DIABETES COMPLICATIONS

People living with diabetes may have to deal with short-term or long-term complications as a result of their condition.

 Short-term complications include hypoglycaemia diabetic ketoacidosis (DKA), and hyperosmolar hyperglycaemic state (HHS).

Long-term complications include how diabetes affects your eyes (retinopathy), heart (cardiovascular disease), kidneys (nephropathy), and nerves and feet (neuropathy).

Impact on overall health

Long- and short-term complications can impact on a wide variety of parts of the body including eyes, heart, kidneys, nerves and feet. Read through the links and get to know the 15 healthcare essentials to find out more about complications, and how to reduce the risk of developing them. With all complications, keeping blood glucose, blood pressure and blood fat levels under control will greatly help to reduce the risk of developing complications. Regular check-ups are essential to help manage the condition

https://www.diabetes.org.uk/Guide-to-diabetes/complications/

if a diabetic patient consume protein rich diet or heavy exercise doctor may be identified microalbuminuri and goes to renal insufficiency.  if a diabetic patient consume a lot of saturated fats doctor may be identified disorders of lipids and this patient tends to cardiovasculary disease.  lack of vitamin or essential elements leads to nerve (vitamin B),  eye complications.  diet is essential for diabetes.

Hi Mr Ali A T Al Dallal and Ms Binnur Tüzün,

I really appreciate your grateful help, from that you said i had understood that the types of foodstuffs have a role for the diversity of complications between individuals, are their other reasons for this ?

In Diabetis all is almost about diet, no doubt about it. A lot medication to control it, but patient compliance is key.

Hi Mr Guillermo Alberto Perez Fernandez ,

This is a great honor to answer my question but our problem is that not all people are aware of the need to diet and this is what led to serious damage to comprise not unexpected, especially in our time. My question is of the essence of the cause of the difference of complications from one person to another without reason the quality of food, eat persons ?

I got your point. There are many things comprising this diversity. Never  forget genetics.

Since I am not a health specialist. Like all people who are interested in their health and especially my family predisposition to the problem of diabetes often I read articles on this topic. See the link

http://www.em-consulte.com/en/article/79961

https://www.axaprevention.fr/sante-bien-etre/sante-question/diabete-type-2

Hi Mr Fadel Djamel ,Sir, I am honored to join us in this discussion, despite the lack of knowledge domain this is a great pleasure for me.

Mr Guillermo Alberto Perez Fernandez ,

Unfortunately, due to range of ambiguities and complexity associated with diabetes complications, these later  factors  highlighted the importance of knowing the cause of differences in complications between individuals and how genetic factors influence these differences and understanding the problem requires more depth that's what i look for ?

YES!    A la Sir William Osler, "to know syphilis (diabetes), is to know medicine".  I had a patient once, 55, glucose "control good"  (this means never was really high and we take the control credit) - no meds:  kidney failure, on transplant list,two MI's, and stroke.   Another patient:  blood sugars consistently 4-500 resistant to all treatments:  normal eye grounds, normal albumin/creatinine ratios.  This is why

studies are so difficult - too much variance.  Need to be huge and run 10 years or more to dissolve out the confounds.   Like the ACCORD study, n:10000  no effect of treatment, increase death rates - probably the most reliable study yet - largely ignored too big of a threat to the Glycemic Control Cartel.

Hi Mr Thomas Kline,

I agree with you sir, There is an obvious reason that the impact of genetic factors in complications between people change, How true this is ? What research findings to prove it in ?

