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Complications of Diabetes
Acute complications of diabetes
Diabetics are susceptible to two major acute metabolic complications.
• Diabetic acidosis - for type 1 diabetics
• Hyperosmolar nonketogenic coma - for type 2 diabetics
Diabetic ketoacidosis
This condition primarily occurs in the type 1 diabetic and, if progressive, can result in coma and numerous metabolic derangements. The coma is usually preceded by a day or more of frequent urination and severe thirst along with severe fatigue, nausea and vomiting, and mental confusion.
This is a medical emergency. Prompt recognition and treatment is important.
Hyperosmolar nonketogenic coma
This is usually the result of profound dehydration as a result of not taking enough fluids or due to fluid loss from events such as pneumonia, burns, stroke, a recent operation, or certain drugs such as phenytoin, diazoxide, glucocorticoids and diuretics.
With a death rate of over 50 per cent, this is a true medical emergency. Prompt medical attention is warranted to save life.
The condition may develop over a period of days or weeks.
Symptoms
• Weakness
• Frequent urination
• Severe thirst
• Progressively worse signs of dehydration
• Weight loss
• Loss of skin elasticity
• Dry mucous membranes
• Racing heart beat
• Low blood pressure
Complications of chronic diabetes
The diabetic patient's condition is worsened by the appearance of six major complications of diabetes.
• Diabetic retinopathy
• Diabetic neuropathy
• Diabetic nephropathy
• Diabetic foot ulcers
• Glycosylated proteins
• Aldose reductase
Diabetic Retinopathy
Damage to the retina due to diabetes (diabetic retinopathy) is the leading cause of blindness in the US.
One in 20 type 1 and one in 15 type 2 patients develop retinopathy, half of whom become legally blind.
Diabetic neuropathy
Damage to the nervous system due to diabetes (diabetic neuropathy) is usually limited to the peripheral nerves. This condition is characterized by feelings of numbness (paraesthesias) and pain. The neurological examination by a physician usually reveals dulled perception of vibration, pain and temperature, particularly in the lower extremities. Nerve conduction is delayed and there may be a delayed response of the Achilles reflex.
Diabetic nephropathy
Damage to the kidneys as a result of diabetes (diabetic nephropathy) is a common complication and a leading cause of death in diabetics. Periodic monitoring of a diabetic patient's kidney function is important.
Diabetic foot ulcers
Lack of oxygen supply and peripheral nerve damage are the key factors in the development of diabetic foot ulcers. The foot ulcers are largely preventable through proper foot care, the avoidance of injury and tobacco in any form, and employing methods to improve the circulation in the area.
Proper foot care includes keeping the feet clean, dry and warm and wearing only well fitted shoes. Tobacco use should be strictly avoided. Circulation can be improved by avoiding sitting with the legs crossed or in other positions that compromise circulation, and by massaging the feet lightly upwards.
Glycosylated proteins and diabetic complications
It appears that the glycosylation of albumin, of low-density lipoprotein (LDL) and of the proteins of the red blood cell, lens of the eye and nerve cells, causes abnormal structure and function of the involved cells and tissues and may contribute to the complications of diabetes.
Aldose reductase and diabetic complications
The study of diabetic cataracts has led to the elucidation of the role of aldose reductase (AR) in the development of diabetic complications. AR is the enzyme involved in the formation of polyols, some of which (sorbitol and galactitol) are implicated in the development of diabetic complications.
The use of drugs which inhibit aldose reductase, such as sorbinil, has led to improvement in some individuals with diabetes. Flavonoids, such as quercetin, are potent inhibitors of polyol accumulation. Many herbs contain high amounts of flavonoids. This may explain why herbs are so effective the treatment of diabetes.
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