Diabetes mellitus is a systemic metabolic disorder associated with a complete or partial deficiency of the hormone insulin secreted by the pancreas. As a result of this deficiency, a steady increase in the concentration of glucose in the blood occurs, all types of metabolism are disturbed.
Types of Diabetes
Type 1 diabetes mellitus – a hereditary disease, manifests itself quite early – in children and adolescents, but older people can also get sick. This type of diabetes is caused by the death of pancreatic beta cells that produce insulin. Type 1 diabetes patient is forced to inject insulin for life.
Type 2 diabetes is associated with obesity and the development of the body’s resistance to insulin. It is more often observed in people of an older age group. Type 2 diabetes patients are treated with hypoglycemic agents of various groups. Gestational diabetes, which develops in pregnant women, is also isolated. As a rule, this form of diabetes passes independently after delivery.
Diabetes mellitus is a chronically ongoing disease, dangerous for its complications. Some of them can occur at any moment of the disease, others – are formed gradually, over time. Consider the main complications of diabetes, which are divided into acute and late.
Acute Complications of Diabetes
Blood sugar levels in diabetes need constant monitoring, otherwise sharp fluctuations in glucose concentration can occur, leading to acute complications of diabetes – hypo- or hyperglycemic conditions.
Hypoglycemia is considered a condition when the blood glucose level drops below 3.3 mmol / L. With regular administration of insulin, hypoglycemia can be attributed to “accidents” – it is not quite accurate to calculate the dose or, by introducing insulin, postpone food intake or increase physical activity for some reason. When taking sugar-lowering drugs, hypoglycemia can develop for the same reasons. So, in one patient, a hypoglycemic coma developed against the background of severe flu. Due to intoxication, the woman’s appetite was reduced, she ate little, but at the same time continued to take pills carefully. Sometimes hypoglycemia occurs during menstruation. In elderly patients, hypoglycemia develops more easily.
Three phases of hypoglycemia are distinguished, each of which imperceptibly passes into the following:
- In the first phase, the patient feels hunger, he develops weakness, drowsiness, trembling, increased sweating, headache, palpitations, and coordination of movements is disturbed.
- In the second phase, double vision joins, blanching, the skin becomes wet. The patient may be inadequate, respond inappropriately or be silent, do not recognize loved ones, aggressiveness is possible.
- At the third stage, inhibition occurs, the patient loses consciousness, may fall into a hypoglycemic coma.
To help the patient in this condition, it is necessary to administer to him an intravenous 20% glucose solution. If you act quickly, irreversible changes will not have time to come.
Hyperglycemia is understood as an increase in blood glucose levels above 5.5-6.7 mmol / L. However, for different patients, this threshold may be different. Some feel good at 9 mmol / L. The main reason for all of the following symptoms is an increase in blood glucose. Signs of hyperglycemia include frequent urination, severe thirst, dry mouth, fatigue, weakness, weight loss, itching, headache, and sometimes nausea and vomiting. The extreme manifestation of hyperglycemia is hyperglycemic coma.
The result of hyperglycemia is ketoacidosis, when ketone bodies appear in the blood, and oxygen starvation of tissues acts on the nervous system. Ketoacidosis is manifested by the smell of apples (acetone) from the mouth, loss of appetite, abdominal pain, noisy, frequent breathing are added to the above symptoms. With hyperglycemic coma, subcutaneous administration of short-acting insulin is necessary.
Late complications of diabetes
Late complications of diabetes form gradually, begin to appear 10–15–20 years after the onset of the disease, and are hardly noticeable to the patient at first. High blood glucose affects the state of the nervous system, eyes, kidneys, blood vessels. Dealing with such complications can be difficult.
Vascular lesions: eyes, kidneys, stroke
Vascular lesions in diabetes mellitus are classified by the size of the vessels:
- microangiopathy is called a lesion of small vessels,
- macroangiopathy – large.
Microangiopathy is the basis of impaired renal function, visual impairment, poor wound healing. Microangiopathy of the vessels of the brain leads to diabetic encephalopathy, frequent headaches and dizziness. With macroangiopathy, the arteries of the heart and brain suffer most.
It has been proven that long-term untreated or improperly treated diabetes mellitus and high blood glucose contribute to the development of atherosclerosis, that is, the formation of plaques on the walls of arteries, which causes them to narrow and impair blood flow through them. Atherosclerosis is the basis of diseases such as coronary heart disease, heart attack, stroke.
Diabetic retinopathy: blindness, cataract
With diabetic retinopathy, hemorrhages occur and microaneurysms (expansion) of the retinal vessels form. Swelling occurs, new vessels form. Ultimately, fundus hemorrhages can lead to retinal detachment and loss of vision. Initial manifestations of retinopathy occur in 25% of newly diagnosed diabetes patients. Over time, the severity of changes and decreased vision progress, often leading to complete blindness. Diabetic retinopathy is a leading cause of blindness in the elderly. In addition to retinopathy, patients with diabetes often develop cataracts.
As already mentioned, diabetic nephropathy occurs due to damage to the small vessels of the kidneys. The main symptom of nephropathy is protein in the urine. Due to the decrease in the amount of protein in the blood, edema is formed. Weakness, dryness and unpleasant taste in the mouth, thirst, loss of appetite are also noted, the amount of urine excreted is reduced. Severity or discomfort in the lumbar region is observed. As edema progresses, fluid begins to accumulate in the abdominal, chest, and other cavities of the body, and the body uses its own proteins to make up for protein deficiency. As a result, patients noticeably lose weight. Often there is an increase in blood pressure. At the last stage of nephropathy, the kidneys stop working, uremia occurs – poisoning with substances that are usually excreted in the urine. This situation has two solutions: permanent hemodialysis, that is, an artificial kidney, and kidney transplantation.
Diabetic neuropathy: pain, burning, cramps
Neuropathy is one of the most common complications that accompany diabetes. High blood sugar adversely affects nerve fibers, destroying their myelin sheaths. The nerve fibers themselves swell and exfoliate. Diabetic neuropathy can affect one section of the peripheral nervous system or act in a complex manner and be combined with other complications. So, a violation of sensitivity leads to the so-called diabetic foot. Diabetic neuropathy increases with time and with an increase in blood glucose. It manifests itself in pain, burning, numbness, fullness, cramps and other unpleasant sensations – most often in the limbs. Leg pain intensifies during rest and decreases when walking.
A diabetic foot is a condition that develops against a background of decreased sensitivity and a tendency to long wound healing – both are characteristic of diabetes mellitus. If a diabetic patient injures or burns a leg, injures a finger during careless nail cutting, combes an insect bite, puts a corn on it or gets infected with a fungus, then the damage will cause him little pain, but it will be easy to become infected and difficult to heal, often turning into a trophic ulcer. The ulcer can persist for a long time, because the patient does not see and does not feel it. The next step after an ulcer is gangrene. Diabetic foot is the most common cause of non-traumatic leg amputation in Russia.
Other complications in patients with diabetes
In addition to the main complications of diabetes described above, diabetes mellitus causes a weakening of the immune system. A diabetic patient is more susceptible to various infections, including tuberculosis. Diabetic arthropathy is a joint damage that causes pain and reduces their mobility. Diabetic encephalopathy covers a number of mental disorders, such as emotional instability, a tendency to depression. The defeat of the reproductive system is manifested by a decrease or disappearance of potency in men and infertility, miscarriages, premature birth, menstrual irregularities in women. In the latter, vulvitis and vaginitis are also possible.