Complications of Diabetes (Diabetes Complications) (Diabetic Complications)
Compications of diabetes can occur in many organ systems. There is no set pattern and they are certainly not inevitable. Diabetes can be an almost silent disease, especially in the beginning. On the other hand severe complications are very possible and every diabetic should be educated to be able to recognize the earliest signs so that treatment is not delayed.
Diabetic coma is diabetic due to the buildup of ketones in the bloodstream. Ketones are a
product of metabolizing fats rather than the sugar glucose for energy. The best approach to diabetic coma is prevention. Careful diet, medication, and insulin dosing (in the case of insulin dependent diabetes) as needed should prevent ketone build-up. Patients with diabetes and their family members should be aware of the early signs of ketone build-up which include weight loss, nausea, confusion, gasping for breath, and a characteristically sweet, chemical odor to the patient’s breath (“acetone breath”) and sometimes sweat. Diabetic coma may be presaged by confusion and convulsions. Immediate emergency medical treatment is needed in a hospital setting for patients who show the early signs of diabetic coma.
Diabetic dermopathy is a skin condition characteristic of diabetes involving light brown or reddish oval or round scaly patches, most often on the shins or front of the thighs and less often on the scalp, forearm and trunk. The cause of diabetic dermopathy is a type of vascular inflammation affecting small blood vessels in the skin. There is no known effective treatment, but fortunately the patches tend to go away after a few years. The patches are also called shin spots. They appear sometimes in nondiabetics after trauma.
Diabetic eye disease is a disease of the small blood vessels of the retina of the eye. The vessels swell and leak liquid into the retina, blurring vision and sometimes leading to blindness. Also called diabetic retinopathy. Diabetes also predisposes a person to cataracts (clouding of the lens) and glaucoma (increased pressure inside the eye that can lead to optic nerve damage and loss of vision). All diabetics should have a dilated eye examination at least once a year.
Diabetic macular edema involves swelling of the retina in diabetes mellitus due to leaking of fluid from blood vessels within the macula (the central portion of the retina, rich in cones, the specialized nerve endings that detect color and upon which daytime vision depends). As macular edema develops, blurring occurs in the middle or just to the side of the central visual field. Visual loss from diabetic macular edema can progress over a period of months and make it impossible to focus clearly. Macular edema in common in diabetes. The lifetime risk for diabetics to develop macular edema is about 10%. The condition is closely associated with the degree of diabetic retinopathy.
Hypertension (high blood pressure) and fluid retention also increase the hydrostatic pressure within capillaries which drives fluid from within the vessels into the retina. A common cause of fluid retention in diabetes is kidney disease with loss of protein in the urine (proteinuria).
Diabetic neuromusculoskeletal disorders. These include:
- limited joint mobility (cheiroarthropathy)
- thickening of the skin over the joints
- stiff hand syndrome (thickening of the skin of the palm that results in loss of ability to hold the hands straight)
- adhesive capsulitis (severe limitation of the range of motion of the shoulder due to scarring around the shoulder joint, aka “frozen shoulder”
- neuropathic joints (below the knee) (destruction, increased density, dislocation, debris, distension, and disorganization of joints due to diabetic neuropathy, nerve damage caused by diabetes)
- diffuse idiopathic skeletal hyperostosis (general overgrowth of bone of unknown cause)
- carpal tunnel syndrome and other nerve entrapment syndromes
- flexor tenosynovitis (inflammation of the extensor pollicis longus tendon on the side of the wrist at the base of the thumb, typically associated with pain when the thumb is folded across the palm and the fingers are flexed over the thumb. Dupuytren contracture — formation of scar tissue in the palm over the tendons that pull the fingers)
- diabetic amyotrophy (acute neuropathy of a large proximal nerve)
Diabetic nephropathy refers to kidney disease associated with long-standing diabetes. Diabetic nephropathy is also called Kimmelstiel-Wilson disease or syndrome and also intercapillary glomerulonephritis. Diabetic nephropathy typically affects the network of tiny blood vessels (the microvasculature) in the glomerulus, a key structure in the kidney composed of capillary blood vessels which is critically necessary for the filtration of the blood. Features of diabetic nephropathy include the nephrotic syndrome with excessive filtration of protein into the urine (proteinuria), high blood pressure (hypertension), and progressively impaired kidney function. When it is severe, diabetic nephropathy leads to kidney failure, end-stage renal disease, and the need for chronic dialysis or kidney transplant.
Diabetic neuropathy is a family of nerve disorders caused by diabetes. Diabetic neuropathy is more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40. Diabetic neuropathies cause numbness and sometimes pain and weakness in the hands, arms, feet, and legs. Neurologic problems in diabetes may occur in every organ system, including the digestive tract, heart, and genitalia. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater is the risk. About half of diabetics have some form of neuropathy, but not all with neuropathy have symptoms. The highest rate of neuropathy is among people who have had the disease for at least 25 years.
Diabetic shock is caused by hypoglycemia (low blood sugar) associated with diabetes. Symptoms include a sweet, chemical odor on the patient’s breath similar to that of acetone or alcohol (“acetone breath”), fatigue, light-headedness or fainting, and often reddening of the skin (in white skin people). Immediate treatment is administration of glucose in a prescription sub-lingual form, or even in the form of hard candy if nothing else is available. If the patient is unconscious an intravenous push of 50% glucose brings them back immediately. Patients with diabetes and their families should learn the early warning signs of hypoglycemia and carry glucose tablets for emergency use. Patients in a state of diabetic shock should also be evaluated medically immediately after emergency treatment. Changes in diet, medication, or insulin administration can then be instituted to prevent future episodes.
Diabetic skin disease is any skin disorder caused by diabetes or affected by diabetes. Skin disorders are common in diabetes. Some of these disorders are conditions that anyone can have but to which people with diabetes are particularly prone, such as atherosclerotic skin changes, bacterial and fungal infections of the skin, and itching. Other diabetic skin diseases are seen mainly or exclusively in people with diabetes as is the case with diabetic dermopathy, necrobiosis lipoidica diabeticorum (NLD), diabetic blisters (bullosis diabeticorum), and eruptive xanthomatosis.
Diabetic spinal cord disease is due to involvement of the spinal cord in diabetes. The nerve damage in diabetes can be more generalized than usually recognized and specifically it can involve the spinal cord leading to diminution in the size of the spinal cord, anthough this does not happen in all patients with diabetes. Whether spinal-cord involvement in diabetes is a primary or secondary is uncertain, it is clear that the spinal cord can be an important target in diabetes.
Diabetic xanthoma (eruptive xanthoma) is a sudden eruption on the skin of crops of pink papules (firm pea-sized bumps) with a creamy center. They may appear on the hands, feet, arms, legs and buttocks and be itchy. They are due to high concentrations of plasma triglycerides, as occurs with uncontrolled diabetes. The xanthomas usually disappear when the underlying condition is treated, as when the diabetes comes under control.