Wednesday, September 13, 2017

Consequences of Diabetes

If your blood glucose isn’t controlled — that is, kept between 70 and 139 mg/
dl after eating or under 100 mg/dl fasting — damage can occur to your body.
The damage can be divided into three categories: irritations, short-term complications,
and long-term complications.

Irritations

Irritations are mild and reversible but still unpleasant results of high blood
glucose levels. The levels aren’t so high that the person is in immediate lifethreatening
danger. The most important of these irritations are the following:

✓ Blurred vision
✓ Fatigue
✓ Frequent urination and thirst
✓ Genital itching, especially in females
✓ Gum and urinary tract infections
✓ Obesity
✓ Slow healing of the skin

 Short-term complications

These complications can be very serious and lead to death if not treated.
They’re associated with very high levels of blood glucose — in the 400s and
above. The three main short-term complications are the following:

✓ Ketoacidosis: This complication is found mostly in type 1 diabetes. It
is a severe acid condition of the blood that results from lack of insulin,
the hormone that is missing. The patient becomes very sick and will die
if not treated with large volumes of fluids and large amounts of insulin.
After the situation is reversed, however, the patient is fine.

✓ Hyperosmolar syndrome: This condition is often seen in neglected
older people. Their blood glucose rises due to severe dehydration and
the fact that the kidneys of the older population can’t get rid of glucose
the way younger kidneys can. The blood becomes like thick syrup. The
person can die if large amounts of fluids aren’t restored. They don’t
need that much insulin to recover. After the condition is reversed, these
people can return to a normal state.

✓ Hypoglycemia or low blood glucose: This complication happens when
the patient is on a drug like insulin or a pill that drives the glucose down
but isn’t getting enough food or is getting too much exercise. After it
falls below 70 mg/dl, the patient begins to feel bad. Typical symptoms
include sweating, rapid heartbeat, hunger, nervousness, confusion, and
coma if the low glucose is prolonged. Glucose by mouth, or by venous
injection if the person is unconscious, is the usual treatment. This complication
usually causes no permanent damage.

Long-term complications

These problems occur after ten or more years of poorly controlled diabetes
or, in the case of the macrovascular complications, after years of prediabetes
or diabetes. They have a substantial impact on quality of life. After these
complications become established, reversing them is hard, but treatment is
available for them early in their course, so watch for them five years after
your initial diagnosis of diabetes. See Dr. Rubin’s book Diabetes For Dummies,
3rd Edition (Wiley), for information on screening for these complications.
The long-term complications are divided into two groups: microvascular,
which are due at least in part to small blood vessel damage, and macrovascular,
associated with damage to large blood vessels.

Microvascular complications include the following:

✓ Diabetic retinopathy: Eye damage that leads to blindness if untreated.
✓ Diabetic nephropathy: Kidney damage that can lead to kidney failure

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