Diabetes Complications


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Content

Diabetes

Diabetes Information

-Diabetes Facts
-History of Diabetes
-Causes of Diabetes
-Diabetes Complications
-Diabetes Education
-Diabetes Research

Diabetes Mellitus

-Diabetes Mellitus Symptoms
-Type 1 Diabetes Mellitus
-Type 2 Diabetes Mellitus
-Diabetes Mellitus Treatment

Types of Diabetes

Type 1 Diabetes
-Type 1 Diabetes Mellitus
-Type 1 Diabetes Symptoms
-Type 1 Diabetes Diet
-Type 1 Diabetes Cure

Type 2 Diabetes
-Type 2 Diabetes Mellitus
-Type 2 Diabetes Symptoms
-Type 2 Diabetes Causes
-Type 2 Diabetes Diet
-Treatment of Type 2 Diabetes
-Type 2 Diabetes Medications

Gestational Diabetes
-Gestational Diabetes Test
-Gestational Diabetes Symptoms
-Gestational Diabetes Diet Plan
-Gestational Diabetes Treatment

Juvenile Diabetes
-Juvenile Diabetes Symptoms
-Juvenile Diabetes Treatment

Diabetes Insipidus
-Nephrogenic Diabetes Insipidus
-Treatment for Diabetes Insipidus

Feline Diabetes

Diabetes Symptoms
-Signs of Diabetes
Also: Diabetes Sign Symptoms
-Type 2 Diabetes Symptoms
Also: Type II Diabetes Symptoms
-Gestational Diabetes Symptoms
-Symptoms, Juvenile Diabetes
Also: Diabetes Symptoms in Child

Diabetes Diet
-Diabetes Food
-Diabetes Nutrition
-Diabetes Diet Plan
-Type 2 Diabetes Diet

Diabetes Supply
-Diabetes Testing Supply

Diabetes Treatment
-Diabetes Medications
-Alternative Treatment for Diabetes

Insulin
-Insulin Resistance
-Insulin Pump
-Lantus Insulin

Diabetes Care
-Diabetes Management
-Diabetes Associations
-Diabetes Prevention
-Diabetes Cure

Diabetes is the No. 6 leading causes of deaths in the United States, according to 2001 data from the United States National Center for Health Statistics.

Diabetes Complications
(or Sequelae of Diabetes)

Sometimes a complication of diabetes may give a clue to the presence of the disease. The principle complications or sequelae associated with diabetes are retinopathy, neuropathy, nephropathy and arteriosclerosis. Whether these are the unavoidable consequences of the diabetic state over time or whether they may be influenced by controlling the diabetes through aggressive monitoring, treatment and life-style management, including diet and supplements and diabetes treatment using alternative medicine, remains a central topic.

One of the largest, most comprehensive diabetes studies conducted to date showed that keeping blood sugar levels as close to normal as possible through aggressive management slows the onset and progression of eye, kidney and nerve diseases caused by diabetes. In fact it demonstrated that any sustained lowering of blood sugar helps, even if the person has a history of poor control.

Specifically it found that lowering and maintaining more constant blood sugar levels reduced the risk of eye disease by 76%, kidney disease by 50%, nerve disease by 60% and cardiovascular disease by 35%.

Since the discovery of insulin nearly 70 years ago, the patterns of morbidity from diabetes have changed. Where the major causes of death were ketoacidosis and infection, they are now the microvascular and cardiovascular complications of diabetes (renal failure and myocardial infarction).

These complications are responsible for a reduction in the life expectancy of a newly diagnosed insulin dependent diabetic by about one-third. The basis of managing diabetes in the 90?s is an improvement in the life-style of the diabetic and prevention of complications responsible for morbidity and mortality in diabetes.

