COMPLICATIONS OF
DIABETES MELLITUS
A. Acute complications
A diabetic is likely to develop acute complications as a result of
sudden decrease or increase in blood sugar levels.
1. Hypoglycaemia
The rapid lowering of blood sugar (below 40 - 50 mg/dl) is known as
hypoglycaemia. The person may experience increased appetite, weakness,
sweating, restlessness, palpitation and giddiness. The diabetic who develops
hypoglycaemia should immediately be given sugar or glucose.
2. Ketoacidosis
When the body cannot utilize carbohydrates to
provide energy, it burns fats and certain amino acids. This results in
increased formation of ketones, which accumulate in the blood resulting in
ketoacidosis. This is a serious condition and the patient can go into a coma.
3. Infections
In diabetics, cuts and wounds heal slowly. They are prone to infections
of the skin, urinary tract and foot.
B. Long term
complications
Diabetics are predisposed to two types of complications of long
duration.
Increased predisposition of the diabetic for
atherosclerosis (hardening of blood vessels due to deposition of fatty
substances) because they generally have high levels of blood lipids as
cholesterol and triglycerides, which make them susceptible to heart disease and
stroke.
Lesions that affect the small blood vessels (microangiopathy) of the
eyes and kidneys. Lesions of the eye (retinopathy) results in rapid
deterioration of eye sight. Lesions of the kidney (nephropathy) result in the
excretion of protein in the urine. Neglect may lead to kidney failure.
Diabetics can develop lesions of the peripheral nervous system (neuropathy).
Patients with neuropathy experience tingling, numbness and it is a
degenerative condition of sensory nerves resulting in pain and absence of
reflexes.
Extra Notes : PATIENT EDUCATION
Environmental factors play a major role in the incidence of NIDDM in those
with a family history. Since we have no control on the selection of our
ancestors, care should be taken to delay the onset of diabetes mellitus by
increasing physical activity and reduction in the intake of fatty foods which
result in obesity which in turn can cause diabetes.
Diabetics should be educated on the nature of the disease and the
possibility of acute and long term complications of the disease, if blood sugar
is not kept under control. Adequate information enables the diabetic to improve
the psychological acceptance of the disease. The importance of following the
instructions of the doctor and the dietitian regarding diet, drugs and exercise
should be explained.
A diabetic should monitor urine, blood sugar and
serum lipids at regular intervals to ensure overall well-being. They should
learn self monitoring of urinary sugar using commercially available strips.
Patients who require insulin injections should know how to measure the insulin
dose and give their own injections. Diabetics should be informed about the
symptoms of hypoglycaemia and the immediate need for sugar. They should be
aware of complications such as ketoacidosis and danger of infections which
require immediate medical attention. Diabetic patients should maintain a diary
to keep a record of their urinary and blood sugar results, body weight and
alterations in their diet and drugs.
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