What health complications does diabetes cause? Even neglected and untreated

Diabetes mellitus is a disease that is characterized by a disorder of sugar metabolism. The risk is mainly due to the chronic, long-term complications that diabetes mellitus causes.

And the worst case is neglected and untreated diabetes.

You often ask:
What is diabetes?
How does it develop and what are its causes?
What are its complications?

We recognize two types of this disease.

Diabetes mellitus

Type 1 diabetes is actually a deficiency of insulin due to the body's autoimmune reaction against the cells in which insulin is produced.

The immune system destroys them. Because of this, not enough insulin can be produced to break down the sugar. Its levels rise as a result. It begins to occur around the age of 15. However, newborns and the elderly can also be affected.

The cause is unclear. It also occurs, for example, in primary hypertension, i.e. high blood pressure. A genetic basis is assumed. A person with this type of diabetes is dependent on lifelong insulin use.

Type 2 diabetes is so-called acquired diabetes.

It is characterised by a lack of insulin action associated with excess insulin production. It is manifested by a so-called relative insulin deficiency. It is caused by resistance of the cells to insulin, i.e. those in which insulin is produced. These cease to respond to elevated blood sugar levels and do not produce insulin.

This disease has a high genetic predisposition. However, it also arises as a result of increased food intake and lack of exercise. Thus, obesity and general unhealthy lifestyle are factors. However, it can also arise as a complication of other diseases.

Therefore, it most often manifests itself only in adulthood. Patients start treatment with diet. If necessary, they switch to oral antidiabetic treatment.

How to eat with diabetes, you can read in our article.

Complications of diabetes

Sugar is necessary for the proper functioning of skeletal muscles and the brain. It provides them with energy to work. However, when it cannot be broken down to be used sufficiently, it causes a problem.

An excess of it is created.

This is the basis for a disease called diabetes mellitus. There are other complications associated with it that are caused by elevated sugar levels. These are mainly due to its long-term effects on the human body.

However, if certain principles of treatment are not properly followed or underestimated, acute lowering of sugar levels can also occur. This is dangerous much more.

Therefore, patients with diabetes should follow the lifestyle and all aspects and principles of treatment. Nothing should be underestimated.

Complications of diabetes are basically divided into acute and later, chronic.

Interesting information can also be found in the following articles:
Blood sugar levels- what are the values
Diet in diabetes - suitable and unsuitable foods

Hypoglycaemia

It is one of the most acute and life-threatening complications of diabetes. It occurs frequently in patients treated with insulin.

Blood glucose levels are usually between 3.9 and 5.6 mmol/l.

Patients with diabetes mellitus are used to higher values because their blood sugar levels are higher due to the disease.

A common and frequent cause is insufficient food intake after insulin administration. Thus, insulin has broken down a large amount of sugar and its intake has been reduced by the lack of food.

It is also caused by alcohol.

Sugar is mostly used by the cells of the muscles and the brain. If there is a deficiency, this can lead to unconsciousness. Diabetics must eat immediately after taking insulin. If this does not happen, hypoglycaemia can occur relatively quickly.

It initially manifests as a mental disorder.
A person may become disoriented and may say things that do not make sense.
In addition, physical weakness, headaches, cold sweats, or a feeling of hunger may occur.
If the sugar level drops too low, convulsions or even unconsciousness may occur.

This is called hypoglycaemic coma. This symptom is more common in type 1 diabetes.

If the symptoms are recognised early, it is advisable to give the sufferer foods with a high glycaemic index. These are those that contain simple sugars and are thus quickly absorbed into the body. For example, cubed sugar, sweet bars, juice and so on are suitable. If unconsciousness has occurred or the condition is not improving, the emergency medical services should be called.

Insulin should never be given in hypoglycaemic states.

You can also read more in the magazine article on hypoglycaemia.

Hyperglycaemia

This is an acute condition in diabetes. It refers to an elevated blood sugar level above the normal range. The upper limit is about 5.6 mmol/l in non-diabetics.

After a meal, the glycaemia increases and gradually decreases as the sugars are broken down. However, in people with diabetes, this value decreases only very slowly. A significantly higher sugar value can put the diabetic at risk of disturbing the acid-base balance.

Read more about acid-base balance in our article.

It is caused by inadequate or incorrect insulin administration. As well as by missing a dose of insulin. In a non-diabetic patient, this can manifest itself in the development of diabetes.

It is manifested by dry mouth, thirst and frequent urination. Along with urine, minerals are also flushed out of the body.

Hyperglycaemia can be reduced by administering the prescribed dose of insulin. It is not recommended to play sports because of the development of ketoacidosis.

Since sugar is not broken down, the body cannot get energy from it for its cells. In prolonged hyperglycaemia, it starts getting it from another source, namely fats. Their breakdown produces energy and ketone bodies. These cause a drop in blood pH. Thus, diabetic ketoacidosis occurs.

Frequently asked questions in hyperglycemia in the magazine article.

Diabetic ketoacidosis

It arises as a result of prolonged hyperglycemia, by the release of ketone bodies into the bloodstream when fats are broken down. The risk of developing it is increased by an almost complete lack of insulin and increased levels of stress hormones.

It can also occur in patients who do not adhere to their insulin dosage or in diabetics who have developed pneumonia or kidney infections.

It is a life-threatening condition. Left untreated, it leads to metabolic collapse and hyperglycemic coma.

It often manifests itself with acetone-like halitosis. That's why it may seem to some that the sufferer is intoxicated with alcohol.

