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Complications of Diabetes

How to Avoid Complications of Diabetes and live a healthy life.

Introduction

Complications of Diabetes are those conditions in which diabetic patients suffer from the effects of high blood sugar levels on different parts or organs of the body.

In my previous blogs/articles on diabetes[Click these nos. above ¹ ² ³ ] I had discussed in detail about signs/symptoms, investigations, and treatment of diabetes.

Having understood what diabetes is, its investigations, and treatment, we now move on to know what can happen if the patient neglects the advice of his healthcare physician.

For whom is this article about complications of diabetes important and why?

This article is meant basically for those patients who are already undergoing treatment for diabetes. Slight negligence of advice on the part of the patient can lead to serious health issues. So, as per the headline of this article, the idea behind it is to help patients avoid complications of diabetes and to live a healthy life.

The purpose behind writing this article is to spread awareness regarding complications of diabetes and not to scare the patient but help him/her to prevent it.

Before we proceed ahead, I would like you all to listen to this short podcast-https://player.captivate.fm/episode/69757f35-ddf2-47e4-8415-e364cfe54521

What are these complications of diabetes?

As far as different complications of diabetes and their treatments are concerned, the subject is quite vast. Hence, I have decided to break up the article into many small parts for a better understanding of each complication.

The Minor Complications[mentioned below] have been covered in previous articles and so will not be discussed here.

In this article, I will discuss in brief about the various major complications. As we go ahead, each complication will be taken up individually. They will be discussed in detail so that you can take timely and preventive action.

Coming to the complications, they can present as-

A] Minor Complications of Diabetes-

  • Hypoglycemia- a side-effect of overmedication or undernutrition i.e. not eating food on time as prescribed by his/her physician[Read here to know more]
  • Hyperglycemia- exactly the opposite of hypoglycemia. Here the patient is non-compliant as far as medication is concerned and does not have control over his diet.

B] Major Complications of Diabetes-

1]Infections

Infections of different tissues in our body is a  very common complication of diabetes.

We are all prone to some infection or the other in our lifetime. What stands out in the case of a diabetic patient is the severity of any infection that the patient suffers from. These patients mostly have uncontrolled blood sugar levels. Most common infection the patient faces are-

A]Respiratory tract infections-

Both upper and lower respiratory tract infections occur as complications of diabetes.

B]Urinary tract infection-

this includes the kidney, ureter, bladder, and the urethra.

C]Skin Infections-

Occurs mostly due to dryness of the skin making the patient prone to bacterial and fungal infections

D]Gastrointestinal infections-

such as cholecystitis[gallbladder infection] and enteritis[intestinal]

2]Retinopathy

a condition where our eye gets affected due to poor blood sugar control causing poor blood supply. The optic nerve supplying the screen of the eye-Retina-gets affected leading to blindness.Complication of Diabetes-Retinopathy

3]Angiopathies

a condition where our blood vessels are affected leading to a lack of blood supply to different parts of the body. They are again classified as-

Macroangiopathy, and

Microangiopathy.

Most of the other conditions mentioned in this article are directly or indirectly related to angiopathy. The above picture of the eye shows microangiopathy.

4]Diabetic Polyneuropathy[DPN]

As the name suggests DPN is related to our nervous system. It is the most common complication of diabetes. It can affect up to 50% of diabetic patients during their lifetime.

A Complication of Diabetes-Peripheral neuropathy
A Complication of Diabetes-Peripheral neuropathy

5]Diabetic Foot disease

This complication of diabetes is a combination of both antipathy[Macro- as well as Micro-] and Peripheral Neuropathy. Foot ulcers occur due to loss of sensation and loss of blood supply to the foot tissues. The patient does not feel pain leading to abuse of foot creating ulcers that are difficult to treat ultimately leading to gangrene[rotting of tissues] and amputation.

6]Diabetic Ketoacidosis-

 This is by far the most dangerous of all the complications of diabetes. In this condition, the tissues in our body cannot take up glucose due to absolute or relative deficiency of insulin. This is common in Type1 diabetes. It also occurs sometimes in Type2 DM where the patient has not adhered to his treatment regimen and/or is suffering from some infection. I will discuss this in detail when we come to this complication later.

