complications of diabetes mellitus type1,type2,gestational dm

complications of diabetes mellitus

There is no cure for diabetes and If care is not taken,diabetes will progress & complications of diabetes mellitus may arise in diabetics which will cause disability & it adversely afeects the quality of life diabetic individuals.

  • As diabetes is a chronic condition, as the time passes there can occur certain complications.
  • These complications of diabetes mellitus appear gradually as the disease progresses.
  • The complications might become so severe that they might be very disabling to the patient or in some condition might also turn out to be fatal.

For more articles on diabetes-types of diabetes mellitus

For more articles on diabetes-prevention of diabetes mellitus

Risk of complications of diabetes mellitus are higher in:

  • Person who has diabetes for a long time.
  • Person who is not on proper treatment for diabetes.
  • Person with uncontrolled blood sugar levels.
  • Person with no life style modification.

ACUTE COMPLICATIONS OF DIABETES MELLITUS

1) DIABETIC KETOACIDOSIS (DKA)

  • It is a very dangerous complication of diabetes and is a medical emergency so requires treatment as soon as possible.
  • Ketoacidosis is much more commonly seen in type1 than in type 2.
  • Normally insulin helps the body to take up insulin, but when there is low levels of insulin the liver turns fatty acids into ketones to use as a source of energy.
  • This can occur normally also as a response to low insulin.
  • In diabetes as the insulin is constantly low the amount of ketones in the body remains high.
  • Increased ketones decrease the pH of blood and causes acidosis.

Signs and symptoms:

  • Patient is dehydrated
  • Fast and deep breathing
  • Severe abdominal pain
  • Lethargy which can progress to coma if not treated
  • Decreased blood pressure
  • Shock
  • Death can occur due to shock or brain edema

It can be diagnosed by urine analysis, which will show significant amount of ketones in urine.

If treated immediately and properly the patient may recover fully.

2) HYPOGLYCEMIA

Hypoglycaemia or very low blood glucose levels.

In patients with diabetes this can occur if:

  • High doses of insulin is taken
  • Insulin administration time is incorrect
  • Excessive exercise
  • Not enough food is eaten

Patient presentation:

  • Patient will have Excessive sweating
  • He will be Irritable
  • Agitated
  • He will have Anxiety and panic
  • Weakness will be present.

If not treated patient can have:

  • Altered sensorium
  • Loss of consciousness
  • Coma
  • Seizures
  • Brain damage
  • Eventually death can occur

Treatment of this condition is to provide glucose. This can be done by giving glucose orally of intravenously as dextrose solution.

3) HYPERGLYCEMIC HYPEROSMOLAR STATE (HHS)

  • Also known as nonketotic hyperosmolar coma is an acute complication of diabetes mellitus.
    • This is more commonly Seen in type 2 than in type 1.
  • It has similar signs and symptoms like that of Diabetes ketoacidosis.
  • This occurs when a person has very high concentration of glucose in their blood (above 300mg/dl).
  • The water from the cells moves into the blood through osmosis to dilute this high concentration of glucose in the blood.
  • Then kidneys throw out the increased amount of glucose into the urine along with lots of water.
  • If the fluid that is lost is not replaced either by mouth or intravenously, it can eventually lead to dehydration.
  • If not treated can progress to coma and eventually death.
  • Therefore the first line of treatment in this condition is fluid volume replacement.

4) DIABETIC COMA

It is a medical emergency which can be caused by any of the acute complication of diabetes.

Due to these the patient may become comatose.

Treatment of this condition is to treat the condition that is causing the coma.

CHRONIC COMPLICATIONS OF DIABETES MELLITUS

A. Microangiopathy

The increased blood glucose levels causes damage to the small blood vessels this is known as microangiopathy.

