COMPLICATIONS IN

Contributors

Dr. Nayanjeet Chaudhury, MD, MPH Director, RICPHI, Bengaluru, Karnataka

Dr. Ruchi Vaidya, PhD Asst. Professor, RICPHI, Bengaluru, Karnataka

Dr. Pramila Kalra, MD, DM- Professor- Endocrinology and Metabolism, RMC, Bengaluru, Karnataka

Dr. Anushree Mehta, MBBS, Fellowship in Diabetology Consultant Diabetologist, Kasturba Health Society, Mumbai

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1. What can happen if diabetes is not treated correctly or controlled? Uncontrolled diabetes can lead to immediate short-term and long term consequences. The short-term consequences result from the very high blood itself described in Chapter 2: Pathophysiology.

Diabetes can affect various parts of the body The longer-term consequences of less than adequate diabetes control result from damage to the small (micro) and larger (macro) vessels of the circulation.

The most common manifestations for the Microvascular complications are as follow: diabetic eye disease (retinopathy), which is the leading cause of blindness among people with diabetes. diabetic kidney disease (nephropathy), which is the leading cause of severe kidney failure necessitating dialysis or transplantation in working-age nerve damage (neuropathy), which is present in about 1 out of 3 people with diabetes at the time of diagnosis and in over 7 out of 10 by the time diabetes has been present for 10 years.

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Both retinopathy and nephropathy can be entirely without symptoms until they reach an advanced and irreversible stage, leading to blindness and the need for kidney dialysis or transplant. can cause very troublesome symptoms and lead to loss of sensation, mainly in the feet, which places the patient at high risk of trauma, infection, and amputations of the legs and feet.

Macrovascular complications (damage of the large blood vessels) may lead to a high rate of heart attack, stroke, heart failure, and amputation of the (usually lower) limbs. About two of every three patients with diabetes will die as a result of large vessel disease. Fortunately, studies have shown that good control of diabetes can prevent or delay the progression of many of these serious problems. Still, other contributing factors, such as blood pressure and cholesterol, must also be given careful attention.

Note: To understand more about macrovascular and microvascular complications and their management, please enrol for level 2 of the course “Basics of ”

2. What care should be taken for the foot? Do’s Don’ts Inspect feet daily using mirror Walk barefoot Wash feet daily in lukewarm water, Smoke/Consume excess alcohol also in between toes Apply moisturizing lotion to feet Expose to extreme temperature after drying Have your feet checked at each clinic Use hot fomentation visit Inspect footwear daily for Use chemical agents (e.g. corn defects/foreign bodies plaster), corn caps or blades to treat corns or calluses Change footwear regularly Wear new footwear for more than a few hours every day Buy footwear preferably in the Neglect any minor foot lesions evening

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To know more about Diabetic Neuropathy and Foot care management, refer to the link below: Video 4: https://www.youtube.com/watch?v=xHZEfGsOoFM

3. What is diabetic ? Diabetic coma is a loss of consciousness occurring as a result of very high blood sugar. Its causes are similar in both type 1 and . In the case of , diabetic coma can occur solely as a result of having insufficient in the body (e.g., running out of or not taking one’s insulin), while in the case of type 2 diabetes, there is almost always another stress to the body that precipitates the coma, such as infection, , etc. In addition, if the severe abnormalities of blood chemistry that led to diabetic coma are not corrected rapidly, death can occur.

Diabetic coma, also known as , is characterized by abdominal pain and manifests with breathlessness, , altered sensorium, and dehydration. The symptoms of diabetic coma are predominantly neurological; dehydration is usually more profound, but abdominal pain is uncommon.

Steps to be taken: 1. Monitor glucose levels 2. Check for urine ketones 3. Intravenous saline infusion at 1 litre in half hour should be started immediately and refer to hospital

To know more about Diabetic Coma, refer to the link below:

Video 3: https://www.youtube.com/watch?v=baQ6S53QM-o

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References:

1. Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of diabetes 2017. https://doi.org/10.1155/2018/3086167 2. Page, M. M., Alberti, K. G. M. M., Greenwood, R., Gumaa, K. A., Hockaday, T. D. R., Lowy, C., ... & West, T. E. T. (1974). Treatment of diabetic coma with continuous low-dose infusion of insulin. Br Med J, 2(5921), 687-690. doi: https://doi.org/10.1136/bmj.2.5921.687 3. National Institute of Diabetes and Kidney diseases (NIDDK). Risk of type 2 diabetes. Source: https://www.niddk.nih.gov/health- information/diabetes/overview/risk-factors-type-2-diabetes 4. ICMR guidelines for Type 2 diabetes. 5. https://main.icmr.nic.in/sites/default/files/guidelines/ICMR_GuidelinesType2diabet es2018_0.pdf

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