Major Complications of Diabetes
Some of the More Serious Complications of Diabetes can be life-threatening emergencies if not treated promptly and even then it might be too late.
Serious Complications of Diabetes Can Include
Insulin allergy
In severe cases, anaphylaxis results. When only human insulin has been used from the onset of insulin therapy, insulin allergy is exceedingly rare.
Antihistamines, corticosteroids, and even desensitization may be required, especially for systemic hypersensitivity.
Lipodystrophy at Injection Sites
Lipohypertrophy is a consequence of the pharmacologic effects of insulin being deposited in the same location repeatedly.
Chronic Complications of Diabetes
Hypertension, end-stage chronic kidney disease, blindness, autonomic and peripheral neuropathy, amputations of the lower extremities, myocardial infarction, and cerebrovascular accidents.
In patients with type 1 diabetes, complications from end-stage chronic kidney disease are a major cause of death, whereas patients with type 2 diabetes are more likely to have macrovascular diseases leading to myocardial infarction and stroke as the main causes of death.
Cigarette use adds significantly to the risk of both microvascular and macrovascular complications in diabetic patients.
Ocular Complications
Diabetic cataracts
Premature cataracts occur in diabetic patients and seem to correlate with both the duration of diabetes and the severity of chronic hyperglycemia.
Diabetic retinopathy
There are two main categories of diabetic retinopathy: nonproliferative and proliferative. Diabetic macular edema can occur at any stage.
Nonproliferative (“background”) retinopathy represents the earliest stage of retinal involvement by diabetes and is characterized by such changes as microaneurysms, dot hemorrhages, exudates, and retinal edema.
During this stage, the retinal capillaries leak proteins, lipids, or red cells into the retina.
Proliferative retinopathy can occur in both types of diabetes but is more common in type 1, developing about 7–10 years after the onset of symptoms.
Proliferative retinopathy is a leading cause of blindness in the United States, particularly since it increases the risk of retinal detachment.
Glaucoma
Glaucoma occurs in approximately 6% of persons with diabetes. It is responsive to the usual therapy for the open-angle disease.
Diabetic Nephropathy
As many as 4000 cases of end-stage chronic kidney disease occur each year among diabetic people in the United States.
However, since there are many more individuals affected with type 2 diabetes, end-stage chronic kidney disease is much more prevalent in type 2 than in type 1 diabetes in the United States and especially throughout the rest of the world.
Diabetic nephropathy is initially manifested by proteinuria and subsequently, as kidney function declines, urea and creatinine accumulate in the blood.
Diabetic Neuropathy
Diabetic neuropathies are the most common complications of diabetes affecting up to 50% of older patients with type 2 diabetes.
Painful diabetic neuropathy
Hypersensitivity to light touch and occasionally severe “burning” pain, particularly at night, can become physically and emotionally disabling.
Autonomic neuropathy
With autonomic neuropathy, there is evidence of postural hypotension, decreased cardiovascular response, gastroparesis, alternating bouts of diarrhea (particularly nocturnal) and constipation, inability to empty the bladder, and impotence.
Cardiovascular Complications
Heart disease
Peripheral vascular disease
Atherosclerosis is markedly accelerated in the larger arteries.
Prevention of foot injury is imperative.
Skin and Mucous Membrane Complications
Chronic pyogenic infections of the skin may occur, especially in poorly controlled diabetic patients.
Special Situations
Diabetes management in the hospital
Most patients with diabetes are hospitalized for reasons other than their diabetes.
The aim of medical management of people with diabetes during the perioperative period is to minimize these stress-induced changes.
Recommendations for management depend both on the patient’s usual diabetic regimen and on the type of surgery (major or minor) to be done.
For people with diabetes controlled with diet alone, no special precautions must be taken unless diabetic control is markedly disturbed by the procedure.
If this occurs, small doses of short-acting insulin as needed will correct the hyperglycemia.
Patients taking insulin represent the only serious challenge to the management of diabetes when surgery is necessary.
However, with careful attention to changes in the clinical or laboratory picture, glucose control can be managed successfully.
The protocol used to control the glucose depends on the kind of diabetes (type 1 or type 2).
Is it a minor surgery (lasting less than 2 hours and patient eating afterward) or major surgery (lasting greater than 2 hours, with the invasion of a body cavity, and patient not eating afterward)?
Patients with type 1 diabetes must receive some insulin to prevent the development of diabetic ketoacidosis.
Many patients with type 2 diabetes who are taking insulin do well perioperatively without insulin for a few hours. Ideally, patients with diabetes should undergo surgery early in the morning.
Pregnancy and the diabetic patient
Diabetes complications can impact both maternal and fetal health. Diabetic retinopathy can first develop during pregnancy or retinopathy that is already present can worsen.
Diabetic gastroparesis can severely exacerbate nausea and vomiting during pregnancy and some patients may require fluid and nutritional support.
Coma and Death
In the most serious case of diabetes, the person can lapse into a coma and never recover and death can occur if there is no emergency medical treatment and it could still be too late.