1. Nephropathy (damage to kidneys)

  • One of the main complication that occurs in diabetes is the damage to small blood vessels.
  • Kidney contains glomeruli which is nothing but a bunch of blood vessels.
  • Glomeruli is the main functional unit of kidney which helps in the filtration of the blood.
  • In diabetes these blood vessels are affected therefore the filtration process is hampered.
  • This leads to severe kidney damage and can progress to end stage kidney disease.

2. Neuropathy:

  • In simple word neuropathy means nerve damage.
  • High amount of glucose damages the very small blood vessel called as the capillaries which supplies blood to the nerves.
  • As the blood supply to the nerves is cut off it causes damage to the nerves.
  • Depending on which site the nerves are damaged there occurs the symptoms.
  • Most commonly the nerves in the legs are affected.
  • The symptoms seen are, tingling, numbness, pain or burning sensation in the legs.
  • If this is not treated properly it can lead to loss of sensation in the affected limb.
  • Nausea, vomiting, diarrhea, or constipation can be seen If the nerves in the digestive tract are affected, this is also known as autonomic neuropathy.
  • Neuropathy can also lead to muscle weakness, this is known as diabetic amyotrophy.

3. Retinopathy (damage to the eye)

  • Increase in the blood glucose can also damage the retinal blood vessels.
  • If diabetes is not controlled properly it may lead to blindness.
  • In patients with diabetes the increase blood sugar causes the lens to loss its transparency and causes a condition called as cataract.
  • The lens of these patients become opaque or pearly white, and they may require to undergo cataract surgery to have a clear vision.
  • Diabetes can also cause rise in the intraocular pressure leading to glaucoma.

4. Diabetic encephalopathy

  • It is seen that patients with type 2 diabetes may have an increased risk of having dementia and increased cognitive decline, including high risk of Alzheimer’s disease.
  • There are theories proposed like, alteration of the blood supply to the brain or interaction of insulin with brain.

5. Diabetes cardiomyopathy

  • In diabetes there can occur damage to the heart muscles which causes diastolic dysfunction.
  • If heart is not able to relax properly and filling of blood in the heart chamber is also impaired.
  • Over time this can lead to heart failure.

6. Erectile dysfunction

  • It means that the male is unable to get an erection firm enough for sexual intercourse.
  • This can occur in other men also but men having diabetes can get this problem about 10-15 years earlier than the men without diabetes.

7. Gum disease or periodontal disease.

B. Macrovascular disease

Diabetes increases the risk of atherosclerosis and causes cardiovascular complications

1. Cardiovascular complications:

 Diabetes mellitus can affect the heart and the blood vessels.

Incidence of a heart attack is more if you have diabetes.

Diabetes itself is a risk factor for many heart conditions, such as:

  • Heart attack (Myocardial infarction)
  • Angina (chest pain due to decreased blood to the hear muscles)

2. Peripheral vascular disease

Intermittent claudication that is excessive pain in the leg muscles during walking or exertion.

3. Stroke

Mainly ischemic stroke.

That is stroke occurring due to decreased blood supply to the brain.

4. Diabetic foot:

  • As the blood vessels of the foot gets damaged it decreases the blood flow to the tissues.
  • Also because of decreased blood the nerves also gets damaged causing decrease in the sensation over the feet.
  • Both the above factors increase the risk of development of complications in the foot.
  • Even if a small prick or a blister occurs on the foot it may progress to a serious infection if left untreated.
  • The increased amount of glucose in the blood  favour the infection.
  • As there is a damage to the blood vessels and nerves there accurs delay in wound healing.
  • If the wound is left untreated, it can cause necrosis and gangrene which might require amputation of the affected part.

5. Female infertility

It is more common in women with type 1 diabetes.

             The cause for this is not known

C. Impaired immune response

In diabetes the increased glucose in the blood damages the immune system at the molecular level by decreasing the function of immune cells and increases inflammation.

1. Respiratory tract infection

  • Respiratory tract infections such as pneumonia and influenza are more common in patient with diabetes.
  • This is because the function of lung is affected due to damage to the blood vessels and increased inflammation.

