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Diabetes Overview
Types of Diabetes
Glucose Meters
Long-term Complications

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Long-Term Diabetes Complications

Both type 1 and type 2 diabetes result in elevated glucose levels which result in numerous toxic effects.

  • Diabetic Retinopathy (eye disease): Diabetic retinopathy is the most common cause of blindness in adults. All people with diabetes should see an ophthalmologist at least once a year. Certain groups of people, including women who are pregnant or diabetics with existing eye problems, should see a doctor more often.
    • Mechanism: The increased glucose in the blood causes more retinal blood flow and loss of vascular regulation by retinal endothelial cells and pericytes. The continued uncontrolled blood flow results in a vasoactive response, coupled with increased endothelial cell proliferation, resulting in capillary closure.
    • Some clinical features of diabetic retinopathy include: microaneurysms, hemorrhages, exudates, cotton wool spots, fibrosis, venous changes and neovascularization.
    • Regular screening for retinopathy is essential for all diabetics. Those individuals who are susceptible for diabetes should also undergo screening.
    • If caught early enough, certain types of retinopathy can be treated with retinal photocoagulation. Laser photocoagulation is a relatively simple procedure that only requires local anesthesia. The prognosis is good.
  • Diabetic Nephropathy (kidney disease): Kidney damage in diabetics is among the most common causes of renal failure.
    • Mechanism: The progression to renal abnormalities begins with the thickening of the glomerular basement membrane and the accumulation of matrix proteins in the mesangium. With increasing deposit of proteins (Kimmelstiel-Wilson nodules), functional renal glomeruli are lost.
    • Loss of renal function in diabetics result in small amounts of albumin in the urine (microalbuminuria). Microalbuminuria is thus often used as a screening tool for overt diabetic nephropathy.
    • Urine testing should be performed annually to check for kidney damage. Additionally, blood pressure should be monitored closely since high blood pressure contributes to kidney disease. Finally, persistent swelling in the legs or feet may signal the advent of kidney disease and should be discussed with your health care provider.
  • Diabetic Neuropathy (nerve disease): Although neuropathy does not occur in most diabetics, some individuals have axonal degeneration of both myelinated and unmyelinated neurons. The damage to essential nerves create both sensory and motor defects associated with diabetic neuropathy.
    • Symptoms include loss of sensation (numbness), tingling, burning, or pain often in the hands or feet. This loss of sensation towards distal limbs is known as symmetrical sensory polyneuropathy. Any of these symptoms should be reported to your health care professional. Redness, calluses, and any other general breakdowns of the skin in your feet should be of concern as it may related to a condition known as Diabetic Foot (see below).
    • Diabetic amyotrophy is the progressive weakening and wasting of proximal muscles of the lower limbs. There is often severe pain involved.
    • Autonomic neuropathy affect system-wide problems including: cardiovascular (hypotension, tachycardia), gastrointestinal (dysphagia, constipation, diarrhea), genitourinary (urinary incontinence, erectile dysfunction), vasomotor (cold extremities, edema) and pupillary (delayed reflexes, decreased pupil size)
  • Peripheral Vascular Disease (heart disease): Diabetics have an increase in the formation of fatty plaques (atherosclerosis) inside the blood vessels. These plaques often block the vessels, leading to heart attacks, strokes and peripheral vascular disease. Diabetics also have a predisposition to elevated lipid levels and high blood pressure.
  • Diabetic Foot: Tissue necrosis of the foot is a very common reason for a diabetic to visit the hospital. Many of these admissions end up in amputation. A combination of neuropathy, peripheral vascular disease and connective tissue changes result in ulceration of the foot. Infection often occurs in conjunction to ulceration, leading to ultimate amputation. Symptoms include ulcers, sepsis, abscess, gangrene, pain, and numbness in the feet.
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This information is not a substitute for your doctor's medical advice.