Diabetic Neuropathic and Ulcers

DIABETES COMPLICATIONS

Diabetes complications involve the disruption of a variety of bodily systems and complications may occur over many timescales - from the date of diagnosis to years after diabetes has developed. The majority of diabetes complications occur due to fluctuations in blood glucose levels, particularly elevated blood sugar over a long period of time. Controlling blood glucose levels and blood pressure has been proven to reduce the risk of diabetes complications.

COMPLICATIONS AND POOR CONTROL

TYPE 1 DIABETES rarely results in retinopathy and nephropathy within the first five years, but kidney damage and eye diseases have been found to be more common amongst those with poor control.Risks of diabetes complications climb once HbA1c levels exceed 9%, and again increase significantly above 12%.

TYPE 2 DIABETES may often result in vascular complications such as heart attacks, stroke and problems with circulation.By closely controlling blood sugar levels, blood pressure and cholesterol, people with diabetes can help lower their risk of diabetes complications.Moreover, a lifestyle involving a good diet, regular exercise and no smoking also help to reduce diabetes complication risks.

ROUTINE TESTS REQUIRED FOR A DIABETIC :

• Urine Analysis.
• Kidney Function tests.
• Lipid profile.
• Eye check up.
• 2D Echo Cardiogram.
• Glycosylated Hemoglobin%.

All these are to be done once a year apart from monthly blood sugar analysis.

COMPLICATIONS OF LONG STANDING DIABETES :

Longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Diabetes should be managed early in its course. The earlier the better. Inadequately treated diabetes can cause in the long run, complications involving symptoms over the whole body, Possible complications include:

Cardiovascular disease : Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.

Nerve damage (Neuropathy) : Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.

Kidney damage (Nephropathy) : The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

Eye damage (retinopathy) : Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

Foot damage : Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.

Skin conditions : Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.

Hearing impairment : Hearing problems are more common in people with diabetes.

Alzheimer's disease : Type 2 diabetes may increase the risk of Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.

Complications of gestational diabetes

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can occur as a result of gestational diabetes, including:

Excess growth : Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth.

Low blood sugar : Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.

Type 2 diabetes later in life : Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.

Complications in your mother can also occur as a result of gestational diabetes, including:

Preeclampsia : This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.

Subsequent gestational diabetes : Once you've had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy. You're also more likely to develop diabetes — typically type 2 diabetes — as you get older.

High blood sugar (glucose) can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild, for others, diabetic neuropathy can be painful, disabling and even fatal.

Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle.

There are four main types of diabetic neuropathy. You may have just one type or symptoms of several types. Most develop gradually, and you may not notice problems until considerable damage has occurred.

The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected.

PERIPHERAL NEUROPATHY

Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:

• Numbness or reduced ability to feel pain or temperature changes.
• A tingling or burning sensation.
• Sharp pains or cramps.
• Increased sensitivity to touch — for some people, even the weight of a bed sheet can be agonizing.
• Muscle weakness.
• Loss of reflexes, especially in the ankle.
• Loss of reflexes, especially in the ankle.
• Loss of balance and coordination.
• Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain.

AUTONOMIC NEUROPATHY

The autonomic nervous system controls your heart, bladder, lungs, stomach, intestines, sex organs and eyes. Diabetes can affect the nerves in any of these areas, possibly causing :

• A lack of awareness that blood sugar levels are low (hypoglycemia unawareness).
• Bladder problems, including urinary tract infections or urinary retention or incontinence.
• Constipation, uncontrolled diarrhea or a combination of the two.
• Slow stomach emptying (gastroparesis), leading to nausea, vomiting, bloating and loss of appetite.
• Difficulty swallowing.
• Erectile dysfunction in men.
• Vaginal dryness and other sexual difficulties in women.
• Increased or decreased sweating.
• Inability of your body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure after sitting or standing that may cause you to faint or feel lightheaded.
• Problems regulating your body temperature.
• Changes in the way your eyes adjust from light to dark.
• Increased heart rate when you're at rest.

RADICULOPLEXUS NEUROPATHY (DIABETIC AMYOTROPHY)

Radiculoplexus neuropathy affects nerves in the thighs, hips, buttocks or legs. Also called diabetic amyotrophy, femoral neuropathy or proximal neuropathy, this condition is more common in people with type 2 diabetes and older adults.

Symptoms are usually on one side of the body, though in some cases symptoms may spread to the other side. Most people improve at least partially over time, though symptoms may worsen before they get better. This condition is often marked by :

• Difficulty rising from a sitting position.
• Abdominal swelling, if the abdomen is affected.
• Weight loss.
• Sudden, severe pain in your hip and thigh or buttock.
• Eventual weak and atrophied thigh muscles.

MONONEUROPATHY :

Mononeuropathy involves damage to a specific nerve. The nerve may be in the face, torso or leg. Mononeuropathy, also called focal neuropathy, often comes on suddenly. It's most common in older adults.

Although mononeuropathy can cause severe pain, it usually doesn't cause any long-term problems. Symptoms usually diminish and disappear on their own over a few weeks or months. Signs and symptoms depend on which nerve is involved and may include:

• Difficulty focusing your eyes, double vision or aching behind one eye.
• Paralysis on one side of your face (Bell's palsy).
• Pain in your shin or foot.
• Pain in the front of your thigh.
• Pain in your chest or abdomen.

Sometimes mononeuropathy occurs when a nerve is compressed :

Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes. Signs and symptoms of carpal tunnel syndrome include:Numbness or tingling in your fingers or hand, especially in your thumb, index finger, middle finger and ring finger .A sense of weakness in your hand and a tendency to drop things.

Seek medical care if you notice :

• A cut or sore on your foot that doesn't seem to be healing, is infected or is getting worse.
• Burning, tingling, weakness or pain in your hands or feet that interferes with your daily routine or your sleep.
• Dizziness.
• Changes in your digestion, urination or sexual function.

These signs and symptoms don't always indicate nerve damage, but they may signal other problems that require medical care. Early diagnosis and treatment offer the best chance for controlling symptoms and preventing more-severe problems.

Even minor sores on the feet that don't heal can turn into ulcers. In the most severe cases, untreated foot ulcers may become gangrenous — a condition in which the tissue dies — and require surgery or even amputation of your foot. Early treatment can help prevent this from happening.