What Are The Complications of A Diabetic
Patients who suffer from excessively high blood sugar concentrations for years must expect serious consequences for the entire body. Exact knowledge of the complications that can arise in the course of the disease is not only important for the state examination. Doctors can make a decisive contribution to avoiding amputations, blindness, kidney damage, and cardiovascular diseases.
Table: Risk of long-term effects
complication Relative risk
- Myocardial infarction Men: 3.7
- Women: 5.9
- Cardiovascular death Diagnosis before the age of 30: 9.1
- Diagnosis after the age of 30: 2.3
- Apoplexy 2-4
- Blindness 5.2
- Renal failure in men 12.7
- Amputation of the lower extremities 22.2-45
- Foot ulcers multiple
- Macroangiopathy
- PAD (peripheral arterial disease), intermittent claudication
- CHD (coronary artery disease), myocardial infarction
- Carotid stenosis (cerebrovascular sclerosis)
- Ischemic insult
- Media calcification
Heart attacks are particularly treacherous for diabetics because the diabetic neuropathy that also occurs is often painless and goes unnoticed by patients. Diabetics die from cardiovascular disease in 60% of cases.
Microangiopathy
In diabetes mellitus, not only the large arteries are damaged, but also the small ones. As a result of hyperglycemia, the basement membranes of the capillary vessels and renal glomeruli stenosed and occlude, leading to hypoxia and impairment of the glomerular filtration capacity. The reason for this is that hyperglycemia causes proteins to glycosylate non-enzymatically. This creates AGEs (advanced glycosylated end products) that attach to structural proteins and connective tissue products. Microangiopathy is particularly symptomatic of the eyes and kidneys but can affect all areas of the body.
Diabetic retinopathy
Diabetic retinopathy is divided into non-proliferative retinopathy and proliferative retinopathy. In the case of non-proliferative retinopathy, a distinction is also made between the three degrees of severity: mild, moderate, and severe. Hypoxia, which is the result of hyperglycemia, increases the formation of growth factors and new blood vessels develop. VEGF (vascular endothelial growth factor), which can be identified in the blood and blocked with medicine, plays a critical part in this.
The new blood vessels can also grow into the vitreous humor, but the greater danger is that they are very unstable, form microaneurysms, and often burst, causing bleeding. If the newly formed blood vessels do not cause any slight visual disturbances, it is non-proliferative retinopathy. Proliferative retinopathy, on the other hand, is defined as excessive bleeding into the vitreous humor and the formation of too many new blood vessels. Vision loss, retinal detachment, glaucoma, and blindness are all possible outcomes.
Another symptom of diabetic retinopathy is cell edema in the retina, which occurs due to the high concentration of sorbitol in the cell. Sorbitol is increasingly produced by the metabolism of glucose from the blood into the cell. This process is normal in tissues that can absorb glucose without insulin. In the case of hyperglycemia, however, there are also shifts in metabolism. Another consequence is the inactivation of the Na + / K + -ATPase and the formation of polyol and Myo-inositol, which cause affection of the myelin sheath.
Note: Diabetes is the most common cause of blindness in working age.
Therapy of diabetic retinopathy
Laser is the most common treatment for diabetic retinopathy. When neovascularization or vitreous bleeding develops, laser treatment is recommended. The corticosteroid preparation dexamethasone can also have a positive effect on diabetic macular edema but must be repeatedly injected into the vitreous humor. Angiogenesis inhibitors such as bevacizumab and pegaptanib block substances that promote vascular growth in the eye directly and can thus lead to swelling of the center of the retina. They're frequently injected into the eye multiple times over the course of a few weeks.
Diabetic nephropathy
Diabetic nephropathy is divided into five stages, which are symptom-free at the beginning and are partially reversible but lead to irreversible damage at the end. Depending on the stage, different symptoms are visible and therapeutic measures are necessary. However, normoglycemia and normotonia are the primary therapeutic goals in all stages.
Stage 1 runs symptom-free. The kidneys try to compensate for the increased glucose concentration in the blood with increased performance, resulting in an enlarged kidney and increased filtration performance. This stage is still reversible.
In stage 2 there are no symptoms either. As a rule, it only begins after several years of diabetes. The basement membrane of the glomeruli is significantly thickened and, as a result, the filtration capacity is already limited. This stage is also partially reversible.
The clearest sign of stage 3 is microalbuminuria and hypertension. The glomeruli are now permeable to proteins that can be detected in the urine. As a rule, these symptoms do not appear until after 5 to 15 years of illness and are a sign of the onset of renal insufficiency. To lower blood pressure, ACE inhibitors are recommended, which also protect the kidneys. These can also be combined with other antihypertensive agents if they are inadequate.
In stage 4, after a period of 10 to 25 years of diabetes, macroalbuminuria (300 mg / d) with reduced blood flow, hypertension, and reduced filtration capacity. In addition to ACE inhibitors, diuretics, calcium channel blockers, and beta-blockers are also used at this stage. A low-protein diet is also aimed for.
Diabetic nephropathy
The renal insufficiency that developed in stage 5 is no longer reversible, the filtration capacity is drastically reduced and pathological creatinine levels can be detected in the blood. At this stage, too, most of the time, hypertension is present. Since kidney failure is irreversible, the only remaining therapeutic measures are dialysis and a kidney transplant.
The first symptoms of diabetic neuropathy make themselves felt as tingling, pain, and numbness in the extremities and should be taken seriously as warning signs. If the diabetic neuropathy is not treated in good time, it can, in the worst case, lead to the death of peripheral nerve fibers. Then not only a feeling of numbness can be observed, but also a reduced sensation of pain up to a complete loss of sensation of pain in the extremities. Injuries are no longer noticed by the patient and can spread unhindered. The diabetic foot in particular is a dangerous complication that can lead to the amputation of the extremity.
In the case of very painful neuropathies, tricyclic antidepressants such as amitriptyline can help alleviate the problem. Gabapentin and pregabalin are also effective drugs for neuropathic pain.
Diabetics should definitely have regular medical foot care to prevent diabetic foot syndrome. In addition, attention should be paid to suitable footwear and the feet should be checked for injuries every day.
When the autonomic nerves are damaged, it has a variety of effects on the body. The following symptoms can occur in diabetics:
- Erectile dysfunction
- Diabetic cysopathy with frequent infections
- Circulatory disorders of the skin
- Dizziness, syncope
- Diarrhea, constipation
- Heartburn, difficulty swallowing, gastroparesis
- Related to cancer
Other complications
In addition to the typical long-term effects, there are also complications that are less well known. Hyperglycemia also affects joints and connective tissue - patients complain of a stiff shoulder ( frozen shoulder ) or fingers ( neuropathy ). D ie diabetic neuropathic osteoarthropathy (DNOAP), and neuropathic arthropathy called, is a disease which is, inflammatory destruction of bones and joints will be a non-infectious. It is a special form of diabetic foot syndrome.
Charcot's foot
Image: “Charcot's foot in diabetes in the X-ray ap and oblique. The destructions with (sub) dislocations are most pronounced around the Lisfranc line. At the lateral edge of the foot, you can also see air pockets as an indication of a deep infection firstling to the skin. ”By Hellerhoff. License: CC BY-SA 3.0
In type 1 diabetes mellitus, the autoimmune reaction can also lead to diabetic mastopathy or Hashimoto's thyroiditis.
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