Complications of diabetes mellitus

The main reason for the development of complications of diabetes mellitus is vascular damage due to prolonged decompensation of diabetes mellitus (prolonged hyperglycemia – high blood sugar). First of all, microcirculation suffers, that is, the blood supply to the smallest vessels is disrupted.

Signs of complications of diabetes

Eye damage in diabetes mellitus is called diabetic retinopathy. This complication of diabetes mellitus is associated with impaired blood circulation in the vessels of the fundus, namely, in the retina. Retinal vessels in diabetic retinopathy become more fragile, permeable, which can lead to hemorrhages. Diabetic retinopathy develops gradually and even its rather pronounced stages may be imperceptible to the patient. With extensive retinal hemorrhage or retinal detachment, a significant decrease in visual acuity, up to complete blindness, can occur. The presence and severity of diabetic retinopathy can only be determined by an ophthalmologist (ophthalmologist) when examining the fundus with a dilated pupil (special drops are instilled into the eyes to expand the pupil, after which vision temporarily becomes blurry, indistinct). A patient with diabetes mellitus must be examined by an ophthalmologist at least once a year! In the presence of proven complications of diabetes mellitus from the eyes, an ophthalmologist examination is carried out more often (depending on the stage of diabetic retinopathy).

Kidney damage in diabetes mellitus is called diabetic nephropathy. The glomeruli (of which the kidney tissue is made up) acts as a filter. Unnecessary substances are filtered from the blood and excreted in the urine, and the necessary ones are retained. When small vessels of the renal glomeruli are damaged in diabetes mellitus, the filter becomes more permeable. Protein, which is a necessary substance, enters the urine, and normally does not penetrate through the kidney filter. It is impossible to feel the initial manifestations of diabetic nephropathy, therefore, it is necessary to take a daily urine test for protein, a biochemical blood test (in particular, creatinine, urea) at least once a year (and with the development of diabetic nephropathy – more often, depending on the stage).

Nerve damage in diabetes mellitus is called diabetic neuropathy and is one of the main complications of diabetes mellitus. First of all, with diabetes mellitus, the legs suffer, since there are the longest nerve fibers in the entire human body. Diabetic neuropathy is manifested by pain in the legs, a burning sensation, “creeping creeps”, tingling, numbness. Also, diabetic distal neuropathy is characterized by a decrease in the sensitivity of the legs: the ability to perceive the effects of high and low temperatures, pain (for example, an injection with a sharp object), vibration, etc. This complication of diabetes mellitus poses a great danger, because it increases the risk and makes minor injuries invisible, for example, when foreign objects get into shoes, wearing improperly selected shoes, when processing nails, calluses. The decrease in sensitivity, combined with the deformity of the feet, which is common in diabetes and overweight, leads to an inappropriate pressure distribution when walking. This leads to trauma to the tissues of the foot, up to the formation of ulcers in the places of greatest stress. The areas of trauma can become inflamed, an infection develops. The inflammatory process in conditions of reduced sensitivity proceeds without pain, which can lead to an underestimation of the danger by patients. Self-healing does not occur if diabetes compensation is unsatisfactory, and in severe advanced cases, the process can progress, leading to the development of purulent inflammation – phlegmon. In the worst case scenario and in the absence of treatment of the limbs, tissue necrosis – gangrene may occur. Gangrene is perhaps one of the most formidable complications of diabetes.

The defeat of the heart and large blood vessels in patients with diabetes mellitus is associated with atherosclerosis of the arteries. According to the mechanism of development, this complication of diabetes mellitus does not differ from that in persons without diabetes mellitus. But in patients with diabetes mellitus, atherosclerosis occurs much more often than in others, and at a younger age.

Examples of manifestations of arterial atherosclerosis:

  •  With coronary artery disease, chest pain, a feeling of heaviness or tightness in the chest when climbing stairs, walking, or other exertion may appear. Often, chest pain radiates to the arm or jaw. Such phenomena are associated with vasoconstriction of the heart.
  •  The classic picture of the development of myocardial infarction: chest pain does not go away, shortness of breath and nausea appear, vomiting begins. The person suddenly breaks out in a cold sweat and experiences a strong sense of fear. Patients with diabetes mellitus due to damage to the nervous system and loss of pain sensitivity may not notice chest pain, then the equivalent of pain is a sharp general weakness.
  •  Arterial hypertension (increased blood pressure) is often a companion of diabetes. It is against the background of high blood pressure that such a formidable complication as a stroke (acute cerebrovascular accident) can develop, which is often fatal or leads to paralysis. Arterial hypertension also badly affects the condition of the vessels of the kidneys and the fundus.
  •  In the vessels of the brain, atherosclerotic changes can also develop – atherosclerosis of the vessels of the brain. In severe cases, this can lead to stroke.
  • Problems with the vessels of the legs, pain in the calves or buttocks when walking are signs of atherosclerosis of the vessels of the legs. Sometimes uncomfortable sensations arise during long walking, sometimes – literally after a few steps. The pain goes away by itself if you stop for a while. With pronounced narrowing of the arteries in the leg area, pain can also occur at rest.

Prevention and treatment of complications of diabetes mellitus

The danger of complications of diabetes mellitus lies in their gradual, often invisible for the patient with diabetes mellitus, development.

The most important component of the prevention and treatment of complications of diabetes mellitus is good compensation for diabetes mellitus, that is, maintaining the target blood sugar level (target blood sugar levels are determined individually by the endocrinologist). In addition to the daily measurement of blood sugar, it is necessary to control the level of glycated hemoglobin (an indicator reflecting the average blood glucose level over the last 3 months) once every 3 months.

