Complications of Diabetes

• Hunger
• Sweating
• Shakiness
• jerky movements
• Dizziness
• Seizure
• Headache 
• Difficulty speaking
• Difficulty paying attention
• Pale skin color
• Tingling sensations around the mouth
• Feeling anxious or weak

Hypoglycemia can be corrected rapidly by eating sugar. If not taken care on time, it can lead to unconsciousness. If it is 70 mg/dl or below, you can take any one of the following:

• 1/2 cup (4 ounces) of any fruit juice
• 1/2 cup (4 ounces) of a regular (not diet) soft drink
• 1 cup (8 ounces) of milk
• 5 or 6 pieces of hard candy
• 1 or 2 teaspoons of sugar or honey

After 15 minutes, check your blood glucose again to know whether you are out of risk zone or not. If it is still too low, have another serving. Repeat these steps until your blood glucose is at least 70 mg/dl.

It is important to know the early signs of hyperglycemia. If hyperglycemia is left untreated, it may develop into an emergency condition. Early signs of hyperglycemia in diabetes include:

• Increased thirst
• Frequent urination
• Fatigue (weak, tired feeling)
• Headache
• Difficulty concentrating
• Blurred vision
• Blood glucose more than 180 mg/dL

Prolonged hyperglycemia in diabetes may result in:

• Weight loss
• Slow-healing cuts and sores
• Vaginal and skin infections
• Decreased vision
• Nerve damage causing painful cold or insensitive feet, loss of hair on the lower extremities, and/or erectile dysfunction
• Stomach and intestinal problems such as chronic diarrhea or constipation

If you have diabetes record your blood sugar levels over a period of time in order to know the trend of blood sugar levels. If you have any of the early signs of hyperglycemia, be sure to test your blood glucose several times. You will have to consult your health care provider so that he/ she may recommend changes to maintain your blood sugar levels. In general follow the following measures to combat hyperglycemia:

• Drink more water.

  Water helps remove the excess glucose from your urine and helps you avoid dehydration. Be physically active. It will help to lower your blood glucose.
  Caution: If you have type 1 diabetes and your blood glucose is over 240 mg/dL, you need to check your urine for ketones. Avoid exercising if your urine has ketones.

  If you have type 2 diabetes and your blood glucose is over 300 mg/dL, avoid exrecising.

• Change your eating habits.

  Consult a dietician to chart out the amount and types of foods you should be eating in order to regulate your sugar levels. Change your medications. Your health care provider may change the amount, timing, or type of diabetes medications you take. Do not make adjustments in your diabetes medications without first talking with your health care provider.

In order to prevent hyperglycemia, you have to follow a regime of diet, exercise and medications. Following steps can be taken in order to prevent hyperglycemia:

• Keep a check on your diet: Count the total amounts of carbohydrate that you are consuming. Space the servings of carbohydrates throughout the day.
• Test your blood glucose regularly.
• Follow a regular physical activity regime.
• Know when to contact your health care provider if you have repeated abnormal blood glucose readings.
• Wear medical identification that states you have diabetes so you can receive proper treatment in the event of an emergency.

• Diabetic retinopathy is the leading cause of vision loss in adults of working age (20 to 65 years) in industrialised countries. It is estimated that more than 2.5 million people worldwide are affected by it.
• 74 percent of people who have diabetes for 10 years or more will develop some form of diabetic retinopathy.
• Approximately 14 per cent of people with diabetes have diabetic macular oedema and prevalence increases to 29 per cent for people with diabetes who use insulin for more than 20 years.
• Left untreated, 25 per cent of people with diabetic macular oedema will develop moderate vision loss within three years.
• Estimates of the rate of annual eye exams vary greatly by country and study, but the rate of screening is generally fairly low (from 40 to 65 percent).

Diabetic retinopathy is caused by damage to the small blood vessels of the retina in the back of the eye. The small vessels can be damaged by high blood glucose and high blood pressure. Thus an individual who suffers from hypertension is at an higher risk of developing diabetic retinopathy than those who have a normal blood pressure.  The high blood glucose levels hinder the flow of blood, and thus oxygen, to the cells of retina. This hinders the working of retina and thus leads to improper vision.

