Diabetic Complications
Definition
Chronic complications of diabetes are a result of uncontrolled, elevated blood glucose levels and include neuropathies, nephropathies and retinopathies.
occur as a result of glycosylation of proteins in the microvascular structures that supply oxygen and nutrition to the peripheral nervous system. These neuropathies can be asymptomatic but may be associated with loss of somatic control, numbness, tingling, pain and paraesthesia in the extremities. This peripheral numbness predisposes diabetic patients to increased risk of peripheral ulceration (e.g., foot ulcers) and infections.
occur as a result of glycosylation of proteins in the microvascular structures of the kidneys, causing glomerular lesions, impaired renal blood flow, progressive loss of kidney function, and eventually renal failure. This nephropathy is usually asymptomatic until end-stage renal disease develops. Hypertension will accelerate the progression to end-stage renal disease.
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Diabetic retinopathy is a non-inflammatory eye disorder that results from glycosylation of proteins in the microvascular structures of the retina. This causes microaneurysms in the retina, haemorrhages, exudates and ocular oedema. Diabetic retinopathy is the most common causes of blindness in people aged 20-75.
Aetiology / Risk Factors
Major risk factors that contribute to the incidence of retinopathies, nephropathies and/or neuropathies in diabetic patients are:
- Duration of the diabetes:
in patients with type I diabetes, no clinically significant diabetic complications are seen in the first 5 years after the initial diagnosis of diabetes is made. After 10 years, approximately 50% of patients show some signs of retinopathy, nephropathy and/or neuropathy. This prevalence increases to 75% after 15 years and approaches 100% after 30 years of diabetes. In patients with type II diabetes, incidence of diabetic complications also increases along with the duration of the disease.
- Blood glucose level control:
effective glucose control is essential to reduce the incidence and progression of diabetic complications. Patients with a history of poor blood glucose level control, dietary misbehaviour and/or sedentary lifestyles are more likely to suffer from diabetic complications.
- Glycosylated haemoglobin levels:
patients with elevated levels of HbA1c (glycosylated haemoglobin) are significantly more at risk or developing diabetic complications. Glycosylated haemoglobin levels less than 7% should be the goal in all patients in order to prevent or slow down the onset of diabetes-related complications.
pre-existing or concurrent renal disease is a significant contributor to diabetic nephropathy and retinopathy.
hypertension may complicate diabetes in that it may result in hypertensive retinal and neural vascular changes, which further compromise microvascular blood flow.
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Elevated serum triglycerides and/or cholesterol: hyperlipidaemia in diabetic patients has been shown to contribute to increased microvascular damage and, consequently, greater incidence of diabetic complications.
Symptoms & Signs
numbness in distal extremities, burning sensation of distal extremities, impotence
: pain on urination, albuminuria, hypertension.
blurred vision, poor vision, failing eyesight, sudden loss of vision in one or both eyes, black spots or cobwebs, or flashing lights in the visual field.