-Dr Chakshu
Contd from previous issue
Short term complications - Hypoglycemia or low blood sugar occurs from time to time in most people with diabetes who are on treatment. It may result from over treatment, missing a meal, doing excessive exertion, any acute illness. Common symptoms are headache, dizziness, poor concentration, tremors of hands and sweating. Diabetic ketoacidosis is a serious acute complication in which uncontrolled hyperglycemia causes build up of waste products called ketones in blood which can cause nausea, vomiting, altered mental state or even weakness of whole body. It is precipitated by infection, stress, trauma, and other medical emergencies like stroke or heart attack. Hyperosmolar hyperglycemic non ketosis syndrome is also an acute complication associated with very high level of blood glucose with severe dehydration which may lead to seizures, coma and eventually death.
Long term complications - Diabetic neuropathy (nerve damage): Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves. This can lead to facial paralysis, tingling, numbness, burning or pain (increased at night) that usually begins at the tips of the toes or fingers and gradually spreads upward, difficulty while getting up from sitting position, calf muscle weakness, paralysis of bladder leading to urinary tract infections, erectile dysfunction, lightheadedness or syncope or passing out when suddenly standing up or stretching, diabetic foot (wounded foot ulcer) which is the leading cause of foot and leg amputation. Cardiovascular disease (conditions caused by narrowed or blocked blood vessels): affects the heart and blood vessels and may cause fatal complications such as coronary artery disease (leading to heart attack) and stroke. Cardiovascular disease is the most common cause of death in people with diabetes. Infections: Diabetes increases susceptibility to various types of infections. The most common sites of infection in diabetic patients are the ear, nose and throat infections, urinary tract infections, skin and soft tissue infections and hepatitis-B. Gastrointestinal tract complications: Since diabetes mellitus affects every organic system, it affects gastrointestinal tract as well. Oral candidiasis (fungal infection of the mouth), oral or mouth ulcer, dysphagia (difficulty or discomfort in swallowing), heartburn or awful burning sensation in your chest or throat due to acid reflux from stomach, gastroparesis or delayed gastric emptying (a disorder that occurs when the stomach takes too long to empty food), nausea, abdominal pain on and off, cholecystitis (inflammation of the gall bladder), anorectal dysfunction also known as pelvic floor dysfunction (a disorder causing abnormalities of bowel storage and bowel emptying, as well as pelvic pain) are some of the gastrointestinal tract complications due to long standing DM. Eye complications: DM over a long period of time damages the retina of the eye (diabetic retinopathy), which is the leading cause of blindness. Other complications include glaucoma (a condition of increased pressure within the eyeball, causing gradual loss of sight), stye (small, painful lump on the inside or outside of the eyelid), dry eyes and refractive errors. Diabetic nephropathy (diabetic kidney disease): is a complication of type 1 or type 2 diabetes caused by damage to the kidneys’ delicate filtering system. In severe cases it can lead to kidney failure. Sexual dysfunction is also more common in diabetes patients. Undiagnosed or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may be bigger than he/she should be.
How to prevent diabetes? The role of the family in the management, care, prevention and education of diabetes is of utmost importance. Changing your lifestyle could be a big step toward diabetes prevention — and it’s never too late to start. Making a few simple changes in your lifestyle now may help you avoid the serious health complications of diabetes down the road, such as nerve, kidney and heart damage. There is no proper way to prevent type 1 DM. When it comes to type 2 diabetes — the most common type of diabetes — prevention is a big deal. It’s especially important to make diabetes prevention a priority if you’re at increased risk of diabetes, for example, if you’re overweight or have a family history of the disease. Type 2 DM can be prevented by controlling weight, regular daily exercise for 30 minutes, quitting smoking and alcohol, decreased oil consumption and following a balanced and nutritious diet.
Treatment for diabetes: Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease. Type 1 diabetes is managed with insulin as well as dietary changes and exercise. Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes. The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10% to 20% of them will need to take some kind of blood-glucose-controlling medications. Diabetes is a serious disease that you cannot treat on your own. Your doctor will help you make a diabetes treatment plan that is right for you — and that you can understand. You may also need other health care professionals on your diabetes treatment team, including a foot doctor, nutritionist, eye doctor, nephrologist, gastroenterologist, neurologist, urologist, dermatologist, physiotherapist and ENT specialist etc. Treatment for diabetes requires keeping close watch over your blood sugar levels (and keeping them at a goal set by your doctor) with a combination of medications, exercise, and diet. By paying close attention to what and when you eat, you can minimize or avoid the “seesaw effect” of rapidly changing blood sugar levels, which can require quick changes in medication dosages, especially insulin. If a patient has complications of diabetes, it should be dealt accordingly. The skin should be taken care to avoid sores and cracks that can become infected. See a dentist regularly to prevent gum diseases. The feet should be washed and examined daily looking for small cuts, sores or blisters that may cause problems later. If you or someone you know already has diabetes, your focus should be on preventing the complications. Don’t forget to monitor blood sugar regularly and most importantly regular follow up with your physician.
The writer is MD (General Medicine) Consultant Physician Shija Hospitals, HealthCity, Langol, Imphal West