Chronic complications of diabetes

Microvascular diseases

The damage to small blood vessels leads to a microangiopathy, which can cause one or more of the following:

Diabetic nephropathy, damage to the kidney which can lead to chronic renal failure, eventually requiring renal dialysis. It is the most common cause of adult kidney failure in the developed world.

Diabetic neuropathy, abnormal and decreased sensation, usually in a 'glove and stocking' distribution starting with the feet but potentially in other nerves, later often fingers and hands. When combined with damaged blood vessels this can lead to diabetic foot. Other forms of diabetic neuropathy may present as mononeuritis or autonomic neuropathy. Diabetic amyotrophy is muscle weakness due to neuropathy.

Diabetic retinopathy, growth of friable and poor-quality new blood vessels in the retina as well as macular edema (swelling of the macula), which can lead to severe vision loss or blindness. Retinopathy is the most common cause of blindness among non-elderly adults in the developed world.

Diabetic encephalopathy is the increased cognitive decline and risk of dementia, including (but not limited to) the Alzheimer's type, observed in diabetes. Various mechanisms are proposed, like alterations to the vascular supply of the brain and the interaction of insulin with the brain itself.

Diabetic cardiomyopathy, damage to the heart muscle, leading to impaired relaxation and filling of the heart with blood (diastolic dysfunction) and eventually heart failure; this condition can occur independent of damage done to the blood vessels over time from high levels of blood glucose

Macrovascular diseases

Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor:

  • Coronary artery disease, leading to angina or heart attack
  • Diabetic myonecrosis ('muscle wasting')
  • Peripheral vascular disease, which contributes to intermittent claudication (exertion-related leg and foot pain) as well as diabetic foot.
  • Stroke (mainly the ischemic type)

Carotid artery stenosis does not occur more often in diabetes, and there appears to be a lower prevalence of abdominal aortic aneurysm. However, diabetes does cause higher morbidity, mortality and operative risks with these conditions.

Diabetic foot, often due to a combination of sensory neuropathy (numbness or insensitivity) and vascular damage, increases rates of skin ulcers (diabetic foot ulcers) and infection and, in serious cases, necrosis and gangrene. It is why it takes longer for diabetics to heal from leg and foot wounds and why diabetics are prone to leg and foot infections. In the developed world is the most common cause of non-traumatic adult amputation, usually of toes and or feet.

Many patients do not even know that they are suffering from diabetes. The disorder is very silent, does not hurt and therefore we usually forget that it can cause serious health issues and if we ignore it it's treatment and early diagnosis. At St. Catherine Specialty Hospital we offer a complete and personalized approach to diagnostics, treatment and education.

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