In diabetes there is an excess of glucose or sugar in the blood. This high level of glucose is harmful. Complications of diabetes can be divided into two broad categories; Acute complications and long term or chronic complications.
Acute Complications of Diabetes
Acute Complications of diabetes are complications which develop suddenly or within a span of 24 hours. Acute complications result from sudden or severe increase or decrease in blood sugar levels.
Complication number one is hypoglycemia or reduction in blood sugar level below critical level (40-50 mg/100 ml of blood). In old age diabetics even the level of 80-90 may cause hypoglycemia, as their body is used to higher level of glucose. The person experiences increased appetite, weakness, sweating, restlessness, palpitations (feeling of own heart beats) and giddiness. Untreated hypoglycemia leads to confusion and later to coma. An old person may appear disoriented. Hypoglycemia results due to following causes:-
- Excessive insulin or other drugs overdose
- Inadequate amount of carbohydrates in the diet
- Alcohol intake with anti-diabetic medicines
- Strenuous exercises.
When hypoglycemia is suspected one must take 1-2 spoons of glucose/sugar. If symptoms are due to hypoglycemia, a dramatic result will be seen.
Complication number two is Ketoacidosis. Type 1 diabetics (Childhood onset diabetics) are more prone to develop ketosis than type 2 diabetics (adult onset diabetes). Ketosis is excess levels of ketones in blood. Ketones are generated when fat or amino acids are utilized for making glucose by body (which usually happens in prolonged starvation). In diabetes, due to deranged regulation, glucose is not available to cells. We are all aware that glucose is the energy currency of the body. Glucose is required by body specially brain and muscles for work. Lack of glucose is seen as a starvation like situation by the body. To keep vital centres of body eg brain, heart and lungs functioning, the body starts breaking fats and amino acids to make glucose, resulting in production of ketones in body. When ketones level increases beyond the handling capacity of body, they accumulate in the blood. This condition is called ketosis. Ketosis is life threatening. The patient experiences intense thirst, weakness, drowsiness with or without vomiting. The patient may go into coma. Ketosis is caused by inadequate or irregular treatment specially during stress and acute infections.
Long term Complications of Diabetes
Long term complications of diabetes occur due to affect of persistent high blood sugar level on smaller blood vessels and capillaries (called microangiopathies). All diabetics will have some complications (may be minor) after five years of disease. If 100 diabetics are followed for 10 years, the distribution of the complications will be; neuropathy or nerve damage (23%), cardiovascular or heart diseases (23%), kidney complications (21%), eye complications (17%) and foot ulcers (6%). People may have multiple complications.
Increased Risk of Cardiovascular Diseases
Diabetes Mellitus (DM) increases the risk of cardiovascular diseases. There is marked increase in peripheral arterial diseases, cardiac failure, coronary heart diseases, heart attack (myocardial infarction), stroke and sudden death by 2-5 times. Diabetics also have high levels of cholesterol and triglycerides which hasten the atherosclerosis. Atherosclerosis, as we are aware, is an important cause of hypertension, stroke and peripheral vascular diseases. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke).
Diabetes also results in reduction of immunity. The cuts and wounds heal slowly. They are more prone to develop tuberculosis, infections of skin, foot & urinary tract. Diabetics have to take special precautions to prevent infections of the skin and foot.
Neuropathies Or Nerve Damage
Diabetes damage nerves. Nerve damage (neuropathy) in the feet increases the chance of foot ulcers & infections. Due to reduced immunity the infection may spread fast resulting in gangrene. Limb amputation is not uncommon in diabetics. A diabetic with neuropathy will experience tingling, numbness and a burning sensation in feet which spread upwards. There may be loss of sensation in the feet which makes them prone for ulceration and injuries. Some may have pain in legs usually present at rest and worsen at night. Involvement of nerves may lead to pain in various part of leg, thigh or weakness of muscles.
With time DM may lead to rapid deterioration of eye sight (called retinopathy). Blindness occurs as a result of long-term accumulated damage to the small blood vessels in the retina. About 1% percent of global blindness is caused by diabetes. People with DM are 25 time more likely to become blind than non diabetics.
Diabetes is the leading causes of kidney failure. The damage to kidney starts after one year of DM, but not detectable by routine tests. After 5-10 years, albumin (a protein) is secreted in urine in small amount (between 30-300 mg/100 ml of 24 hours urine collection). This is called micro-abluminaria. Kidney damage at microalbuminaria level is reversible. Albumin level more than 300 mg/100 ml of urine in 24 hrs hallmarks the onset of frank kidney damage. It will lead to irreversible kidney damage if untreated. When hypertension & diabetes co-exist, chances of early kidney damage doubles up. Kidney failure is a serious and crippling disease. There is no treatment, but dialysis or renal transplant.
Impotence in Men
Diabetes is an important cause of impotence in men. Impotence may be devastating to the self-esteem of a man and of his partner. The development of complications depends upon control of blood sugar and duration of diabetes.
DM also Harms the Pocket
DM does not differentiates between caste, economic status or religion. Once diabetes is diagnosed, the treatment is lifelong. At least 1-2 thousand rupees per month are required for medicines, blood tests and consultation. If complications are present, the cost of consultations and medicines go up proportionally due to involvement of other specialists like eye specialist, neurologist, cardiologist etc.
Survival with kidney failure (chronic kidney disease or CKD or end stage kidney disease or grade 5 kidney disease) is a costly affair. One has to undergo dialysis thrice a week. One session of dialysis takes 2-3 hours. Dialysis is a costly affair. Even in government hospitals one setting of dialysis costs Rs 2500-3000 or 7500/- per week or 30,000/- per month (2016 prices). In addition, medicines add up to another 10-20 thousands per month. Spending about Rs 40-50 thousands per month on treatment is beyond the capability of an average middle class Indian. In this cost calculation, fare from home to hospital, loss of wages on the particular day of dialysis, loss of productivity once the disease occurs etc has not been included. Since most of people can’t afford, about 80% of diabetes deaths occurs in low and middle-income groups. Only definitive treatment is kidney transplant, which has its own limitations. It’s very costly, costing about 1-3 lakhs in different centres. Donor may not be available. Even if donor is available the success rate is not 100%.
From the above discussion it is clear that diabetes must be taken seriously. Complications of diabetes are major cause of death and disability. One has to look after himself. Diabetics must adopt healthy life styles to delay the onset of complications and save money. The message is clear; Reduce weight, restrict calories & be physically active. For proper control of diabetes you may also read my posts on diabetic diet and self care tips
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