7]Diabetic Nephropathy

Uncontrolled or poorly controlled blood-sugar levels lead to malfunctioning of kidneys. It does this by affecting the filtration units of the kidneys-the glomerulus. This is called Glomerulosclerosis and it causes kidney failure or chronic kidney disease in the long run.

8] Pregnancy-

A female diabetic patient can get complications during the course of pregnancy such as abortion, or antenatal [in-pregnancy] uterine bleeding which can retard fetal growth. Poorly controlled diabetes can also lead to the baby being born large for its age.

I will now discuss these complications in detail in the forthcoming articles as we go along. Before going on to the next level I would like to share some information which is quite important-

Can you imagine how many people are living with Complications of Diabetes worldwide and how many in India?

As per the latest statistics on the total number of diabetes patients, China led the number with 116.4 million and India coming second with 77 million patients. The cases in India are increasing rapidly. According to the International Diabetes Federation, it was 40.9 million in 2015 and is set to cross 69.4 million by 2025. This includes pre-diabetes, diabetes without complications, and those with complications.

That said, it will be now up to us to bring this number to manageable levels so that diabetic patients do not develop complications. How to do it, we will discuss in my future articles as we go ahead.

To know more about Complications of Diabetes you can read here on the site of IDF- Click here.

In my next article, I will be focussing on a major complication  – Retinopathy of Diabetes. This is an important topic as many of the diabetics with poor control land up having impaired vision and blindness. I will also be discussing its management.

For those who love the information in Hindi, Click here

Here is a short video that you can watch to know more about complications of Diabetes- linkhttps://youtu.be/HdR4CTm4Ptg

To know how diabetes can be controlled naturally,  click here- Link

Do post your comments and if you have any suggestions to add, kindly do so.

Low blood sugar
What is Hypoglycemia and What are its Effects
High Blood Sugar or Low Blood Sugar we do not want- what we want is Normal Blood Sugar Click To Tweet

Hypoglycemia and its after-effects

What is Hypoglycemia?

Hypoglycemia is basically a patient getting low blood sugar while on treatment for Diabetes Mellitus. It is a complication that can occur during the treatment of diabetes.

When the blood sugar of a diabetic patient goes below 50 mg/dl, the patient starts showing signs and symptoms of hypoglycemia. So, if you are a diabetic patient, it is all the more important that you be aware of it.

What are the Signs and Symptoms of Hypoglycemia?

A patient under treatment for diabetes is bound to get low blood sugar some time or the other during the course of his/her treatment. This I will illustrate by an example.

Case Study-1

Last Sunday i.e. 16th February 2020 I got a call from one of my family patients regarding his father’s condition. He was having lapses of consciousness off and on. Upon visiting his residence, I found out that-

  1. the 84-year-old patient was breathing heavily
  2. he could barely open his eyes even though responding to queries
  3. his speech was slurred
  4. his BP was normal

My initial diagnosis was that the patient was going in for a stroke [paralysis], which is quite normal as the patient was old enough to suffer from a stroke. On further questioning, I came to know that the patient was under treatment for –

  1. Diabetes
  2. Hypertension

Both of these conditions can cause a stroke. So I advised the patient to be shifted to a hospital, which they did, for further evaluation and treatment.

In the hospital, his blood sugar was checked and it came out to be 50mg/dl. Immediately 10oml of 25% Dextrose was given by IV route and the patient became conscious instantly and started questioning why he was brought to the hospital.

What to do in case you are having Hypoglycemia?

So, if any of your near and dear ones undergoing treatment for diabetes show the above signs and symptoms, do call your family physician as hypoglycemia for a prolonged period can cause irreparable damage to your brain [ your brain needs a constant supply of glucose to keep you conscious and active] by going into hypoglycemic coma.

Better still- keep a glucometer handy at home to check regularly on your diabetic relative.

Glucometer set for checking blood glucose
Glucometer set for checking blood glucose

 

In the initial phases, oral consumption of glucose powder or some sweets can avert hypoglycemia.

