrying light sensation to Brain at the back of eyes leading to Blindness.Symptoms may range from sever headaches to decreasing vision. Cataracts in Diabetes Cataracts are cloudy deposits on the lens of the eyes, they are usually formed with age, but their extent and severity is much higher in Diabetics, moreover they occur at an earlier age in Diabetics. Catarct causes clouding and haziness of vision.
Early diagnosis and treatment of all the conditions of eye is very important as they threaten the vision of Diabetics.
All Diabetics should undergo through eye examination by a specialist with dilated pupils atleast once a year.
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Last Updated on Tuesday, 25 August 2009 07:09 |
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Complications of Diabetes -
Acute Complications of Diabetes
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Written by Dr Rajesh Kesari MD
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Saturday, 25 July 2009 10:03 |
Hyperglycemic Hyperosmolar State
This is an acute complication of Diabetes in which blood glucose levels are extremely high, in excess of 800 mg/dl (45 mmol/l). Body tries to get rid of the excess blood glucose through urine, as a result blood gets more concentrated and may even start clotting in blood vessels. Extreme dehydration occurs leading to even seizures and coma. This may affect both Type I & Type II diabetics, even though Type II Diabetics may be affected more.
Causes
It is generally caused due to extreme stress, either a result of infection , Stroke ( paralytic attack) or Heart attack. Blood levels of Hormones which increase blood glucose increase drastically and their just isn't enough insulin in the body to cope up.
Symptoms
Dryness of skin
Excessive urination and thirst
Drowsiness, clouding of consciousness
Seizures, Coma
Treatment
This is a life threatening medical emergency, any diabetic having these symptoms should be rushed to a hospital where Diagnosis is done based on his blood parameters and treatment is initiated.
Insulin in infections & Surgery
During treatment of infections of during surgery it is always preferable to use insulin instead of oral drugs in order to avoid these complications.
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Last Updated on Tuesday, 05 January 2010 15:30 |
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Complications of Diabetes -
Acute Complications of Diabetes
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Written by Dr Rajesh Kesari MD
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Saturday, 25 July 2009 06:40 |
Diabetic Ketoacidosis (DKA)
Diabetic ketoacidosis is an acute complication of Diabetes. It generally affects persons with Type I Diabetes but may rarely occur in Type II diabetes as well. Interestingly Blood glucose levels are not very high during DKA, usually less than 250 mg/dl.
Causes
Its caused by acute deficiency of insulin in the body- this forces the body to breakdown fat for utilization inside the cells as the source of energy. Ketones are the waste products generated during breakdown of fats and when in high quantities they affect the pH of blood leading to the dis-balance between acid and base components in blood.
Generally it happens when a dose of insulin is skipped due to illness by type I patients, Hence the sick day rule. It can also be precipitated due to infections or Heart attacks.
Symptoms of Diabetic Ketoacidosis (DKA)
Dehydration, Dryness of skin, mouth
Deep breathing with a strong fruity odour coming from breaths
Drowsiness
Unexplained pain in stomach
Tests for detection
DKA can be easily detected using urine dipsticks which measure ketones which are excreted by the kidneys in urine. Some glucometers also have function of measuring blood ketones with special strips.
Treatment
Any patient with these symptoms or any doubt of having DKA should be rushed to Hospital Emergency departments. This is a life threatening condition and requires immediate medical attention.
