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diabetes

Long term complications of diabetes

Premise

The complications of diabetes (or diabetes mellitus ) are the unpleasant consequences that can arise from this serious metabolic disease.

Diabetes is caused by a deficiency of insulin - a key hormone for maintaining normal blood glucose levels - and its characteristic clinical sign is the high concentration of glucose in the blood ( hyperglycemia ).

Reminding readers that the most known and widespread types of diabetes are type 1 diabetes and type 2 diabetes; this article aims to treat the possible long-term complications of the aforementioned two types of diabetes.

Chronic complications

The complications of long-term diabetes are the late consequences of diabetes mellitus, resulting from the persistence of metabolic alterations caused by the disease.

Definitely more frequent in type 2 diabetes, long-term diabetes complications generally target the eyes, kidneys, nervous system and cardiovascular system.

Coming to the point, among the complications of long-term diabetes, there are:

  • Diabetic macroangiopathy;
  • Diabetic microangiopathy, which in turn includes
    • Diabetic retinopathy;
    • Diabetic neuropathy;
    • Diabetic ulcer;
  • Other.

When do they start?

Statistical studies have shown that, 10-15 years after the onset of the disease, the majority of diabetic patients have one or more of the aforementioned long-term complications.

However, these same studies have also shown that in some patients the complications in question can develop long before 10-15 years have elapsed, while in others they never have the opportunity to manifest themselves.

Diabetic macroangiopathy

Diabetic macroangiopathy is an alteration of the large blood vessels, which leads to a tendency to develop atherosclerosis earlier and more intensely than occurs in the average population.

Probably linked to the phenomenon of the glycation of LDL lipoproteins, diabetic macroangiopathy and the atherosclerosis that follows represent an important risk factor for cardiovascular diseases, such as coronary artery disease, stroke, angina pectoris, myocardial infarction and peripheral arterial disease.

Curiosity

According to some statistical studies, 75% of diabetic patients die of coronary artery disease.

Diabetic microangiopathy

Diabetic microangiopathy is an alteration of the capillary vessels, which produces its most important consequences in terms of kidney (diabetic nephropathy), retina (diabetic retinopathy) and peripheral and autonomic nervous system (diabetic neuropathy).

Currently, the precise cause of these consequences is unclear.

Most experts, however, attribute the aforementioned phenomena to the glycation of some essential proteins for the integrity of the capillaries, a development that would lead to the thickening of the basement membrane of the latter and to a slowing of the internal blood flow, with logics negative repercussions on oxygenation and nourishment of the tissues involved.

Certainly, diabetic microangiopathy and its consequences are all the more serious and precocious in the onset, at least the metabolic control of diabetes mellitus through the therapies provided is perfect.

Diabetic nephropathy

Diabetic nephropathy is a renal disease, which involves damage to the vast network of capillaries constituting the renal glomeruli (in fact, in fact, we also speak of diabetic glomerulopathy).

Conditions such as the nephrotic syndrome and glomerulosclerosis can derive from severe diabetic nephropathy, which, in turn, can degenerate into renal failure .

Renal failure due to diabetic nephropathy requires dialysis or kidney transplantation, as renal function is irretrievably impaired.

Symptoms of diabetic nephropathy include: severe tiredness, headache, general feeling of sickness, nausea, vomiting, loss of appetite, itching of the skin and edema of the legs.

Curiosity

Diabetic nephropathy is one of the most common long-term complications of diabetes and one of the main reasons for the implementation of dialysis in the most developed countries of the world.

Diabetic retinopathy

Diabetic retinopathy is an eye disease, characterized by more or less extensive damage to the retina, which appears over time (even after 20 years), in about 85% of patients with diabetes mellitus.

Diabetic retinopathy is usually responsible for partial vision defects; however, in some serious circumstances or if the treatments are inadequate, it can lead to the complete loss of vision.

Diabetic retinopathy can be divided into two phases (or stages): an initial phase, called simple (or non-proliferating ) diabetic retinopathy, and an advanced phase, called proliferative diabetic retinopathy .

  • Simple diabetic retinopathy is characterized by the formation, on the capillaries of the retina, of small aneurysms, which can break and cause haemorrhages at the retinal level. Nevertheless, the affected patient does not experience any visual disturbance.
  • Diabetic proliferative retinopathy, on the other hand, is characterized not only by the same aneurysms of simple diabetic retinopathy, but also by the occlusion of different capillaries of the retina, an occlusion which causes retinal ischemia and above all the formation of new capillaries. to replace the occluded capillaries, in the blood supply to the retina.

    Being very fragile, the neoformation capillaries tend to break easily and this prevents them from fulfilling the function for which they are intended. Furthermore, their continuous rupture causes the creation of scar tissue.

    The lack of adequate blood supply to the retina and the creation of scar tissue at the latter level are responsible for the visual disturbances typical of diabetic retinopathy.

Today, there is the possibility of diagnosing and accurately monitoring a complication such as diabetic retinopathy, through an examination known as ophthalmoscopy .

Being able to count on a precise diagnostic examination such as ophthalmoscopy is very important, as early treatment of diabetic retinopathy prevents the latter from having serious repercussions on a visual level.

About the treatment of diabetic retinopathy, this, today, consists of an extremely effective therapeutic technique, the result of the incredible advances in medical technology and known as retinal laser therapy .