Neuropathy (nerve disease)

Diabetic neuropathies are among the most frequent complication of long-term diabetes. It is estimated that 60% to 70% of diabetics have mild to severe forms of nervous system damage. The femoral nerve is commonly involved giving rise to symptoms in the legs and feet. Pain is the chief symptom and tends to worsen at night when the person is at rest. It is usually relieved by activity and aggravated by cold. Paraesthesias are a common accompaniment of the pain. Cramping, tenderness and muscle weakness also occur but atrophy is rare. Advanced femoral nerve disease is a major contributing cause of lower extremity amputations. Nerves in the arms, abdomen and back may also be affected. Symptoms may include impaired heart function, slowed digestion, reduced or absent perspiration, severe oedema, carpal tunnel syndrome, alternating bouts of diarrhoea and constipation, bladder atony, urinary and faecal incontinence and impotence.

With respect to sexual impotence, diabetes is probably the single most common disease associated with erectile failure (termed neurogenic impotence in the diabetic). Since diabetes is a metabolic disease with vascular and nervous system complications and an erection involves all levels of the nervous system from the brain to the peripheral nerves, lesions anywhere along the path may be responsible for erectile failure. It has been estimated that close to 50% of diabetic males have some degree of erectile dysfunction. Neuropathies usually improve with the control of the diabetes. Severe or chronic changes may require several weeks or months to show maximum improvement.

Retinopathy (eye disease)

Changes occurring in the eye which are distinctive of diabetes involve the narrowing, hardening, bulging, haemorrhaging or severing of the veins and capillaries of the retina. This is a serious complication known as retinopathy and may lead to loss of vision. Visual changes in the earlier stages may include diminished vision, contraction of the visual field, changes in the size of objects or photophobia. In the more advanced stage, termed 'proliferative retinopathy', haemorrhages, retinal detachment and other serious forms of deterioration are observed. When the disease progresses to this late stage total blindness may occur.

It usually takes between 10-13 years for diabetic retinopathy to develop and it is present in some degree in most diabetics who have had the disease for 20 years. In only about half of the diabetics who develop it however, is vision markedly impaired and blindness occurs in only about 6%. Still, diabetes is the leading cause of blindness in adults 20 to 74 years old and is estimated to cause from 12,000 to 24,000 new cases each year. Two other complications of diabetes, cataracts and glaucoma, can also lead to loss of vision

The development of laser therapy will probably reduce the prevalence of diabetes-induced blindness, however this therapy is not without occasional side effects (haemorrhage, retinal detachment and loss of visual field) and is therefore indicated only for the more serious conditions.

Arteriosclerosis (vessel disease)

The diabetic state is associated with earlier and more severe vascular changes than normally occur at a given age. Cardiovascular- renal disease is the leading cause of death among diabetics. Atherosclerosis can be accurately described as the end stage of Type 1 and Type 2 diabetes, since the vast majority of diabetes patients will die from an atherosclerotic event. Most commonly these events are cardiovascular in nature (an estimated 60% to 65% of diabetics have high blood pressure) although 20-25% of atherosclerotic events may be cerebrovascular or microvascular.

The incidence of coronary occlusion in persons with clinical diabetes has been estimated at from 8-17% with diabetic adults having heart disease death rates about 2 to 4 times as high as the general population. The risk of stroke is also found to be 2 to 4 times higher in people with diabetes. Arteriosclerosis obliterans in the lower extremities, a form of peripheral vascular disease, may produce disturbances in sensation, decrease in muscular endurance, intermittent claudication on effort, absence of peripheral pulses in the lower legs and feet and gangrene, and ultimately lead to amputation of the extremity. Diabetic gangrene usually involves the toes, heels or other prominent parts of the feet and is precipitated by trauma, infection or extremes in temperature. Needless to say, careful attention to proper foot care, avoidance of injury and consistent use of methods to improve peripheral circulation, including withdrawal from tobacco use in any form, are critical for the diabetic. The aetiology of large vessel disease is multi-factorial in the diabetic as well as the non-diabetic population with lipoprotein metabolism, hypertension, physical activity, obesity, cigarette smoking, stress, personality and genetic and racial factors all playing a part.