What are the likely causes of Hypoglycemia?

A patient undergoing treatment for diabetes is likely to have hypoglycemia if-

  1. he/she is fasting while taking medication[very common amongst Indians]
  2. takes medicines on time but does not eat on time
  3. he/she is on Insulin injections
  4. takes an overdose of medicine[more than what has been prescribed by his/her doctor] in order to bring down blood sugar fast.

I will illustrate this with another example-

Case Study 2-

This case occurred 30 years ago, in the early days of my medical practice. That was a time when glucometers were not available in India. So diagnosing hypoglycemia was based purely on the history given by the patient’s relatives.

I was called upon to have a look at a 65-year-old lady who was a diabetic, was speaking incoherently and sweating profusely. My first impression on seeing her was that she must have had a heart attack. I checked her B.P. which was normal.

She did not recognize me even though she knew me very well. As she was undergoing treatment with oral antidiabetic drugs and also having insulin, I enquired about it ant the last time she had her regular meal.

I was told that her last meal was only a cup of coffee and that 8 hours back as that day was her fast but had taken her regular medicines on time. This gave me a clue as to what was wrong and the diagnosis-hypoglycemia.

I immediately ordered 20 ml of 25% Dextrose solution and injected it through her veins as a bolus. And guess what-the effect was dramatic. The patient perked up and started talking and asking why we were all here.

Later on, I got her random blood sugar done which came out to be 60 mg/dl even after the injection. That meant the patient was having severe hypoglycemia before I arrived at her place.

What are the precautions you can take?

The reason behind writing this article is to make diabetic patients aware of what can happen in case of a low blood sugar level, which is very much preventable. This is what you if you are a diabetic, can do to prevent hypoglycemia:-

  1. Take medicines on time and as suggested by your physician. For eg., before or after meals.
  2. Never increase the dose of medicines on your own. For eg., if you are taking 12 units of insulin[as prescribed by your doctor], do not increase it to 14 or 15 units on your own.
    Insulin Pen Used For Injecting Insulin
    Injecting Insulin Using Insulin Pen

    Consult your doctor if your blood sugar control is not satisfactory.

  3. Have all your meals on time so as to match your antidiabetic drug schedule.
  4. Never skip a meal.
  5. Have a good glucometer
    Using a glucometer to check blood sugar
    Checking Your Blood Sugar

    at hand to check your blood glucose levels.

  6. Keep glucose powder handy so that you can consume if you feel that your sugar is going down.

I am in the process of writing my next blog on Diet in Diabetes-Part 2, which I will be publishing shortly.

If you have any doubts regarding hypoglycemia, be sure to contact me with your queries on drrao@raodoctor.com. I will respond to it personally.

 

 

 

 

 

 

 

 

Diabetes Mellitus-Part 3-Know the signs and symptoms

SIGNS AND SYMPTOMS OF DIABETES ARE UNIQUE-THEY LET YOU KNOW WHETHER YOU ARE GETTING APPROPRIATE TREATMENT OR NOT. Click To Tweet

Know your diabetes and live a happy, trouble-free life

Today, as I am writing this article, all over the world Diabetes Mellitus is spreading like wildfire with barely any solution to end it. What we as human beings, have achieved is control over the signs, symptoms, and complications of the disease.

Is there any way to eliminate DM? Well, as far as I have known, in all my 35 years of medical practice, you cannot do away with it totally.

But, in the early stages, also known as Impaired Glucose Tolerance or Pre-diabetes, you can prevent it from advancing to its full-fledged form. This can save one from the suffering and the cost of treatment, not to mention man-hours lost due to co-morbidities like heart failure, kidney failure, stroke, urinary tract infection, obesity, etc.

As mentioned in my last post, there are 4 types of diabetes. In this article, I will be highlighting the signs and symptoms of DM.

The Signs and Symptoms of Diabetes-the 3 Ps

The signs and symptoms [S/S] common to all the types of diabetes are in the form of this 3 Ps:

1] Polyuria

This means frequent urination. A person feels like passing urine, more so at night. This disturbs the sleep of the person with diabetes.

