Complications of Diabetes mellitus

Prolonged untreated diabetes or imbalanced treatment causes serious complications include:

Cutaneous complication:

Infection: carbuncles & recurrent abscesses, Delayed healing of the wounds, Necrobiosis diabeticorum: Red painless papules with yellow center- usually over the anterior surface of the legs – due to cutaneous blood vessels occlusion, Cutaneous features of diabetic foot, Acanthosis nigricans: black patches due to insulin spillover into the skin in type 2DM, Lipodystrophy: destruction of fat at the sites of insulin injection.

Cardiovascular complication:

1. Microangiopathy: Diabetic retinopathy → retina, Diabetic nephropathy → glomeruli, Diabetic neuropathy → vasa nervosa (blood supply of nerves).
2. Macroangiopathy: cerebral: thrombosis & ischemia, coronary: angina & myocardial infarction, may be painless due to neuropathy, peripheral: gangrene & intermittent claudication, renal: reno-vascular hypertension.
3. Cardiomyopathy: due to microangiopathy, Blood pressure: systemic hypertension, postural hypotension due to autonomic neuropathy.

Chest complication:

Recurrent chest infection e.g. T.B. (T.B. follows Diabetes mellitusas it’s shadow), (acetone smell in DKA).

Gastrointestinal complication: Diabetics never have normal bowel habits.

Mouth: gingivitis, loosening of teeth, Stomach: gastroparesis, Nausea, vomiting & abdominal pain in diabetic keto acetones, Intestine: Diarrhea: due to sympathetic neuropathy, vasculopathy & GIT infections, Constipation: due to vagal neuropathy, Liver: fatty liver, Gall bladder: chronic cholecystitis, gall stones.

Eye complication:

Lids: infection, Xanthelasma, Iris: New vessels formation in iris (rubeosis iridis) Lens: Senile cataract (occur at an earlier age), Repeated error of refraction Hyperglycemia leads to myopia, Hypoglycemia leads to hypermetropia, Nerves: Optic neuritis, Cranial nerve palsy (3, 4 & 6 nerves).

Diabetic retinopathy: a. It’s characteristic for diabetic eye. It has relationship to the duration of disease & control it it occurs in about all patients of type 1 DM10 years after diagnosis. It is present in 10% of type 2 Diabetes mellitus at diagnosis, 50% after 10 years and 80 % after 20 years, it is usually accompanied by nephropathy & neuropathy

Renal complication:

Interstitial injury: Pyelonephritis, Fever, Pain, Dysuria, Diabetic nephropathy: increase in urine albumin excretion, increase blood pressure lead to renal failure

Hypertension is common. End stage chronic renal failure.

Diabetic foot:

Definition: Trophic changes in foot of diabetic patients (ulcers, falling of hair & gangrene).