Problems in Diabetes – Short, Long-Term Diabetic Complications

Diabetes mellitus, commonly referred to as sugar diabetes, is a growing problem globally associated with with a ‘modern lifestyle’, a term used to describe lack of exercise, diet high in saturated fats and refined carbohydrates and prolonged levels of stress. Diabetes mellitus is essentially a disorder with glucose metabolism and the regulation of blood glucose levels. This is a consequence of a lack of insulin, the pancreatic hormone that regulates glucose levels in the blood, or a decreased senstivity to insulin. As a result, the blood glucose levels are elevated above the norm for long periods of time which in turn causes a host of complications as damage to cells throughout the body ensues.

Apart from the signs and symptoms of diabetes and short-term complications, which are often minor, a diabetic can go for years or even decades without significant discomfort. This often creates a false sense of security but the reality is that diabetes mellitus is a life-threatening disease if poorly managed in the long term. Management depends on a combination of medical treatment (medication), lifestyle (diet and exercise) and weight control. The aim of treatment and management is to alleviate symptoms, prevent complications and improve the patient’s quality of life and level of functioning.

Presenting Problems in Diabetes Mellitus

Hyperglycemia is an elevation of blood glucose levels beyond the upper limits of the normal range. It may arise in life for various reasons but is usually acute and asymptomatic. Chronic hyperglycemia as is seen with diabetes mellitus, however, gives rise to a number of signs and symptom.

Symptoms of High Glucose Levels

• Polydipsia – excessive thirst.
• Polyuria – excessive/frequent urination.
• Dry mouth
• Hunger with a craving for sweet foods.
• Nausea
• Fatigue and lethargy
• Blurred vision
• Headache
• Itchy skin
• Weight loss but can also contribute to weight gain in chronic cases.
• Changes in mood – irritability, apathy,difficulty concentrating.

Short Term Diabetic Complications

Most complications associated with diabetes mellitus occurs after several years or even decades, although it may arise within months. However, certain complications like diabetic ketoacidosis can occur in early cases of diabetes mellitus and is potentially life-threatening.

Diabetic ketoacidosis occurs when the body consumes fat stores and there is a subsequent rise in the blood acid levels due to fat metabolism and utilization.

Lactic acidosis is low blood pH (acidic) associated with a build up of lactate in the blood. It may be associated with diabetic ketoacidosis or caused by certain diabetic medications, particularly metformin.

Hypoglycemia (low blood glucose levels) occurs with inappropriate use of diabetic medication in addition to missing a meal, eating too little  or drinking alcohol.

Long Term Diabetic Complications

Elevated glucose levels cause damage to the cells in the body. It does this via various mechanisms and alters biochemical processes that are essential for maintainig homeostasis and hence normal functions.

Eye or Vision Problems In Diabetes

Visual problems in diabetes mellitus may be a consequence of :

• Diabetic retinopathy where the blood vessels of the eye may be damaged due to long term diabetes and cardiovascular changes including micoaneurysms.
• Cataract where the lens of the eye becomes opaque.
• Diabetic neuropathy (nerve damage) affecting optic nerve

Nerve Problems in Diabetes

• Peripheral neuropathy where there is damage to the nerves of the extremities resulting in pain, loss or sensation and muscle weakness.
• Autonomic neuropathy where there is damage to the nerves that control involuntary processes in the body thereby affecting the function of the heart, blood vessels, gut and bladder.

Cardiovascular Problems in Diabetes

• Hyperlipidemia is an elevation of lipids in the blood.
• Hypertension which is the elevation of the blood pressure above the upper limit of the normal range.
• Atherosclerosis is the narrowing of blood vessels due to the build up of plaques (atheroma).
• Venous insufficiency is the weakening of the veins, particularly in the legs, thereby hampering the return of deoxygenated blood to the heart.
• Myocardial infarction (heart attack) occurs when part of the heart muscle is starved of oxygen due to a compromised blood supply and resulting in tissue death (infarction).
• Cerebrovascular accident (stroke) is when then blood supply to brain tissue is compromised leading to a impaired oxygen availability and tissue death.

Kidney Problems

• Diabetic nephropathy is when the ability of the kidney to filter the blood and excrete wastes is hampered when the filtering apparatus of the kidney is damaged due to long term diabetes and related cardiovascular complications.

Foot and Leg Problems

Although diabetes mellitus can affect any part of the body, the periphery – particularly the distal parts of the lower limb – are more prone to the effects of diabetic complications.

This causes :

• Pain, tingling and numbness due to peripheral neuropathy.
• Diabetic ulcers due to circulatory disturbances (arterial and venous) and poor wound healing.
• Claudication which is pain in the leg, particularly the calf, upon walking and is related to atherosclerosis and.or venous insufficiency.
• Joint disorders like diabetic arthropathy which are associated with neurological problems like diabetic neuropathy.