{"id":898,"date":"2025-03-04T09:49:00","date_gmt":"2025-03-04T14:49:00","guid":{"rendered":"https:\/\/mickeylieberman.com\/diabetes\/?p=898"},"modified":"2025-02-24T09:48:03","modified_gmt":"2025-02-24T14:48:03","slug":"what-are-the-major-complications-of-diabetes","status":"publish","type":"post","link":"https:\/\/mickeylieberman.com\/diabetes\/what-are-the-major-complications-of-diabetes\/","title":{"rendered":"What are the Major Complications of Diabetes?"},"content":{"rendered":"

Major Complications of Diabetes<\/span><\/p>\n

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.<\/span><\/p>\n

\"\"<\/a><\/p>\n

Serious Complications of Diabetes Can Include<\/span><\/p>\n

Insulin allergy<\/span><\/p>\n

In severe cases, anaphylaxis results. When only human insulin has been used from the onset of insulin therapy, insulin allergy is exceedingly rare.<\/span><\/p>\n

Antihistamines, corticosteroids, and even desensitization may be required, especially for systemic hypersensitivity.<\/span><\/p>\n

Lipodystrophy at Injection Sites<\/span><\/p>\n

Lipohypertrophy is a consequence of the pharmacologic effects of insulin being deposited in the same location repeatedly.<\/span><\/p>\n

Chronic Complications of Diabetes<\/span><\/p>\n

Hypertension, end-stage chronic kidney disease, blindness, autonomic and peripheral neuropathy, amputations of the lower extremities, myocardial infarction, and cerebrovascular accidents.<\/span><\/p>\n

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.<\/span><\/p>\n

Cigarette use adds significantly to the risk of both microvascular and macrovascular complications in diabetic patients.<\/span><\/p>\n

Ocular Complications<\/span><\/p>\n

Diabetic cataracts<\/span><\/p>\n

Premature cataracts occur in diabetic patients and seem to correlate with both the duration of diabetes and the severity of chronic hyperglycemia.<\/span><\/p>\n

Diabetic retinopathy<\/span><\/p>\n

There are two main categories of diabetic retinopathy: nonproliferative and proliferative. Diabetic macular edema can occur at any stage.<\/span><\/p>\n

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.<\/span><\/p>\n

During this stage, the retinal capillaries leak proteins, lipids, or red cells into the retina.<\/span><\/p>\n

Proliferative retinopathy can occur in both types of diabetes but is more common in type 1, developing about 7\u201310 years after the onset of symptoms.<\/span><\/p>\n

Proliferative retinopathy is a leading cause of blindness in the United States, particularly since it increases the risk of retinal detachment.<\/span><\/p>\n

Glaucoma<\/span><\/p>\n

Glaucoma occurs in approximately 6% of persons with diabetes. It is responsive to the usual therapy for the open-angle disease.<\/span><\/p>\n

Diabetic Nephropathy<\/span><\/p>\n

As many as 4000 cases of end-stage chronic kidney disease occur each year among diabetic people in the United States.<\/span><\/p>\n

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.<\/span><\/p>\n

Diabetic nephropathy is initially manifested by proteinuria and subsequently, as kidney function declines, urea and creatinine accumulate in the blood.<\/span><\/p>\n

Diabetic Neuropathy<\/span><\/p>\n

Diabetic neuropathies are the most common complications of diabetes affecting up to 50% of older patients with type 2 diabetes.<\/span><\/p>\n

Painful diabetic neuropathy<\/span><\/p>\n

Hypersensitivity to light touch and occasionally severe “burning” pain, particularly at night, can become physically and emotionally disabling.<\/span><\/p>\n

Autonomic neuropathy<\/span><\/p>\n

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.<\/span><\/p>\n

Cardiovascular Complications<\/span><\/p>\n

Heart disease<\/span><\/p>\n

Peripheral vascular disease<\/span><\/p>\n

Atherosclerosis is markedly accelerated in the larger arteries.<\/span><\/p>\n

Prevention of foot injury is imperative.<\/span><\/p>\n

Skin and Mucous Membrane Complications<\/span><\/p>\n

Chronic pyogenic infections of the skin may occur, especially in poorly controlled diabetic patients.<\/span><\/p>\n

Special Situations<\/span><\/p>\n

Diabetes management in the hospital<\/span><\/p>\n

Most patients with diabetes are hospitalized for reasons other than their diabetes.<\/span><\/p>\n

The aim of medical management of people with diabetes during the perioperative period is to minimize these stress-induced changes.<\/span><\/p>\n

Recommendations for management depend both on the patient\u2019s usual diabetic regimen and on the type of surgery (major or minor) to be done.<\/span><\/p>\n

For people with diabetes controlled with diet alone, no special precautions must be taken unless diabetic control is markedly disturbed by the procedure.<\/span><\/p>\n

If this occurs, small doses of short-acting insulin as needed will correct the hyperglycemia.<\/span><\/p>\n

Patients taking insulin represent the only serious challenge to the management of diabetes when surgery is necessary.<\/span><\/p>\n

However, with careful attention to changes in the clinical or laboratory picture, glucose control can be managed successfully.<\/span><\/p>\n

The protocol used to control the glucose depends on the kind of diabetes (type 1 or type 2).<\/span><\/p>\n

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)?<\/span><\/p>\n

Patients with type 1 diabetes must receive some insulin to prevent the development of diabetic ketoacidosis.<\/span><\/p>\n

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.<\/span><\/p>\n

Pregnancy and the diabetic patient<\/span><\/p>\n

Diabetes complications can impact both maternal and fetal health. Diabetic retinopathy can first develop during pregnancy or retinopathy that is already present can worsen.<\/span><\/p>\n

Diabetic gastroparesis can severely exacerbate nausea and vomiting during pregnancy and some patients may require fluid and nutritional support.<\/span><\/p>\n

Coma and Death<\/span><\/p>\n

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.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

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