Diabetes Mellitus:- Part 6 – Diabetes Mellitus Complications and Prevention

- Diabetic patients need follow-up and proper control to prevent diabetic complications.
The complication of Diabetes Mellitus:
- There may be hypoglycemia.
- In patients with hyperglycemia of Type I, left uncontrolled may develop life-threatening complications like diabetic Ketoacidosis.
- Without treatment, the patient may become acidotic and dehydrated and may lose consciousness.
- Type II may develop hyperosmolar coma.
- Peripheral neuropathy.
- Diabetic retinopathy and cataract formation, it may lead to blindness.
- Cardiovascular microangiopathy.
- Coronary atherosclerosis.
- Myocardial infarction is 3 to 5 times more common in diabetic patients.
- AMI is the leading cause of death in patients with diabetes mellitus type 2.
- Peripheral vascular diseases like ischemia of lower extremities, erectile dysfunction, and intestinal ischemia.
- Gangrene of the foot.
- Diabetic kidney diseases, diabetic nephropathy.
- It may lead to renal failure.
- Chronic pyogenic skin infection.
- Candidal infection of the skin.
- Bone and joints show contracture.
- In the end, maybe result in stroke, gangrene, and coronary artery diseases.
Diagnosis | Fasting glucose level | Random glucose level | 2-hour glucose level (in OGTT) | HbA1c |
Prediabetics | 100 to 125 mg/dL | 140 to 199 mg/dL | 40 to 199 mg/dL | 5.7 to 6.4% |
Diabetes mellitus | > 126 mg/dL | >200 mg/dL | >200 mg/dL | >6.5% |
The Complication Of Diabetes Mellitus:
Acute complications are:
- Hypoglycemia:
- In the case of excess insulin injection, and excess intake of alcohol especially with an empty stomach can lead to hypoglycemia.
- The increased risk for hypoglycemia includes autonomic neuropathy, gastroparesis, and end-stage chronic kidney disease.
- Hypoglycemia occurs in impaired glucagon response, sympathoadrenal responses, and cortical deficiency.
- Hyperglycemia:
- In patients with hyperglycemia of Type I diabetes mellitus left uncontrolled, they may develop life-threatening complications like diabetic Ketoacidosis.
- Without treatment, the patient may become acidotic and dehydrated and may lose consciousness.
- Type II may develop hyperosmolar coma.
Chronic complications are:
- These lead to hypertension, end-stage chronic renal diseases, Blindness, autonomic and peripheral neuropathy, amputation of the lower limbs, myocardial infarction, and cerebrovascular accidents.
- Diabetic neuropathy:
- The most common is diabetic peripheral neuropathy where there is loss function appears ina stocking-glove pattern and is due to an axonal neuropathic process.
- Foot both motor and sensory nerve conduction is delayed in the peripheral nerves and ankle jerk may be absent.
- Isolated peripheral neuropathy is the involvement of the distribution of one nerve. This is attributed to vascular ischemia or traumatic damage. Cranial and femoral nerves are more commonly involved.
- Autonomic neuropathy is seen in advanced and long-standing diabetes mellitus. This may involve visceral functions, like blood pressure, pulse, gastrointestinal activity, urinary bladder function, and erectile function.
- Peripheral neuropathy. There is the involvement of the cranial and peripheral nerves.
- Occular complications:
- Premature cataracts occur in diabetics.
- There is retinopathy of two types, one is called nonproliferative and the other is called proliferative retinopathy.
- Glaucoma occurs in 6% of the diabetics.
- The involvement of small and large size blood vessels.
- Cardiovascular microangiopathy may explain the etiology of congestive cardiomyopathy in diabetics who don’t have evident coronary artery disease.
- Coronary atherosclerosis gives 3 to 5 times more myocardial infection in diabetics and is the leading cause of death in type 2 diabetes mellitus.
- In type 1 diabetes mellitus, they have also increased the risk of coronary artery disease. It is lower than the type 2 DM.
- AMI is the leading cause of death in patients with diabetes mellitus type 2.
- Peripheral vascular diseases like ischemia of lower extremities, erectile dysfunction, and intestinal ischemia.
- Gangrene of the foot.
- Diabetic nephropathy:
- 30 to 40% of the type 1diabetes Mellitus develop nephropathy over 20 years of diabetes.
- In type 2 diabetes, nephropathy is less common. Only 15 to 20% develop renal disease.
- Diabetic kidney diseases (diabetic nephropathy), and may lead to end-stage renal disease.
- Initially, there is proteinuria, followed by the decline in renal functions where there is an increase in the blood urea and creatinine.
- This renal disease can be assessed by the microalbuminuria.
- Also, advise the albumin/creatinine ratio.
- Albumin/creatinine ratio <30 is normal.
- The ratio of 30 to 300 mcg/mg suggests abnormal microalbuminuria.
- A chronic renal disease suspected when there is persistent albumin excreted more than 30 mcg/mg creatinine.
- When the treatment is inadequate then patients develop nephrotic syndrome with hypoalbuminemia, edema, an increase in the LDL-cholesterol, and increasing azotemia.
- Ultimately there is end-stage renal disease.
- Chronic pyogenic skin infection.
- Candidal infection of the skin. Also, there is vulvovaginitis in the female with uncontrolled diabetes mellitus.
- In type 2 poorly controlled diabetics, there are eruptive cutaneous xanthomas.
- Bone and joints show contracture.
- In chronic and long-standing diabetics, there is progressive stiffness of the hand secondary to the contracture and tightening of the skin over the joints (diabetic cheiroarthropathy).
- There may be frozen shoulders which is adhesive capsulitis.
- There may be carpel-tunnel syndrome and dupuytyren-contracture.
- There may hyperuricemia and the tophaceous gout are more common in the type2 diabetics.
Work up of diabetic patients to prevent the complications:
- Basic metabolic panel :
- Fasting glucose level.
- Postprandial glucose level
- Microalbuminuria.
- BUN (urea).
- Creatinine.
- Electrolytes.
- Anion gap = (Sodium + potassium) — (Chloride + bicarbonate)
- HbA1c.
- Lipid profile:
- Cholesterol.
- Triglycerides.
- HDL.
- LDL.