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Last Updated on Tuesday, 05 January 2010 15:57 |
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Complications of Diabetes -
Chronic Complications of Diabetes
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Written by Dr Rajesh Kesari MD
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Friday, 03 July 2009 17:05 |
Hypoglycemia Unawareness Our Body has an inbuilt mechanism to control Blood glucose levels and insulin is instrumental in bringing down the glucose levels- but what if there is'nt enough glucose in the blood- their exists another set of hormones called the glucose counter regulatory hormones which increase the blood glucose levels whenever required. The brain has no reserves of energy and cannot survive even few minutes without suffiecient energy to power the enormous processing which goes on all the time, even when we are asleep. If the blood glucose levels fall below 60 mg/dl the glucose counter regulatory hormones come into action and release reserves of glucose stored in the liver and kidneys. Glucose counter regulatory hormones These Hormones comprise of Glucagon- secreted by the pancreas, Noradrenaline secreted by the adrenal glands, the sympathetic nervous system also becomes active, epinephrine is released from the nerve endings- this stimulates the body to release glucose from body stores, food to be expediently absorbed from intestines, heart beats faster, peripheral blood vessels constrict and skin becomes cold. The central nervous system ( our brain) comes into action and directs us to eat something- we have a craving for food. The signals for all these actions is transmitted by the autonomic nervous system, due to autonomic neuropathy- a diabetic person may not feel any symptoms of hypoglycemia or low blood sugar like extreme hunger, craving for food, palpitations, cold skin and sweating,- Which a normal person would have felt. Autonomic Neuropathy But what if the nerve circuitory fails, blood glucose levels keep falling and the body does'nt take any action to increase the blood glucose levels. This is what happens in Hypoglycemia unawareness, blood glucose levels are critically low, brain may stop functioning leading to coma or epilepsy like seizures but body still does not do anything to mobilize glucose from its stores and pump it into blood. This is one of the fatal complications of longstanding diabetes and is caused when the nerves of the autonomic nervous systems like some branches of the vagus nerve get affected and do not conduct the required signals to heart, intestines stomach liver and pancreas which increase the blood glucose levels. |
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Last Updated on Saturday, 04 July 2009 04:51 |
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Complications of Diabetes -
Chronic Complications of Diabetes
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Written by Dr Rajesh Kesari MD
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Friday, 03 July 2009 14:36 |
Diabetic Neuropathy
Consistently raised blood Glucose levels and deficiency of insulin damage the nerves which carry signals in form of impulses from skin, internal organs to the brain and from vital centres controlling functioning of these organs , muscles and skin. The reason and mechanism of this damage is a very complex and still poorly understood despite tremendous research that has been conducted. As fas as yet understood- a number of factors together bring about the changes in structure of nerves and cause inflammation and destruction of the nerves or the outer covering of the nerves- the myelin sheath which is intrumental in conducting nerve signals, nerves require insulin and Insulin like growth factors which are provide nutrition and growth stimulus to nerves- these may be deficient in diabetes. This leads to the different types of neuropathies that are seen in diabetes.
Peripheral Neuropathy
Peripheral neuropathy are diseases of the peripheral nervous systems, i.e those nerves which carry signals to and from the extremeties like legs and hands. Diseases of the central nervous systems affect the nerves arising out of brain and controlling vital organs like heart, major blood vessels, lungs, stomach, intestines etc. Both of them may occur more frequently in diabetics.
Distal peripheral Neuropathy
Distal peripheral neuropathy - is quite common in Diabetics mainly affecting the feet, symptoms may range from numbness, decreased or complete loss of sensation to hot or cold. The first sensation to be lost in this type of neuropathy is the perception of vibration. These are all caused due to damage to the respective nerves conducting these sensations from the skin of the feet to the spinal cord which further relays these sensations to brain.This plays a very important part in development of the Diabetic foot.
Progressive damage to nerves may cause abnormal perception of touch- even a light touch may feel like burning or pricking pain and make walking difficult.
Compression neuropathies
Compression Neuropathies may also be caused in diabetes like Carpal Tunnel Syndrome, shoulder outlet syndrome- symptoms may range from pricking sensation in the palms or hand to weakness and dystrophy of muscles.
Autonomic Neuropathy
Autonomic nervous system includes many nerves which arise directly out of brain and control and regulate the functioning of vital organs of the body like heart, blood vessels, lungs, stomach, intestines and urinary bladder. These organs are under involuntary regulation, generally their functioning is not controlled by the conscious mind. These functions include controlling the heart rate, dilation and constriction of major blood vessels, working of lungs, acid secretion and contraction of stomach, peristalsis- contraction alternating with relaxation of muscles of intestines which results in forward movement of ingested food, passage of urine, erection of sexual organs etc. Longstanding diabetes, specially uncontrolled may damage this part of the nervous system resulting in loss of many symptoms like the pain of heart attack, impotence, fullness in abdomen, vomitting, hypoglycemia unawareness. for more on these click here...
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Last Updated on Saturday, 12 December 2009 15:53 |
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Complications of Diabetes