Some interesting facts about diabetic retinopathy

  • Diabetic retinopathy is one of the most common causes of blindness among subjects aged between 45 and 65 years.
  • Every year in the United States, diabetic retinopathy is the cause of 12% of all new cases of blindness.
  • At least 90% of cases of diabetic retinopathy are largely controllable through periodic monitoring of the situation and appropriate treatment.

Diabetic neuropathy

Diabetic neuropathy is a medical condition characterized by more or less extensive damage to peripheral nerves ( peripheral nervous system ).

Currently, it is not yet clear what the precise cause of diabetic neuropathy is. On this subject, however, there are several theories; among these theories, the most reliable one argues that, at the origin of the nerve damage characteristic of the medical condition in question, there would in turn be damage to the small blood vessels and capillaries responsible for supplying peripheral nerves with oxygen and nutrients .

Also according to the same theory, vascular damage would be linked to hyperglycemia and to the already mentioned phenomenon of the glycation of some proteins important for the functionality of the blood vessels and capillaries involved.

Diabetic neuropathy can affect only one nerve ( mononeuropathy ) or, as often happens, many nerves ( polyneuropathy ).

The symptomatology of diabetic neuropathy varies in relation to the type of nerve or damaged peripheral nerves. In fact, if the damaged peripheral nerves are of the motor type ( diabetic motor neuropathy ), the patient complains:

  • Spasms and muscle cramps;
  • Muscle weakness and / or muscle paralysis
  • Difficulty in holding objects;
  • Disorders of posture and gait (falling foot).

If the damaged peripheral nerve (s) are sensitive ( diabetic sensitive neuropathy ), the patient may manifest:

  • Pins and needles;
  • pricking;
  • Numbness and reduced ability to feel pain;
  • Burning pain similar to pangs;
  • Allodynia;
  • Balance deficit;
  • Loss of coordination capacity.

Finally, if the damaged peripheral nerves are autonomous (autonomous diabetic neuropathy ), the patient may suffer from:

  • Constipation or diarrhea;
  • Feeling sick, abdominal swelling and / or vomiting;
  • Orthostatic hypotension;
  • Tachycardia;
  • Excessive sweating or lack of sweating (anhydrosis);
  • Sexual dysfunctions (for example, in humans, cause erectile dysfunction or retrograde ejaculation);
  • Difficulty of complete emptying of the bladder;
  • Intestinal incontinence;
  • Dysphagia;
  • Thinning of the skin.

Curiosity on diabetic neuropathy

  • According to the University of Chicago Center for Peripheral Neuropathy, 50-60% of diabetic patients would suffer from a more or less severe form of diabetic neuropathy.
  • In the diabetic, to favor the onset of diabetic neuropathy are certainly: obesity, poor control of hyperglycemia, the presence of triglycerides high in the blood and the age above 40 years.
  • According to some statistical studies, diabetic neuropathy would play a central role in 50-75% of cases of non-traumatic amputation.

Diabetic ulcer

In medicine, diabetic ulcer is the term indicating a lesion that is difficult to heal spontaneously, which depends on the coexistence of the aforementioned diabetic neuropathy and diabetic macroangiopathy.

Diabetic ulcer is a phenomenon that generally affects the lower limbs and, in particular the feet (see the in-depth study on the diabetic foot).

Usually, to trigger the episodes of diabetic ulcer is a trauma (ex: rubbing against a foot by a not completely suitable shoe), that the interested diabetic subject does not perceive because of lesions to sensory nerves, produced by a Diabetic type neuropathy.

As regards the difficulties of healing, these are due to diabetic macroangiopathy and the ease with which diabetic people develop infections where there is a predisposition to these phenomena (NB: cutaneous wounds are excellent access points for microbes and other pathogens).

All this explains why doctors recommend that patients with diabetes mellitus carefully choose their shoes, carefully check for any calluses on their feet (often calluses on the feet are the first signs of a dangerous trauma) and, finally, of pursuing scrupulous hygiene of the lower limbs, in particular feet.

Treatment of diabetic ulcer episodes in the lower limbs is important. Without appropriate therapy, in fact, these lesions can degenerate to the point of necessitating the amputation of a more or less important part of the affected lower limb.

Other complications

In the long run, other possible complications of diabetes are:

  • Cutaneous alterations: they can concern the legs and be small, detected and rounded spots, with crusts at the periphery and ulcer in the center ( diabetic dermopathy ) or with a central yellowish area, surrounded by a brown border ( lipoid necrobiosis ).

    Otherwise, they can affect the buttocks and have the appearance of yellowish papules, surrounded by eruptive xanthomas ( xanthomatosis ); or they can also involve the palms and soles of the feet and consist of phenomena of carotenemia (yellowish pigmentation), due to the unusual deposition of carotene.

  • Other types of ocular complications: in diabetics, eye disorders are not limited to the phenomena of retinopathy, but also include cataract episodes (opacity of the crystalline lens).

    According to the most reliable estimates, cataracts would occur in about half of patients with type 2 diabetes, some 20 years after the onset of the disease.

  • Hypertriglyceridemia: it is particularly frequent especially in long-standing diabetics. These subjects develop particularly high plasma triglyceride levels, with an increase in both VLDL and chylomicrons.

    Curiously, hypertriglyceridemia is often associated with xanthomatosis.

Recurrent infections: these mostly concern the skin, the urinary tract and the respiratory system, but they can also affect the ear (malignant otitis externa caused by Pseudomonas aeruginosa ) and the gallbladder (emphysematous cholecystitis)

For a diabetic, these are very dangerous events, much more than for a non-diabetic, as diabetes affects the functional efficiency of white blood cells.

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