The symptoms of ketoacidosis are quite extensive. They include:

• extreme fatigue
• extreme thirst despite adequate fluid intake
• frequent urination
• Acetone-like odour from the mouth
• breathing is rapid and shallow at first, gradually slowing and deepening
• loss of body weight
• yeast infections
• psychological irritability
• feeling like vomiting
• pain in the shoulders, chest and neck

These symptoms may escalate until the sufferer becomes unconscious. Emergency medical services should be called immediately.

Chronic complications of diabetes

Chronic complications of diabetes are divided into specific and non-specific.

The following table shows the breakdown of chronic complications of diabetes mellitus

Macroangiopathy is an affection of the large blood vessels, microangiopathy of the small ones. This then results in complications of the diabetes of that nature.

Diabetic retinopathy

It is an affection of the blood vessels nourishing the retina of the eye. It belongs to the affections of small blood vessels, i.e. microangiopathies.

These blood vessels become damaged due to increased sugar levels. They become blocked and the retina of the eye becomes bloodless.

New blood vessels begin to form, bypassing the original closed ones. The new ones are not of the same quality. Blood leaks through the weakened wall. The retina bleeds or swells. These are the manifestations of its most serious form, the so-called proliferative retinopathy.

There are three types of retinal vascular involvement: blockage of the blood vessels, enlargement of the blood vessels or their neoplasm.

This complication of diabetes causes the patient almost no pain.

The manifestations are different:

• deterioration of vision due to swelling at the point of sharpest vision
• a decrease in the ability to distinguish colours
• the sufferer observes tiny black dots in front of the eyes
• distortion of the image
• falling out of part of the image

Risk factors for retinopathy in diabetics include: high blood pressure, smoking, drinking alcohol, hormonal contraceptives, blood fat disorders, poor compensation for diabetes.

Every diabetic should have an eye examination at least once a year.

The treatment of retinopathy consists mainly in lowering blood pressure and blood fats and stabilizing them and metabolically compensating for diabetes. For the actual treatment of the retina, a laser is used. The method is called photocoagulation. This destroys newly formed inferior blood vessels. This prevents them from bursting and leaking blood into the retina.

Diabetic nephropathy

This is damage to the kidneys.

It is one of the most dangerous chronic complications of diabetes. It arises because of damage to small blood vessels. Thus, it belongs to the group of diabetic microangiopathy.

It is usually caused by inadequate or neglected treatment. It manifests itself in both type 1 and type 2 diabetes.

Diabetic nephropathy occurs in almost 40% of diabetics.

It can take up to 15 years to develop from the diagnosis of diabetes to the first symptoms. Initially, it begins to manifest itself by increased protein in the urine. This is taken in from the small blood vessels of the kidneys damaged by diabetes. This is known as microalbuminuria.

This can only be detected by urine tests. Therefore, diabetics should have their urine examined regularly as a precaution. If two positive results are recorded within two to four weeks, microalbuminuria can be said to be present. This must, of course, be confirmed by further kidney tests.

Other factors that cause diabetic nephropathy are hypertension, smoking or a high level of fat in the blood. However, if the disease is still caught at the stage of microalbuminuria, there is a greater chance of its successful treatment.

The complications of diabetes associated with kidney damage can be prevented in the following ways:

• stabilise blood pressure at the correct values
• maintain ideal blood sugar levels
• reduce blood fat levels if they are elevated
• Reduce dietary protein intake, ideally less than 10% of total daily energy intake
• not to take any nicotine
• adhere to regular examinations and check-ups

In our next article you will read how to look after your kidneys.

Diabetic neuropathy

This is nerve damage in diabetics.

It arises because of prolonged elevated blood sugar levels. This breaks down to produce toxins that are harmful to nerve cells. As a result, they disrupt the nerve fibre protein myelin, damaging the cell itself.

It appears as a peripheral neuropathy, which is accompanied by pain in the limbs. However, it can also be a so-called autonomic neuropathy, in which case it is accompanied by cardiovascular disorders or disorders of the digestive and excretory systems. This form is mostly found in younger diabetics.

It is manifested by typical symptoms such as:

• paresthesia of the limbs (tingling)
• dysaesthesia of the limbs (impaired tactile perception)
• impaired sensation in the limbs
• pain in the limbs at rest
• decreased pain perception
• muscle weakness

The tingling in the limbs, whether lower or upper, progresses from the fingertips. It gradually develops towards the knees or elbows.

Diabetic foot syndrome and diabetic foot pain

This disease is caused by damage to the blood vessels and nerves of the lower limbs. It results from permanently elevated blood glucose levels. Its underlying cause is diabetic polyneuropathy.

For this reason, the legs develop ulcers or gangrene, i.e. the death of unhealed parts of the lower limbs. This occurs gradually due to damage to the small blood vessels, which are mainly located in the fingers.

Ulcers occur at the places of greatest pressure. Especially on the feet.

In the table we list the risk factors for the development of lower limb ulcers in diabetic foot syndrome

Diabetics should take extra care of their lower limbs. For this reason, they should follow certain guidelines:

• 3 times a week, take a 3-minute foot bath at a water temperature of 30 to 35 °C.
• do not use soap or alcohol-based products that dry out the skin
• dry the feet thoroughly after the bath, even between the toes
• apply oily cream to your feet every day
• do not use impermeable plasters on abrasions and corns
• it is better to file nails, not cut them
• nails should be filed straight
• check for inflammation or fungal diseases on the nails and between the toes (redness or white coating)
• check the underside of the feet (use a mirror)
• even the smallest injuries should be treated by a doctor
• exercise the lower limbs every day, at least by clenching and unclenching the toes
• wear suitable footwear in which the feet are not constricted
• if possible, take at least a 30-minute walk once a day
• wear white cotton socks (they absorb sweat well and show blood marks from injuries, even in summer)
• never go barefoot