The early stage of this disease is called non- proliferate diabetic retinopathy, characterized by the development of occasional small blisters caused by enlarged capillaries and small hemorrhages on the surface of the retina. Moderately severe to very severe non-proliferative diabetic retinopathy is also known as pre-proliferative diabetic retinopathy. The blurred and distorted vision is because of macular edema. Symptoms of this stage are: blurred or double vision; reduced vision; and dark or floating spots.

 Proliferative diabetic retinopathy is the advanced form of diabetic retinopathy; the new blood vessels break, as they are weak and leak blood into clear gel of the eye, which will lead to floating spots in the eye, blocking vision. The pace of damage is not similar in both the eyes but, both the eyes are affected by this disease. Some times one eye is affected more easily than the other. After some period, the swollen and scar nerve tissue of the retina is totally destroyed and pulls up the entire layer of retina and detaches it from the back of the eye.Retinal detachment is the cause behind blindness among diabetics in middle age. The other two types of eye problems usually seen earlier in the people suffering from diabetes are:
Cataract: A thin cloudy layer appears in front of your eye leading to unclear vision. In cataract surgery this thin layer is removed and setting of a plastic layer in front of the lens is done, thus gives you a clear vision again.
Glaucoma: Due to high pressure on the optic nerve, it gets damaged. The damaged optic nerve creates disturbance in clear vision. Laser surgery or simple eye drops may help in regaining the normal vision.
A diabetic must go for the regular eye checkup so that the early stages of diabetic retinopathy can be detected and treated in initial stages itself, with less harm to the eyes. Blood sugar levels should also be monitored and maintained to prevent blood vessel damage.

There is no pharmaceutical therapy available at present that stops the progression of diabetic retinopathy by treating the underlying process of microvascular damage.

Current treatment options (generally reserved for late stage pre-proliferative and proliferative diabetic retinopathy and sight-threatening diabetic macular oedema) include two different forms of laser surgery. Laser therapy seals the leaking blood vessels in the macula, slowing the swelling that causes impaired vision. This procedure does not improve blurred vision but it can prevent it from worsening. While laser surgery can usually prevent vision from deteriorating, in most cases it cannot restore vision that has already been lost.

• Diabetic kidney disease occurs in approximately one- third of all people with diabetes.
• Kidney failure typically occurs after 20-30 years of diabetes. 
• In type 2 diabetes, the risk of developing cardiovascular disease is 2-3 times higher in someone with micro- albuminuria compared to a person with normal albumin excretion.
• Type 2 diabetes has become the most frequent condition in people with kidney failure in countries of the Western world. The reported incidence varies between 30% and 40% in countries such as Germany and the USA.
• Stopping smoking can reduce the risk of disease progression by 30%.

Kidney functions as a filtering machine in a human body by throwing out the waste in the form of urine. It maintains electrolyte balance, blood pH level and regulates blood pressure, and also releases some of the hormones. Diabetic Nephropathy is a complication in which kidneys are damaged due to persistent high blood sugar level in the blood. When the kidneys start damaging, they fail to carry out these functions with proficiency. It’s one of the common causes of kidney failure world wide, especially in adults.

Protein molecules along with other bodies which are present in the blood, start appearing in the urine. In the initial phase of nephropathy where damage is not too severe, drugs and diet can control the condition. When protein starts leaking in the urine it is called as microalbuminuria, as the condition starts worsening, large amount of protein is thrown in the urine with heavy losses of protein from the body. This can eventually lead to kidney failure and End Stage Renal Disease (ESRD). Few easily noticed symptoms of kidney failure are:

• Fatigue
• Decreased Appetite
• Nausea and Vomiting

The disease is characterized by:

• Increased proteins in the urine
• Increasing blood pressure
• Failing kidney function

Diabetic Nephropathy can be screened in simple urine test at any diagnostic laboratory. When Shall I go for the Test for Diabetic Nephropathy?
Type 1 diabetes: Fourth year of diagnosis of diabetes
Type 2 diabetes: At the time of diagnosis of diabetes
It is always better to go for routine tests in the further years.

