Over the last years, proper guidelines on diabetes management, together with intensive patient health education has resulted to an overall decline in  diabetes patients dying from infections and ketoacidosis. However, the number of diabetes patients dying from cardiovascular and other renal related complications continues to rise and it is still a major concern in the modern world.  Most of these complications result from uncontrolled high blood sugar, over a long period of time. In some patients the complication is aggravated by high blood pressure.

Diabetic complications can be classified into three different categories;

• Diabetic Macrovascular Complications
• Diabetic Microvascular Complications
• Diabetic Neuropathy

Diabetic Macrovascular Complications

Diabetic macrovascular complications are all diseases and conditions, resulting from diabetes that affect medium and large blood vessels (blood vessel diseases). Diabetes can lead to hardening and narrowing of blood vessels (arteriosclerosis) and obstruction of blood vessels with plaque (atherosclerosis), leading to coronory artery disease. 

Coronary artery disease is a condition is which there is an obstruction inside the medium and large blood vessels.  This results into impaired blood flow to the heat and without proper medical care, it can lead to a heart attack.  The risk of having a heart attack is two times higher in men with diabetes and three times higher in women with diabetes, compared to those without diabetes.

Other major diabetic complications that affect medium and large blood vessels include; stroke (cerebral vascular accident) and peripheral vascular disease (obstruction of large arteries outside the heart and brain).   People with diabetes are also twice likely to suffer from stroke than those without diabetes.

 

Diabetic Microvascular Complications

Diabetic microvascular complications are all diseases and conditions that lead to destruction of small blood vessels.  Diabetes is believed to cause the thickening of the base membrane of the capillaries (small blood vessels) several times beyond their normal size.  

The two major types of diabetic microvascular complications are: diabetic retinopathy and diabetic nephropathy, classified according to the organ that they affect.

 

(a)   Diabetic Retinopathy

Diabetic retinopathy (injury of the small blood vessels found in the retina) is the most common type of diabetic microvascular complication. The retina is an important part of the eye with its main function been to receive images and to send the received images to the brain for interpretation. 

 

According to American Diabetes Association, atleast more than 60% of all patients diagnosed with diabetes mellitus type 2 and almost all patients diagnosed with diabetes mellitus type 1 are believed to  suffer from some sort of  retinopathy after 20 years of diabetes.

 

Other eye conditions that can result from diabetic complications include; 

Symptoms of  Diabetic Retinopathy

In the early stages of retinopathy, most patients do not have any symptoms and if present, it may only include a blurred vision. However, in the present of vitreous hemorrhage (bleeding inside the retina), symptoms like seeing star or cobwebs along the visual field, hazy vision or even complete loss of the eye sight may occur.

 

Diagnosis of Diabetic Retinopathy

Retinopathy can be diagnosed by either looking directly at  retina through the use of ophthalmoscope (a lighted instrument that is used to examine inside the eye) or by flourescein angiography (a dye is injected through the arm vein and carried to the blood vessels of the retina). The retina blood vessels are then examined in details using special instruments by an ophthalmologist. 

 

Treatment of  Diabetic Retinopathy

The treatment and management of retinopathy is directed towards controlling and maintaining the blood glucose level within the normal or near normal levels, in both diabetes type 1 and diabetes type 2. Patients education and intensive insulin therapy (for patients suffering from diabetes type 1) has shown to be effective in the early stage of retinopathy. Other lifestyle changes  like; exercises, controlling of blood pressure and cessation of smoking can help in slowing down the progression of the diabetic retinopathy.

 

For patients with advanced cases of diabetic retinopathy, treatment may include a process known as argon laser photocoagulation (destruction of the leaking blood vessels) and panretinal photocoagulation (burning of the whole retinal by use of a laser) to stop the growth and bleeding of the destroyed blood vessels. In the presence of severe bleeding in the vitreous, a surgical procedure known as vitrectomy may be performed (the vitreous fluid is removed and replaced with another clear fluid to restore the lost vision.

 

(b)  Diabetic Nephropathy

Diabetic nephropathy is the destruction of small blood vessels found in the kidney due to increased  blood glucose over a long period of time. When this  happens, the kidney filtration mechanism becomes ineffective, resulting to various symptoms. If left untreated, it  can eventually lead to kidney failure (an serious irreversible kidney disease that require dialyis or  kidney transplant) for an individual to survive.

 

Diabetic Neuropathies

Diabetic Neuropathies is  a term used to refer to all disorders that affect the nerves (peripheral, autonomic and spinal nerves).  Peripheral neuropathy and the autonomic diabetes neuropathy are the most common types.

 

(a)  Diabetic Peripheral Neuropathy

This is the damage of nerves, particularly on the legs and feet, resulting from impaired blood flow caused by the diabetes. Signs and symptoms of peripheral neuropathy include; loss of sensation on the legs,  tingling sensation, burning sensation and numbness.

Diabetes patients are more prone to injuries due to decreased sensation on the legs (unable to detect when an injury has occured).  This is the reason why taking good care of self and inspecting your legs is important to protect yourself from injuries and to check if new injuries have occured.   Injuries left untreated can lead to infection and necrosis (death of the tissues) and eventually to toe or leg amputation.

 

(b)  Diabetic Autonomic Neuropathies   

Diabetic autonomic neuropathies is a complication of diabetes that affects the autonomic nervous system. Autonomic is a part of the peripheral nervous system that regulates involuntary functions of the body, such as heartbeat, digestion and renal function.
 

Some common signs and symptoms of autonomic neuropathies may include;