For the purpose of early diagnosis and timely treatment of diabetic retinopathy, regular examinations by an ophthalmologist (ophthalmologist) with an examination of the fundus with a dilated pupil are necessary (special drops are instilled into the eyes to dilate the pupil, after which vision temporarily becomes blurry, indistinct). A patient with diabetes mellitus must be examined by an ophthalmologist at least once a year. In the presence of proven complications of diabetes mellitus from the eyes, an ophthalmologist examination is carried out more often (depending on the stage of diabetic retinopathy). For the treatment of complicated diabetic retinopathy, laser coagulation of the retina is used. Timely and correctly performed laser coagulation allows you to preserve vision even in the late stages of diabetic retinopathy.

In order to diagnose diabetic nephropathy early and prevent its further development, it is necessary to take a daily urine test for protein, a biochemical blood test (in particular, creatinine, urea) at least once a year (and with the development of diabetic nephropathy – more often, depending on the stage) …

In addition, it is necessary to quit smoking, actively fight excess weight, move more, monitor the level of blood pressure and blood cholesterol (maintain their normal values).

For active prevention of complications of diabetes mellitus, it is necessary to conduct vascular therapy once every six months. Its main purpose is to maintain microcirculation. The main drugs for the prevention and treatment of complications of diabetes mellitus are preparations of alpha-lipoic acid, B vitamins, antioxidants, antiplatelet agents, anticoagulants and other metabolic and vascular drugs. Prophylactic courses can be carried out both in a hospital or day hospital with intravenous and intramuscular injections, intravenous drip infusions, and on an outpatient basis with the use of tablet forms of drugs.

Preventive recommendations for the care of feet that are affected by obliterating atherosclerosis of the arteries and diabetic neuropathy:

Do not use sharp objects when caring for your feet: scissors, corn knives, razor blades (this is one of the most common causes of injury, especially in conditions of reduced sensitivity and poor eyesight!) It is better to use a file for processing feet. 

 You should not deeply cut the corners of the nail, because this can lead to the formation of an “ingrown” nail – the cause of painful sensations, inflammation and long-term treatment of the extremities, up to surgical intervention. Wearing narrow-nosed shoes also contributes to the ingrown toenail. 

 It is advisable to give up uncomfortable shoes (tight, chafing) and high-heeled shoes. A high heel contributes to poor blood circulation in the foot and the formation of zones of increased pressure on its plantar surface. You need to be careful about new shoes: put them on for no more than an hour the first time. 

 If your feet are cold, you cannot warm them with heating pads (including electric ones), central heating batteries, heating appliances. The patient’s temperature sensitivity is often reduced, therefore, the protective reaction is weakened and you can easily get a burn. 

 For the same reason, you cannot take hot foot baths. The water temperature should not be higher than 40 ° C (it is better to measure it with a water thermometer, as for bathing children). In addition, foot baths do not have to be long – this dries out the skin and makes it more vulnerable. 

 After washing your feet, you need to blot dry (do not rub!) With a towel, especially the interdigital spaces. The increased humidity in these areas contributes to the development of diaper rash and fungal diseases. 

 You must use foot cream daily! 

 You should not walk barefoot, since there is a high risk of injury with simultaneous penetration of infection into the area of ​​damage. Bathing slippers must be worn on the beach and when swimming. You should also protect your feet from sunburn. 

 If you have calluses on your feet, you should not try to get rid of them with ordinary corn plasters, ointments or liquids, as they all contain substances that corrode the skin. The most suitable remedy for treating calluses and areas of excessive keratinization of the skin of the feet is pumice. 

 It is important to pay attention to the elastic of the socks. If they are too tight, and leave depressions on the skin of the lower legs, it becomes difficult for blood circulation. If your legs are chilly, it is better to use warm, warming socks with a loose elastic band. It is necessary to ensure that the socks in the shoes do not stray. 

 Before putting on your shoes, you need to check its inner surface. 

 Every day, a diabetic patient should carefully examine their feet, especially the plantar surface. In case of difficulty (in the elderly and overweight patients), a mirror can be used.

First aid for injured legs in a patient with complications of diabetes mellitus

If, when examining the feet, a wound, scuff or crack is found, you need to rinse it with a disinfectant solution. You can use a 1% solution of dioxidine, chlorhexidine or 0.02% furacilin solution. The washed wound must be closed with a sterile dressing or a bactericidal plaster. You cannot use ordinary adhesive plaster! Do not use alcohol solutions (alcohol solution of iodine, brilliant green – “brilliant green”), as well as a concentrated, dark solution of potassium permanganate (“potassium permanganate”). They can cause burns.

Arterial hypertension (high blood pressure) and dyslipidemia (high total blood cholesterol or a violation of the ratio of their fraction) are subject to mandatory monitoring and treatment. Every diabetic patient needs to check lipid metabolism and blood pressure at least once a year. Such monitoring frequency is sufficient only at normal levels of these indicators, i.e. if: 

  •  the concentration of total cholesterol is below 4.5 mmol / l; 
  •  systolic (upper) blood pressure below 135 mm Hg; 
  •  diastolic (lower) pressure below 85 mm Hg.

If the levels of these parameters exceed the norm, more frequent monitoring and, of course, treatment are required. Typically, medications are prescribed to treat both hypertension and dyslipidemia. However, diet is also a powerful tool for addressing these disorders. It can be used as the only method of treatment if deviations from the norm are not very pronounced, and is an indispensable background for the use of medications to correct dyslipidemia.

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