2]Polydypsia

This means excessive intake of water. Due to excessive urination, the diabetic patient develops mild dehydration which causes excessive thirst and drinking more and more water.

3]Polyphagia

This means excessive hunger. Even though there is enough sugar in the blood, it is not available for uptake by tissues. This is especially so in obese patients and is called insulin resistance. The satiety center in the brain sends a signal to the digestive system to absorb more glucose and that is why one feels hungry.

The picture shown below illustrates the signs and symptoms of both Type1 and Type 2 Diabetes Mellitus-

Picture showing signs symptoms of Diabetes Mellitus
Picture showing signs symptoms of Diabetes Mellitus

Other common signs and symptoms of Diabetes Mellitus

Apart from these 3 major signs and symptoms [S/S] discussed above, there are many more  S/S due to the co-morbidities of DM. This I will cover as we move forward.

Type 1 Diabetes-Signs and symptoms-

If you look at the illustration shown above, apart from the s/s mentioned earlier[3Ps], those words shown in black are common for both types of DM. The words shown in blue will give you an idea of the other signs and symptoms of Type1 DM. Clicking on the blue words will give you the detailed information.

The Co-Morbid conditions-

1] Yeast [candida] infections of-

a] Genitals-⇓
Fungal[yeast] infection of genitals in diabetes mellitus
Fungal[yeast] infection of genitals in diabetes mellitus
                                                                                                                                           b] Mouth-⇓
Candida infection of the oral cavity -Oral Thrush
Oral Thrush-candidal/yeast infection of the tongue

 

 

 

 

 

 

 

2] Delayed healing of Wounds.

There is slow healing of wounds as there is an excess of sugar in the blood. This excess sugar is a good medium for the growth of infection-causing bacteria.

3] Nerve Problems-Neuropathy-

Due to excess sugar in the blood plasma, the myelin sheath surrounding the nerves coming out from the spinal cord undergoes degeneration. This causes tingling/pinprick sensation and numbness in the area supplied by these nerves. This occurs mostly in the limbs, more so in the legs.

4] Obesity/overweight.

The excess sugar in the blood, which is not utilized by tissues due to insulin resistance in Type2 diabetes get converted into fats. It is stored in fatty tissues in the abdomen causing a rise in the girth of the abdomen gradually. This is called Central Obesity. This leads to a substantial increase in weight causing other problems like breathlessness, an increase in BP, arthritis, etc.

5] Blurring of vision

Uncontrolled diabetes can lead to blurring of vision due to changes like opacity in the lens of the eye leading to early cataract. The nerve supply of the eyes can also get affected causing blindness- a condition called retinopathy.

6]Fungal infection

Fungal infection of nails[onychomycosis] and scalp[tinea capitis], as shown below are very common in both types of diabetes. They are stubborn infections and take a lot of time to heal.

Fungal Infection of the Scalp-Tinea capitis
Tinea Capitis-the fungal infection of the scalp

7] Microalbuminuria-

This is passing of proteins in the urine. Diabetes mellitus in the long run affect the kidney also. They manifest as a decrease in the filtration rate, known as GFR. This ultimately causes a condition called nephropathy which leads to Chronic Kidney disease or Kidney failure.

8] Acanthosis nigricans-

There is a darkening or velvety appearance of the skin in areas like axilla, nape of the neck known as Acanthosis Nigricans.

Acantosiis Nigricans-darkening or velvetty appearance of skin in diabetes mellitus
Acanthosis Nigricans-darkening or velvety appearance of skin in diabetes mellitus

9] Gangrene of feet-

Diabetes causes a condition called diabetic microangiopathy which leads to loss of blood supply to fingers and toes. This causes swelling and infection of the feet.

Diabetic microangiopathy leading to gangrene and amputation of fingers of the foot.
Diabetic microangiopathy leading to gangrene and amputation of fingers of the foot

Sometimes you need amputation of the gangrenous part like the picture shown here⇒

The picture shown here is of one of my patients who had to undergo amputation of the toes due to severe infection leading to gangrene. Had it not been amputated, the patient would have lost his foot and probably his whole leg.