Dear Houria , from dermatological point of view DM has many cutaneous manifestations as regards Microangiopathy, infectins, neuropathy and glycosylation :

Cutaneous Manifestations (CM) of D. mellitus (DM)

     Cutaneous manifestations of diabetes mellitus has been  classified into:

A. Skin symptoms due to diabetic vascular abnormality.

1. Diabetic microangiopathy.

2. Eryspelas- likes erythema.

3. Wet gangrene of the foot.

4. Diabetic rubeosis.

5. Diabetic dermopathy (diabetic shin spots).

6. Large vessel disease.

B. Diabetic neuropathy- Diabetic foot.

C. Cutaneous infections in diabetes mellitus.

1.     Staphylococcus aureous (Furuncles- carbuncles-Styes).

2.     Speudomonaus (Cellulitis-Ostiitis-Cranial nerve damage-Meningitis).

3.     Non clostridial gas gangrenes (E. Coli-Klebsiella-Pseudomonaus-Bacteroids).

4.     Candida albicans (Mouth-Nail folds-Genitalia-Intertrigenous )

                D.Insulin resistance and acanthosis nigricans.

E.Various skin disorders associated with diabetes mellitus.

1.     Necrobiosis lipoidica.

2.     Disseminated granuloma annulare.

3.    Diabetic bullae.

4.     Pruritis.

        5.  Stiff joints and wax skin (diabetic hand syndrome).

      6.  Scleredema of diabetes mellitus.

7. Vitiligo.

8.                 Licken planus.

9.     Haemochromatosis

10.Eruptive xanthomas of the skin.

11.Finger pebbles.

12.Skin tags.

13.Local insulin reaction.

14.Insulin lipodystrophy.

15.Reactive perforating collagenosis (Folliculitis).

Hi Mr Adil H.H. Bashir ,

You have indicated your hand to an important point of the many points touched by diabetes, thank you sir.

Unfortunately, the diabetes has complications almost at the level of all members of the body , Sir, I hope if you can provide me with references in the field, and studies have proven the health of our saying that if possible ?

Dear Ali Merina Houria , hope you find these references of fulfilling your interest.

 Bashir, A.H.H. (2004). Clinico-epidemiological Study of Cutaneous Manifestations of Diabetes mellitus in Jabir Abu Eliz Diabetic Center in Khartoum, Sudan. Paper, Collage of Medicine, University of Juba, Sudan- Sudanese Journal of Dermatology. September 2004; 2(2):34-38.

1. National Diabetes Data Group 1979.Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes; 28:1039-57.

2.Perez M I, Kohn SR 1994.Cutaneous manifestations of diabetes mellitus. J Am Acad.Dermatol; 30:519-31.

3.OyerDS 1982.Diabetes mellitus: new developments. Arch.

Dermatol.:118:132-4.

4. Diabetes Statistics-MSN Home/Hotmail-For the latest MSNBC Health. Internet.

5. Sonck CE, Somersalo O 1963: The yeast flora of the anogenital region in diabetic girls. Arch. Dermatol. 88:846-852.

6. Knight L, Fletcher J 1971: Growth of Candida albicans in saliva: Stimulation by glucose associated with antibiotics, corticosteroid, and diabetes mellitus. J Infect Dis 123:371-377.  

7. Lugo-Somolinos A, Sanchez JL 1992: Prevalence of dermatophytosis in patients with diabetes: J. Am. Acad. Dermatol. 26:408-410.

8.Alteras I, Saryt E 1979: Prevalence of pathogenic fungi in the toe-webs and toe-nails of diabetic patients. Mycopathologia 67:157-159,.

9. Cole GW, Headley J, Skowsky R (1983): Scleredema Diabeticorum: A common and distinct cutaneous manifestation of diabetes mellitus. Diabetes Care 6:189-192.

10. West KM 1978: Epidemiology of diabetes and its vascular lesions. New York, Elsevier North-Holland Inc. p 353.

11.Huntley AC, Walter RM Jr 1990: Quantitative determination of skin thickness in diabetes mellitus: relationship to disease parameters. Journal of Medicine, , 21(5):257-64.

12. Blackwell science Ltd. Rook/Wilkinson/Ebling 1998. Textbook of dermatology. Sixth edition.

13. Gupta AK, Humke S. The prevalence and management of onychmycosis in diabetic patients. University of Toronto, Toronto, Canada.

