DIABETES - COMPLICATIONS

• SHORT-TERM complications. These are caused mainly by imbalance of the sugar level.
  • If it is too high then this is HYPERGLYCAEMIA which untreated can lead to coma and even death although this is rare nowadays - especially in non-insulin dependant diabetics. Hyperglycaemia, especially if associated with KETONES in the urine is therefore potentially very serious (any diabetic with a blood sugar >20 mmol/L - certainly if they feel unwell or have ketones) should seek IMMEDIATE medical advice. The causes of hypERglycaemia are:
    • Undiagnosed diabetes. Diabetes, especially insulin dependent diabetes, can quite often first come to be noticed through an illness directly caused by a very high sugar.
    • Insufficient medication - either tablets or insulin.
    • Inappropriate diet. Excess intake can be inadvertent - check food labels.
    • Illness. Infections and other illnesses, even colds, can cause the body to release more of its own sugar.
    • Change in exercise habits. Reduction in exercise - e.g. after an injury or on holiday reduces the body's energy requirements. Some manual jobs may utilise a lot of energy.
  • If the sugar is too low then this is HYPOGLYCAEMIA. This can also be dangerous and needs to be promptly recognised and treated. The causes of hypOglycaemia are:
    • Insufficient intake. Missing a meal or eating too little. Delaying a meal, especially after taking medication as normal can cause the sugar to go too low.
    • Too much insulin. Also, the sulphonylurea drugs can cause hypoglycaemia as they act by stimulating the production of insulin. Long acting insulins and some sulphonylureas can cause prolonged hypoglycaemia or hypoglycaemia which is liable to recur after initial recovery. After initial treatment of the attack with GLUCAGON INJECTION, HYPOSTOP or sugar it is vital to eat a meal of some substance to prevent the hypo recurring.
    • Exercise. Unusual amounts of exercise can cause a hypo as the glucose in the blood goes to the muscles to give them energy. If you know that you are going to do extra exercise then you must either consume extra calories or reduce your insulin. Diabetics on sulphonylureas are also prone to this problem and are going to find it difficult to adjust their medication so extra calories are going to be required in this situation - especially if the sugar is normally quite well controlled.
    • Diabetics on diet alone or with just Metformin and/or Acarbose are most UNLIKELY to become hypoglycaemic.

• Long-term complications. This is the main reason for holding diabetic clinics.  After some controversy a few years ago it is now widely accepted that good diabetic control plus control of blood pressure and cholesterol has a vital role to play in reducing the long term consequences of being diabetic. These are:
  • Eye complications. Diabetes can affect the circulation to the back of the eye. The most serious form of this complication causes the production of fragile new blood vessels which can easily burst causing a haemorrhage which can blind the eye. Laser therapy is effective in preventing these vessels proliferating so it is important to attend for regular eye screening - usually at the optician's. This complication gets increasingly likely with time, however many non-insulin dependent diabetics have possibly had diabetes for quite a long time before diagnosis so eye problems may be present in them even at the time of diagnosis.
  • Kidney complications. Diabetes is a major cause of kidney failure. As with the eye the site of the damage is in the small blood vessels where filtering of impurities takes place. An early sign of damage taking place is the presence of a protein called albumin in the urine. Initially the quantities may be very small so a special test to look for microalbuminuria is done at the laboratory. We now know that strict control of blood pressure in diabetics goes a long way towards preventing this going on to destroy kidney function.
  • Circulation problems. Diabetes tends to attack the smaller blood vessels and the feet and toes are particularly vulnerable. At worst this can lead to ulcers that are difficult to heal and even gangrene. It is vital therefore that diabetics look after their feet and regularly see a chiropodist - we have a chiropodist attending our diabetic clinic each month.
  • Nerve damage:
    • Sensory nerves. Loss of sensation again tends to involve the feet. This can allow foreign bodies to cause damage to the feet quite painlessly and the wounds thus caused, because the circulation is also invariably poor, can be very resistant to attempts to heal them. Diabetics must NEVER BE BAREFOOT  and ALWAYS CHECK SHOES AND SOCKS FOR FOREIGN BODIES.
    • Autonomic nerves. These nerves control such things as blood pressure and male potency. If they are damaged by diabetes then the blood pressure may fall on standing - this is checked at your annual clinic visit. Impotence is quite common among diabetics but there are new and effective treatments available now.
  • Heart disease. There is an increased rate of angina and heart attack in diabetics. This makes it vital to control blood pressure and cholesterol but it is also essential that the diabetic is not a smoker too.

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