Conclusion-

Some of the S/S is a part of complications of Diabetes, which I will discuss in detail when I come to the complications part of the series.

Depending upon the signs and symptoms of diabetes your doctor will initiate the appropriate treatment. Patients should comply fully and follow the instructions of his/her family physician. This will get the best results and prevent complications of diabetes.

Next in line-

Having said this, we will now proceed to find out what are the lab tests we have to carry out to confirm if one is a diabetic:-

1] Blood sugar  fasting and post-lunch;

2] Hba1c [glycoslated haemoglobin];

3] C-peptide test to know the level of insulin in the blood and the health of the pancreas.

4] Serum insulin level to know whether it is Type 1 or Type 2 diabetes in adults.

We will study the interpretation and implications of these tests in Part 4 of this series.

Some more knowledge on Diabetes-

  1. Type 1 Diabetes- Click here to read-https://www.webmd.com/diabetes/type-1-diabetes
  2. Signs and symptoms of Diabetes-Click here to read-https://www.medicinenet.com/diabetes_mellitus/article.htm
  3. Click here to know more about diabetes management- Link

Before we go to the next article, listen to this interesting podcast on Type 2 diabetes-

 

 

Diabetes Mellitus-Causes and Types

ββPicture showing Diabetes Mellitus Logo

Having Diabetes is like keeping us on our toes constantly-you never know when and how it will complicate your life. Click To Tweet

Causes and Types of Diabetes

Introduction-

Knowing the types and causes of diabetes can help in better control of its effect on all parts/ organs of our body.

In my last post, I discussed how Diabetes Mellitus{DM} derived its name and the difference between Diabetes Mellitus and Diabetes Insipidus.

Today we will try to learn the pathology[reason, disease] behind getting diabetes and the different types of DM.

A] Pathophysiology of Diabetes:-

Have a look at these pictures shown below:-

Fig.1                                                                                                                                                                 Fig.2

Islet Of Langerhans with beta cells and alpha cells
The Pancreas gland in the abdomen

 

These two pictures show a gland in the abdomen called pancreas which contains special cells in a part called Islet of Langerhan. These cells are named as the Beta [ β]-cells and the Alpha [α]-cells.

β- cells produce a hormone called Insulin which controls sugar [glucose] levels in the blood by pushing it into different tissues in our body to produce energy for the cells of the tissue.

α- cells produce a hormone called Glucagon that helps in releasing glucose in the blood circulation whenever there a drop in blood glucose levels. In other words, these two hormones regulate blood sugar levels.

There is a balance in the action of the above two mentioned hormones and this helps in maintaining the blood sugar level. 

The normal blood glucose range is as follows:-

a] Fasting:- i.e early morning blood sugar level as soon as we get up:-70 to 120 mg/ml

b] Postprandial:- meaning the blood sugar level after 2 hours of having a meal:- up to 140mg/ml 

The lack of insulin or the dysfunction of insulin receptors in various parts of the body raises the blood sugar level. This is termed hyperglycemia. Persistent hyperglycemia- a level above 200 mg/ml after a meal- if not controlled by diet and exercise leads to diabetes.

How does this actually happen?

The reasons are many, and a few important ones are as given below:-

1] Congenital:-

This is inherited from parents wherein there is a total absence of insulin in the body;

2] Pancreatitis:-

This is due to inflammation 0r infection of the pancreas due to viral or bacterial disease;

3] Autoimmune disease:-

This is due to antibodies -substances that act against the cells in our body-formed against pancreatic cells[which destroys the β-cells] and/or insulin receptors on target tissues like muscle, fatty cells, etc.

4] Central obesity:-

This is the accumulation of fats around the central part of the body-the trunk- that leads to a condition called insulin resistance;

5] Tumors of the pancreas;-

Tumour or cancerous growth in the pancreas destroys the insulin-secreting cells of the pancreas.

6]Chronic alcoholism:-

Alcohol consumption can lead to the accumulation of fats in the liver causing fatty liver. Sometimes vomiting after taking alcohol can cause it to backflow in the pancreatic duct and then the pancreas itself. This also destroys pancreatic cells to some extent.