14. Murphy RA 1965: Skin lesions in diabetic patients: The “spotted leg” syndrome. Lahey Clin Found Bull 14:10-14.

15.Bear CL, Wall LN 1969. Idiopathic bullae in diabetics. Australas J Dermatol; 10: 337.

16. Derighetti M, Hohl D, Krayenbuhl BH, Panizzon RG. Bullosis diabeticorum in a newly discovered type 2 diabetes mellitus. Department of Dermatology, DHURDV, CHUV, Lausanne, Switzerland.

17. A Huntley December 1995. Photo-essay: The Skin and Diabetes Mellitus. Dermatology Online Journal, Volume 1, Number 2.

18.Boyd-AS; Neldner-KH 1991 Oct. Lichen planus, Department of dermatology, Texas Tech University Health Sciences Centre, Lubbock 79430. J-AM-Acad-Dermayol.; 25(4) :593-619.

19. Karvonen SL, Haapasaari KM, Kallioinen M, Oikarinen A, Hassinen IE, Majamaa K 1999 Apr. Increased prevalence of vitiligo, but no evidence of premature ageing, in the skin of patients with bp 3243 mutation in mitochondrial DNA in themitochondrial, encephalomyopathy, lactic acidosis and stroke-like episodes syndrome (MELAS). Br J Dermatol; 140(4): 634-9.

Thank you very much Mr Adil H.H. Bashir .

There are  major differences in complications between type 1 and type 2 diabetes. In type 1 diabetes microvascular complications(retina, kidney and nerve) are predominant.There no dept that duration and degree of hyperglycemia play a major role in the production of complications. Better diabetic control with Intensive insulin therapy (MDII and CSII) can reduce the onset and progression of complications. On the other site, in type 2 diabetes macrovascular complications(atherosclerosis) are more frequent;for example: stroke two times, myocardial infarct two to five times, amputation of a foot for gangrene is 50 times. Good diabetic control  has a small effects and it is very important to reach those targets : HbA1c 1,2 mmol/l (for male).        

Hi Ms Brankica Krstevska ,

Thank you for your interest in the subject of debate and answered.

I've noticed that the psychological aspect of the patient is very important in the development of complications of the disease .

Can anyone tell me How does this affect at some point if the patient is in a bad psychological state, or good ?

What are the physiological changes that occur to him in his organism through it ?

Major depression has been found as a risk factor for diabetic complications. The symptoms of depression are similar to that of hyperglycemia (lethargy, fatigue, poor concentration, changes in appetite and sleep patterns) The patients have no adequate diabetic self-care, fear of injection, fear of hypoglycemia.  In addition, major depression can worst with onset and progression of complications. For example, visual impairment , painful neuropathy or nephropathy are another "loss" for diabetic patients. 

Yes I agree with Krstevska as there is strong evidence that depression involves alterations in multiple aspects of immunity that may contribute to the development or exacerbation of a number of medical disorders like DM or MS through cytokines.

Thank you Ms Brankica Krstevska, that's what I noticed through to some patients.

I hope if you can provide me with references , and studies have proven that if possible ?

Thank you Mr Adil H.H. Bashir I really appreciate your contribution and your  help this a  greate pleasure for  me thank you a  lot .

The complications in diabetes are due to multiple factors , in addition to hyperglycemia . In T2DM , macrovascular complications such as CAD & PVD are due to associated hypertension & dyslipidemia , which are probably due to polygenic inheritance . These factors play a role also in diabetic renal disease also , which is a microvascular disease . In addition , smoking & obesity add to the risk factors . Treatment of diabetes alone is not going to reduce the morbidity & mortality of T2DM , unless hypertension & lipid disorders are also treated . Indians are vulnerable to T2DM , a decade earlier than western societies , as the genetic factors play an important role & is also polygenic in nature . Therefore , screening for each of the multiple risk factor is essential to improve long term  survival in diabetes .