When it shows albuminiuria, modification of diet, regular exercise with some medication for blood pressure control (an ACE inhibitor or angiotension receptor blocker [ARB]) is generally recommended, even if blood pressure is normal.
Patients with elevated blood pressures and albuminuria are treated with an ACE inhibitor or ARB. These medications can reduce the percent of protein extraction in the urine and help in slowing down the progression of diabetes, nephropathy and related kidney diseases.
The main treatments for diabetic patients with end stage renal disease are:

• Hemodialysis
• Renal transplant

• Maintain blood sugar level within normal range.
• Keep blood pressure under control.
• Decrease intake of salt, fast foods, preserved and baked items to maintain blood pressure.
• Decrease animal protein, simple sugars and animal fats in the diet.
• Check urine regularly for microalbumin.
• Quit smoking.
• Control blood lipid levels.
• Take care of bladder or urinary tract infections and treat them early.
• Exercise
• Reduction of alcohol intake

Dry scaly skin with callus formation and no sweating.
Numbness, tingling, and some sort of burning sensation.
Weakness and loss of reflexes.
Decrease sensation to the slight change in temperature.

The first step is to keep the blood sugar levels and blood pressure under control. You should take care of your feet especially the area between toes, and must not overlook if there is any kind of blisters, ulcer, redness or soreness or formation of callus etc.

If any suspicion or doubt arises for the foot then it should be followed by immediate physical examination. The clinical examination will show the sensation in the feet and determine if it is normal or diminished.

LDL Cholesterol (Low Density Lipoprotein- Cholesterol): LDL Cholesterol, often called “Bad Cholesterol”, increases the risk of heart diseases by increasing the tendency of clot formation. LDL Cholesterol increases with the consumption of saturated fats such as ghee, butter, cream, mutton, sausages and other animal products. For prevention, a diabetic should follow a strict regime to keep the LDL Cholesterol under control. A target of 70 mg/ dL is safe for most of the diabetics. However, your doctor will give you your individualized target level of LDL- Cholesterol.

HDL- Cholesterol (High Density Lipoprotein Cholesterol): This is also called “Good Cholesterol”. This cholesterol prevents us from heart diseases by mobilizing the fat accumulated in our arteries to liver. Liver, in turn, excretes this fat out of our bodies. Thus, higher the HDL Cholesterol, better it is. A diabetic should try to aim for HDL Cholesterol as high 45 mg/ dL- 60 mg/ Dl. 

You can prevent heart disease by being diligent about your cholesterol level being below 200mgs%, your blood pressure below 140/90 mm of hg and your weight at a healthy level for you. If you are a smoker, quitting will reduce your risk of heart disease more than almost anything else you do.

• Mild tightness or heaviness in your chest.
• Severe pain or pressure in your chest.
• irregular heartbeat
• Chest pain or shortness of breath during physical activity, such as climbing a flight of steps.
• Nausea, sweating, or dizziness.
• Difficulty in breathing or shortness of breath.
• swollen ankles

Serious cardiovascular disease can begin before the age of 30 in persons with diabetes. Many studies demonstrate that persons with type 2 diabetes are at increased risk for heart disease. In fact, one study found that persons with type 2 diabetes without apparent heart problems ran the same risk for heart disease as persons without diabetes who had already suffered one heart attack.

When risk factors are eliminated (or reduced) in a person with diabetes, the risk for heart disease may be reduced. Taking care of yourself and controlling your blood sugar can often slow down or prevent the onset of complications. Other preventive treatment measures may include:

• See your doctor regularly.
• Have annual electrocardiograms (a test that records the electrical activity of the heart, shows abnormal rhythms, and detects heart muscle damage), cholesterol and blood pressure check-ups, and pulse measurement in legs and feet.
• Pay attention to your symptoms and report them promptly to your physician.
• Control your blood sugar levels.
• Control blood pressure levels with lifestyle and diet changes, and/or medication.
• Keep low-density lipoprotein (LDL) levels (the "bad" cholesterol) at less than 70 mg/dL.
• Control your weight.
• Exercise regularly.
• Eat a healthy and balanced diet.
• Do not smoke.
• Limit consumption of alcoholic beverages.