Nephropathy (kidney disease)

Nephropathy is a common and important accompaniment of diabetes and one that in young diabetics takes precedence over heart disease as a cause of illness and death. As with eye changes, there is a wide variation in the type and degree of renal damage. Nephropathy is less frequent than retinopathy and where it occurs is also a development of long standing diabetes. Nevertheless, diabetes is the leading cause of end-stage renal disease in the US, accounting for about 40% of new cases. In 1995, a total of 98,872 people with diabetes underwent dialysis or kidney transplantation and 27,851 developed end-stage renal disease.

One study reported that among 200 juvenile diabetics who survived 20 years after onset, one half had evidence of renal disease. Another study found that the majority of these patients have hypertension and two thirds show significant albuminuria, but the fully developed nephrotic syndrome of hypertension, proteinuria and oedema occurs in less than 10% and renal function is impaired in only one half to three quarters of those patients.

Like other long-term complications, good blood glucose control goes a long way towards reducing the risk of diabetic nephropathy. In addition to monitoring the blood sugar levels, periodic monitoring of a diabetic patient?s kidney function (blood urea nitrogen, uric acid, creatinine and creatinine clearance) is important.

Hypoglycaemia

If there is too much insulin in the body compared to the amount of blood sugar, and the blood sugar falls below normal levels, a condition known as hypoglycaemia occurs. This problem of hypoglycaemia due to insulin or oral hypoglycaemic drugs is much more common in Type 1 than Type 2 diabetes since the Type 1 diabetic is directly injecting insulin. If too much insulin is administered, or the person misses a meal or over-exercises, hypoglycaemia may result. In this condition, commonly referred to as insulin shock, the brain is deprived of an essential energy source. The first sign is mild hunger, quickly followed by dizziness, sweating, palpitations, mental confusion and eventual loss of consciousness. Before the condition reaches emergency proportions, most diabetics learn to counteract the symptoms by eating a sweet or drinking a glass of orange juice. In some cases, the only effective measure is an intravenous injection of glucose.

Digestive Disorders

Based on the 1989 US National Health Interview Survey, diabetics are more likely than the general population to report a number of digestive conditions, including ulcers, diverticulitis, symptoms of irritable bowel syndrome, abdominal pain, constipation, diarrhoea and gallstones.

Oral Complications

Periodontal disease, which can lead to tooth loss, occurs with greater frequency and severity among diabetics. Periodontal disease has been reported to occur among 30% of people aged 19 years or older with Type1 diabetes.

Infections

Studies in clinic, community and hospital populations indicate that diabetic subjects have a higher risk of some infections, including asymptomatic bacteriuria, lower extremity infections, re-activation tuberculosis, infections in surgical wounds and group B streptococcal infection. Populationbased data suggest a probable higher mortality from influenza and pneumonia.

Complications of Pregnancy

The rate of major congenital malformations in babies born to women with pre-existing diabetes varies from 0% to 5% among women who receive preconception care, to 10% among women who do not receive preconception care. Between 3% to 5% of pregnancies among women with diabetes result in death of the new-born; the rate for women who do not have diabetes is 1.5%4.

Ketoacidosis

Another acute complication more likely to occur in the IDDM is ketoacidosis, a condition caused by a lack of insulin leading to a build-up of ketoacids. Chemical compounds called ketones are one of the natural by-products of fat metabolism. Excessive ketone bodies are formed by the biochemical imbalance in uncontrolled or poorly managed diabetes. The condition known as diabetic ketoacidosis can directly cause an acute life-threatening event, a diabetic coma.

The possibility of ketoacidosis is suggested by:
? Confusion or coma, the patient almost always appearing extremely ill.
? Air hunger - an attempt to compensate for metabolic acidosis.
? Acetone odor (fruity) invariably on the breath.
? Nausea and vomiting almost always present.
? Abdominal tenderness which may mimic viral gastroenteritis.
? Extreme thirst and dry mucous membranes.
? Diabetic history (present in about 90% of cases).
? Weight loss.

Before the discovery of proper treatment by insulin and other intravenous injections, acidosis was the chief cause of death among diabetics. Today diabetics can use a simple urine dipstick at home to measure the level of ketones (excreted ketoacids) in the urine.

(by Clinton Choate, L.Ac.)