These diabetes complications are related to blood vessel
diseases and are generally classified into small vessel disease, such as those
involving the eyes, kidneys and nerves (microvascular disease), and large vessel
disease involving the heart and blood vessels (macrovascular disease). Diabetes
accelerates hardening of the arteries (atherosclerosis) of the larger blood
vessels, leading to coronary heart disease (angina or heart attack),
strokes,
and pain in the lower extremities because of lack of blood supply
(claudication).
Eye Complications
The major eye complication of diabetes is called
diabetic retinopathy.
Diabetic retinopathy occurs in patients who have had diabetes for at least five
years. Diseased small blood vessels in the back of the eye cause the leakage of
protein and blood in the retina. Disease in these blood vessels also causes the
formation of small aneurysms (microaneurysms), and new but brittle blood vessels
(neovascularization). Spontaneous bleeding from the new and brittle blood
vessels can lead to retinal scarring and retinal detachment, thus impairing
vision.
To treat diabetic retinopathy a laser is used to destroy and prevent the
recurrence of the development of these small aneurysms and brittle blood
vessels. Approximately 50% of patients with diabetes will develop some degree of
diabetic retinopathy after 10 years of diabetes, and 80% of diabetics have
retinopathy after 15 years of the disease. Poor control of blood sugar and blood
pressure further aggravates eye disease in diabetes.
Cataracts and glaucoma are also more common among
diabetics. It is also important to note that since the lens of the eye lets
water through, if blood sugar concentrations vary a lot, the lens of the eye
will shrink and swell with fluid accordingly. As a result, blurry vision is very
common in poorly controlled diabetes. Patients are usually discouraged from
getting a new eyeglass prescription until their blood sugar is controlled. This allows for a
more accurate assessment of what kind of glasses prescription is required.
Kidney damage
Kidney damage from diabetes is called diabetic nephropathy.
The onset of kidney disease and its progression is extremely variable.
Initially, diseased small blood vessels in the kidneys cause the leakage of
protein in the urine. Later on, the kidneys lose their ability to cleanse and
filter blood. The accumulation of toxic waste products in the blood leads to the
need for dialysis. Dialysis
involves using a machine that serves the function of the kidney by filtering and
cleaning the blood. In patients who do not want to undergo chronic dialysis,
kidney transplantation can be considered.
The progression of nephropathy in patients
can be significantly slowed by controlling high blood pressure, and by
aggressively treating high blood sugar levels. Angiotensin converting enzyme
inhibitors (ACE inhibitors) or
angiotensin receptor blockers (ARBs) used in
treating high blood pressure may also benefit
kidney disease in diabetic patients.
Nerve damage
Nerve damage from diabetes is called
diabetic neuropathy
and is also caused by
disease of small blood vessels. In essence, the blood flow to the nerves is
limited, leaving the nerves without blood flow, and they get damaged or die as a
result (a term known as ischemia). Symptoms of
diabetic nerve damage include numbness, burning, and aching of the feet and
lower extremities. When the nerve disease causes a complete loss of sensation in
the feet, patients may not be aware of injuries to the feet, and fail to
properly protect them. Shoes or other protection should be worn as much as
possible. Seemingly minor skin injuries should be attended to promptly to avoid
serious infections. Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor foot
injuries can lead to serious infection, ulcers, and even gangrene, necessitating
surgical amputation of toes, feet, and other infected parts.
Diabetic nerve damage can affect the nerves that are
important for penile erection, causing erectile dysfunction (ED, impotence).
Erectile dysfunction can
also be caused by poor blood flow to the penis from diabetic blood vessel
disease.
Diabetic neuropathy can also affect nerves to the stomach
and intestines, causing nausea, weight loss, diarrhea, and other symptoms of gastroparesis
(delayed emptying of food contents from the stomach into the intestines, due to
ineffective contraction of the stomach muscles).
The pain of diabetic nerve damage may respond to
traditional treatments with certain medications such as
gabapentin (Neurontin),
henytoin (Dilantin), and
arbamazepine (Tegretol) that
are traditionally used in the treatment of
seizure disorders.
mitriptyline (Elavil, Endep) and
desipramine (Norpraminine) are medications that are traditionally used for
depression. While many of these medications are not indicated specifically
for the treatment of diabetes related nerve pain, they are used by physicians
commonly.
The pain of diabetic nerve damage may also improve with better blood sugar
control, though unfortunately blood glucose control and the course of neuropathy
do not always go hand in hand. Newer medications for nerve pain include
Pregabalin (Lyrica) and
duloxetine (Cymbalta).
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