B] Types of Diabetes:-

We will now learn about different types of DM. They are:-

1] Type 1:-

This is also known as Insulin-dependent DM because there is a total absence of insulin in the body and external insulin has to be administered. Reason no. 1 & 3 are the main causes of this type of DM.

2] Type 2:-

This is also known as Maturity onset, wherein there is sufficient insulin but it is not able to push glucose into the target cells[muscles, liver, fatty tissue]. Reasons no. 2,4,5 and 6 cause this type of DM.

3] Intermediate type/Prediabetes:-

This is also known as Impaired Glucose Tolerance or Pre-diabetes. The cause is mostly obesity.

4] Gestational DM[Diabetes of pregnancy]:-

This is present in some women due to physiological changes that take place in the body during pregnancy and are mostly reversible. Sometimes the high blood sugar levels persist even after delivery and this can lead to Type 2 diabetes.

A picture is shown below briefly summarises the different causes leading to diabetes:-

Having understood the cause and types of DM, we will now learn about the signs and symptoms and investigations of diabetes in Part 3 and 4 of this series.

In the meantime, see if you at risk of getting diabetes by Clicking Here

By now,  you must have fully understood the basics of diabetes.

If you have any doubts or suggestions, feel free to contact me on my email address-vasu56deva@gmail.com.

Diabetes Logo
Diabetes Mellitus-Part 1-What is it and how do you manage it

 

Diabetes is the root cause of many health-related problems; let us stall it by first understanding it, try preventing it and finally by treating it if every other attempt fails Click To Tweet

What is Diabetes Mellitus?

Introduction

Today, in these modern times, where there has been a cultural shift in our style of living and eating, we are facing a glut of chronic diseases like Diabetes Mellitus, Dyslipidaemias, Heart diseases, Chronic Kidney disease, Arthritis, etc. to mention a few.

Out of these, Diabetes Mellitus stands out as a leading No.1 cause to the other mentioned diseases due to its effect on various organs in the body. I will come to it when we reach the complication part of the disease.

What exactly does the term Diabetes Mellitus mean?

The word ‘Diabetes’ is a Latin word. It was first coined by an ancient  Greek physician, Aretaeus of Cappadocia, meaning “ to pass a lot of urine“. The word ‘Mellitus’ is also a Latin word, meaning “as sweet as honey“. This was added to Diabetes by a British physician, Thomas Willis in 1675 when he noticed that the urine of a diabetic had a sweet taste, probably after noticing that ants collected at the site whenever a diabetic patient passed urine.

So, in conclusion, Diabetes Mellitus means ‘to pass a lot of urine that is as sweet as honey’. It is also termed as glycosuria. [There is another type of diabetes in which a lot of urine is passed but that does not contain sugar and it is termed Diabetes Insipidus].

Causes of Diabetes

That said, we would like to know what causes this mild appearing dreaded disease. Today, the main cause of diabetes is the shift from active life to a sedentary type of life. There is also a change in eating habits from a balanced diet to a high glycemic indexed fast foods. Again, due to the advent of new gadgets like video games, childhood games are shifting from outdoor games to indoor sedentary games.

Other causes like a disease of the pancreas[called pancreatitis], a gland that releases a hormone called Insulin, also leads to diabetes. Insulin helps our body to utilize the sugar which has been absorbed by our digestive system after a meal.

Apart from insulin deficiency, an abundance of fatty tissue in obese people and lack of exercise can lead to a condition called insulin resistance in some people. This prevents sugar absorption by fatty tissues leading to a rise in blood sugar levels.

In people fasting continuously for many days, there is an acute lack of blood sugar. This prompts the body to release sugar stored in the liver. This increases the blood sugar level drastically and leads to a condition called “fasting diabetes”.

Here is a short video to show how you get diabetes-

I will discuss the signs and symptoms of diabetes mellitus along with investigations in my next post.

To know more about diabetes, try these links-

1.Link

2.Link

Dr. K. P. V. Rao's Health Blogs
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