2. Restrictive lung disease

Due to factors like:

  • long standing low grade inflammation in the lung
  • microangiopathy
  • increased accumulation of advanced glycation end products

individual with diabetes has increase risk of developing restrictive lung disease.

3. Lipohypertrophy

  • When insulin injections are given at the same place it leads to accumulation of subcutaneous fat and it presents as a lump underneath the skin.
  • To prevent this insulin injections are not given at the same site again and again.

D. Other complications

1. Depression.

Patient with diabetes might find it difficult to cope up with the disease and might suffer from depression.

2. Skin infections

Diabetic individuals are more prone to get infections because the high blood sugar levels act as food for the bacteria and yeast.

The yeast infection is seen in warm, moist areas such as fold of skin.

Common areas for yeast infection are:

  • Between the finger (in web spaces)
  • Below the breast
  • In genital region

3. Hearing impairment.

Hearing problems are more common in people with diabetes.

complications of diabetes mellitus

Complications of gestational diabetes mellitus

  • Most of the pregnancies with gestational diabetes end up with delivery of a healthy baby.
  • The problem occurs only if the diabetes was not treated or the blood glucose levels during the antenatal period were not controlled

Complications of diabetes mellitus in the baby

a. Macrosomia or big baby:

  • High maternal blood glucose crosses the placenta and reaches the fetus.
  • The glucose which goes to the fetal blood will stimulate pancreatic cells to produce more insulin causing the pancreas to hypertrophy.
  • Increased fetal insulin causes increase in the carbohydrate utilisation and causes fat accumulations.
  • Insulin like growth factors are involved in increasing the growth of the fetus and adiposity.

b. Increased chances of caesarean:

As the baby is a big baby (that is birth weight more than 4kg) the incidence of delivery with C-section increases.

c. Congenital malformations:

  • If diabetes is present in the first trimester it affects the organogenesis resulting in congenital malformation.
  • Factor related to teratogenesis in these patients are:
  • Genetic susceptibility, hyperglycemia, increased ketone bodies, free radical injury, somatomedin inhibition, arachidonic acid deficiency etc.

d. Hypoglycemia in newborn:

  • Hypoglycaemia or low blood sugar level is seen in newborn of diabetic mother shortly after birth.
  • This occurs because the newborn produces high amount of insulin in response to the increased glucose that was delivered to it through the umbilical vessels.
  • This can be treated by either early breastfeeding the baby or in severe hypoglycemia intravenous glucose solution can also be given.

e. Babies of diabetic mother has a higher risk of developing diabetes later in life.

f. Death:

If proper treatment is not enforced on the mother with gestational diabetes to control the blood glucose levels it can be fatal to the baby.

Fetal death occurs in the womb or immediately after birth.

Main cause of fetal death in these patients is hypoxia and lactic academia.

Risk of fetal death is increased if:

  • Uncontrolled diabetes
  • Vasculopathy
  • Preeclampsia
  • Ketoacidosis
  • Fetal macrosomia (big baby)

Complications of diabetes mellitus in the mother

1) During pregnancy:

  1. Recurrent spontaneous abortions.
  2. Preterm labour due to increased infections and polyhydramnios.
  3. Increase chances of infections like urinary tract infection or vulvovaginal infections.
  4. Preeclampsia
  5. Polyhydramnios (increased amount of amniotic fluid)
  6. Maternal distress due to large baby causing pressure on the abdominal organs and also on the diaphgram.
  7. Diabetic retinopathy.
  8. Diabetic nephropathy.
  9. Ketoacidosis
  10. Coronary artery disease.

2) During labour:

  1. Labour duration is prolonged.
  2. Perineal injuries due to big baby.
  3. Post partum hemorrhage.
  4. Increased chances of caesarean: section.

3) After delivery:

  1. Pueperal
  2. Lactational failure
  3. Patient with gestational diabetes may develop gestational diabetes in subsequent pregnancies.
  4. These patients are more prone to development of diabetes in later stage of life.

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