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Complications

Today, there is no cure for diabetes; although transplantation of donator islets or whole pancreas yields a very god outcome for a few individuals. New drugs and a holistic approach to treatment have certainly improved the prognosis for individuals with diabetes and their quality of life. However, diabetes is still recognized as a leading cause of disability, morbidity and premature mortality. These outcomes are largely due to the complications of diabetes that affect the eyes, kidneys, nerves, and cardiovascular system. Diabetes is the leading cause of blindness, kidney failure, and amputations of the feet and legs in adults. Diabetic nephropathy is the single most common cause of end-stage renal disease in western countries.

 

Macrovascular complications

Macrovascular disease manifested as atherosclerosis is located within the arteries and is more common in diabetic than in non- diabetic patients. Development of cardiovascular and cerebrovascular disease is a typical consequence of the long-term effect of diabetes as a primary metabolic disorder. Acute myocardial infarction (heart attack) is at least three times, stroke five to ten times and ischemic disease of the lower limbs nearly twenty times more common in patients with diabetes than in the non-diabetic population.

The diabetic foot is a condition that includes infection, ulceration and destruction of deep tissues consequent to neurological abnormalities and peripheral vascular disease. Around 60 percent of lower leg amputations are due to diabetes.

While the risk of dying from acute complications has been reduced substantially, the age-adjusted mortality for those with diabetes remains two to four times greater than the general population.

 

Microvascular complications

Microvascular changes are located mainly in capillaries and are manifested as diabetic retinopathy, nephropathy and neuropathy.

These adverse outcomes are observed despite widespread awareness of diabetes. Although it is clear that loss of the ability to regulate and maintain healthy blood glucose levels is fundamental to the development of the microvascular complications, the mechanisms by which poor glucose control mediates functional changes and initiates and sustains tissue damage are poorly understood.

Diabetic retinopathy is a condition of the blood vessels supplying the retina of the eye. When one of the arteries that supply blood to the retina becomes blocked, blood flow diminishes which can lead to blindness. It’s the most common cause of blindness in the working-age group of western world

Diabetic nephropathy is the major cause of kidney failure. High blood glucose affects small blood vessels in the glomeruli (the filtering units of the kidney). Damage to these vessels reduces the kidney’s ability to remove waste and to reserve important nutrients such as protein.

In diabetic neuropathy nerves that branch from the brain and spinal cord to the rest of the body are damaged as a result of high blood glucose. Symptoms of possible nerve damage are burning sensations in the toes that eventually progresses up the foot. This can contribute to foot ulcers, impotence, diarrhea and more.

Moreover, diabetes in pregnancy poses numerous problems for both mother and fetus. Diabetes is teratogenic particularly in the first 8 weeks of gestation when the major organs are forming. A malformation rate relates to the degree of hyperglycemia and tight control can reduce the rate. This emphasizes the vital importance of excellent control of diabetes from the time of conception and optimization of glycaemic control in preparation for pregnancy.

In a diabetic pregnancy there is an increased risk for complications like malformations, stillbirth, preeclampsia, macrosomia, birth trauma and neonatal hypoglycemia and respiratory distress syndrome in neonate compared to a non-diabetic pregnancy.