Chronic complications of Diabetes and How to prevent them

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Uncontrolled diabetes
Syringe with drugs for diabetes treatment

In our day-to-day living, we commonly see many diabetics land up in chronic complications. We may not always know how high blood sugar affects our health. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Complications of diabetes is a alarming topic for anyone with diabetes, but if spotted early, they can be prevented from being a problem. Here, we will outline the possible chronic complications of diabetes and how to prevent them. 

Long-term complications of diabetes develop gradually. Eventually, they may be disabling or even life-threatening. Overall, diabetes complications can be studied into 2 majors i.e. Microvascular and Macrovascular.

Microvascular Complications

These complications are specific for diabetes. These are predominantly linked to severity and duration of hyperglycemia.

1. Diabetic Neuropathy

Excess sugar can injure the walls of the tiny blood vessels (capillaries) that
nourish your nerves, especially in legs. This can cause tingling, numbness, burning or pain
that usually begins at the tips of the toes or fingers and gradually spreads upward. Left
untreated, you could lose all sense of feeling in the affected limbs.

2. Diabetic Nephropathy

In this complication, high blood glucose can damage blood vessels that filter waste. Hence, it causes impairment in kidneys. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

3. Diabetic Retinopathy

Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

4. Autonomic Neuropathy

Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. This can also affect urinary system and sex organs. For men, it may lead to erectile dysfunction.

Macrovascular Complications

Macrovascular complications cause most of the mortality associated with type 2 diabetes. Macrocascular complications can occur even in individuals without diabetes. These are multi factorial i.e. other factors are also responsible.

1. Coronary Artery Disease

It is within the group of Cardiovascular disease. Diabetes dramatically increases(2-4 times) the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis).

2. Peripheral Vascular Disease

A condition in which the arteries in the legs, and sometimes the arms, are narrowed by fatty plaque. Peripheral vascular disease is 20 times more common in people with diabetes than in the general population.

Diabetic Foot : Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.

3. Cerebrovascular Disease / Stroke

The patients are at a 2-4 times higher risk to develop cerebrovascular disease. Cerebrovascular disease refers to a group of conditions that can lead to a cerebrovascular event, such as a stroke. These events affect the blood vessels and blood supply to the brain.

Other Complications

Individuals with diabetes are more prone to develop a variety of infections. These infections are also common in non-diabetics. Respiratory tract infections, Gastrointestinal tract infections, Skin infections, Urinary tract infections. Also fungal or microbial infections can also be seen in diabetic individuals.

Gestational diabetes : Most women who have Gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for both mother and baby. Gestational diabetes causes complications in baby including excess growth, Low blood sugar, Type 2 diabetes later in life or Death. Consequently complications in the mother including Preeclampsia and subsequent gestational diabetes can occur.

Once chronic complications develop, the treatment options are unsatisfactory.  Hence, to prevent these complications from developing in the first place should be the prime target. Failing this, to detect them at early enough stage in order to prevent their progression or even reverse them.

Prevention of chronic complications

Prevention are of 4 types; Primordial, Primary, Secondary and Tertiary. Primordial is when the patient doesn’t have the risk factor , the prevention is at the basic level. It begins with education of the general population. At primary level the risk factors are present in the patient , here we can control the various risk factors and bring about lifestyle modification like diet and exercise and stress control. In secondary prevention we target control of the BP, tight glucose control and specific medical therapy. Tertiary prevention occurs when the disease has progressed and we want to limit the exacerbation of the complications of the disease. E.g. Stenting , vascular surgery.

Lifestyle modification

1. Eat healthy foods : Choose food higher in fiber. Focus on fruits, vegetables and whole grains. Recent research in low carbohydrate diet can help in control of blood sugar. High protein diets should be avoided while  patients are having albuminuria. Salt restriction also helps patient in control of BP. Saturated fatty acids and trans Fatty acids and cholesterol intake should be restricted.

2. Increasing physical activity. Moderate physical activity a day.

3. Weight loss. Reduction in BMI (Body mass Index) is known to reduce the progression of disease.

4. Stress reduction. Stress reduction has been implemented in reduction of CAD.

Medical management

1. Periodic checkup and followup of the patient : Once diagnosed with diabetes, the patient needs to undergo periodic tests and physical examinations. E.g. Yearly retinal examination in Type 2 Diabetes.

2. Early identification of diabetes.

3. Tight glycemic control : Tight glucose control helps to reduce the progression of
disease and also helps in causing advanced diseases.

4. BP control : ADA states that all patient with diabetes should aim to keep their BP <
140/90 mm Hg . Individuals with proteinuria needs higher BP control. ACEI and ARB are the drugs of choice.

5. ACE inhibitors and ARB : They reduce intra glomerular pressure, systemic blood pressure, tissue ACE levels and correct endothelial dysfunctions. This leads to decrease in
albumin excretion and progression of microalbuminuria.

6. Avoid nephrotoxic substancesNSAID‘s, radiocontrast media.

7. Lipid lowering therapyStatins helps in reduction of LDL cholesterol. The increase of HDL cholesterol is helpful.

8. Aspirin : Low dose aspirin should be considered in all patients with diabetes and no
previous history of vascular disease who are at increased CVD risk and who are not
at increased risk of bleeding.

9. Avoid dehydration

10. Smoking cessation : smoking causes vasospasm, increased production of
carboxyhemoglobin and CO leading to endothelial injury. It also worsens diabetes
dyslipidemia. Furthermore, it increase thrombogenesis due to decrease in prostacyclin and increase in viscosity and clotting factor.

11. Reduce alcohol intake : Alcohol intake is associated with increased risk of Cardiovascular diseases.

Blood vessels helps to transport glucose and insulin. In Diabetes, blood vessels can be damaged by the effects of high blood glucose levels and this can in turn cause damage to organs. 

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