Diabetes is one of the commonest medical conditions among Thai people. A chronic disease, medical science has yet to find a cure. All a diabetic can do therefore is reduce the symptoms to a level where they can continue to live as close to a normal life as possible. Diabetes also has the potential to cause several complications. Therefore, let’s delve into the six chronic complications diabetics should be aware of.

Diabetes and its complications

Diabetes is a condition where the body has excess sugar. It is caused by abnormal functioning of insulin, a hormone produced by pancreatic beta cells. Early-stage symptoms of diabetes aren’t noticeable if the blood sugar level isn’t especially high. Diabetes mellitus isn’t limited to the elderly. The younger generation is also at risk of developing it. It all depends on lifestyle behaviours and food choices.

Those having diabetes for five years or more are more likely to develop complications. Those who can’t control their blood sugar levels as prescribed are particularly vulnerable. The severity of complications varies from case to case but can be divided into two main groups:

·       Acute complications comprise two groups of symptoms:

o   Hypoglycemia is a condition in which the blood sugar level at the fingertips is less than or equal to 70 mg/dL which often indicates low blood sugar. The symptoms disappear when blood sugar levels rise.

§  Symptoms: trembling hands, palpitations, sweating, feeling hungry, dizzy, confused, tired, weak limbs, convulsions, loss of consciousness.

§  Solution: Based on the 15:15:15 principle, patients should eat 15 grams of carbohydrates such as 1 tablespoon of honey, 1 glass of juice or soft drink, 3 candies, etc. After 15 minutes, check the sugar level at the fingertips. If the glycemic index is greater than 70 mg/dL, eat the main meal as soon as possible. However, if it is lower than the specified level, repeat 15 grams of carbs and 15 minutes before another glucose test. If the patient has stupor unconsciousness or convulsions, don’t give food by mouth as it may get stuck in the trachea and choke the patient. If that happens, the patient must be rushed to hospital immediately.

o   Acute hyperglycemia comprising two conditions:

1.        Diabetic Ketoacidosis (DKA) is hyperglycemia with blood sugar greater than 250 mg/dL, along with metabolic acidosis from ketone acid in the body.

2.        Hyperosmolar Hyperglycemic state (HHS) is hyperglycemia with blood sugar greater than 600 mg/dL and blood osmolality greater than 320 mOSmol/kg with decreased consciousness.

§  Symptoms: Nausea, vomiting, abdominal pain, malaise, breathlessness, excessive urination, lethargy, convulsions, unconsciousness.

§  Solution: If the patient has symptoms of acute hyperglycemia, they must be taken to the hospital immediately.

·       Chronic complications: This is a long-term condition and is the cause of death in up to two-thirds of those with diabetes. Or it could necessitate a dismemberment and cause a deterioration in quality of life along with higher costs of treatment. Chronic complications can be divided into two groups:

o   Small vascular complications include:

§  Retinal complications

§  Kidney complications

§  Nerve complications

o   Major vascular complications include:

§  Coronary heart disease

§  Cerebrovascular disease

§  Multiple vascular disease which causes foot ulcers in diabetic patients

Six chronic complications to be aware of

As mentioned above, chronic complications are a big and serious problem that diabetics should be aware of. The chronic complications can be divided into two groups: small vascular complications and chronic conditions in large blood vessels. Let’s go into more detail on each condition.

1.        Retinal complications

Also known as “eye diabetes”, this complication occurs in diabetic patients who can’t control their sugar levels. It causes the blood vessels in the retina to become inflamed, aneurysm and bleeding as well as lymph seepage all over the retina. If leakage reaches the center of image acquisition, it may cause blurred vision. If the new blood vessels and fascia still have weak walls and are easily torn, they will be the ones that hold the retina against peeling off which would leave the patient completely blind.

·       Symptoms

o   Blurred vision caused by abnormal refraction of light from the lens while blood sugar is high. Caused by cataracts or changes in the retina which without proper treatment can lead to blindness.

o   Seeing shadows when looking at images. Caused by bleeding of vitreous fluid.

o   Double vision. Caused by malfunctioning of the eye muscles controlled by the cranial nerves.

2.        Kidney complications

Diabetes is the cause of end-stage renal disease. Kidney complications are one of the leading causes of death in both type 1 and type 2 diabetes patients, a condition associated with glycaemic control and blood pressure levels.

·       Symptoms

o   In the early stages, patients show no symptoms. However, if the urine is tested, a small amount of albumin or egg white is found in it (approximately 30-300 milligrams of albumin protein in the urine per day).

o   In the subsequent stage with more protein leakage, foamy urine and swelling may be observed. At this stage, high blood pressure is detected. (The amount of albumin protein in the urine at this stage is more than 300 milligrams per day.)

o   If there is no appropriate treatment, it will result in decreased kidney function and eventually chronic renal failure until requiring treatment with haemodialysis or dialysis.

3.        Nerve Complications

With this condition, patients have numbness at the tip of the feet which is a factor in foot ulcers especially among patients with peripheral vascular disease. As a result, patients may have to have toes, feet or legs amputated. Factors that increase the risk of nerve complications include blood sugar levels, high blood pressure, and smoking, etc.

·       Symptom

o   Patients may experience numbness in both hands and feet. Some patients will have a burning pain or stabbing pain. Most of the symptoms occur at night.

o   In the subsequent stage, the pain is reduced but patients feel numb and less tactile. Some patients experience weakness in the small muscles of the arms and legs.

4.        Cardiovascular disease

Those with diabetes are more likely to develop coronary heart disease than others. This is a very dangerous complication as it puts diabetic patients at risk of heart failure 1.5 times more than general patients and they are almost twice as likely to die. Patients have arterial pressure and high blood fat but don’t recognize the symptoms themselves. As such, regular checking is required.

5.        Stroke

This complication is caused by a narrowing of the blood vessels supplying the brain. It can cause severe disability or death. The likelihood of stroke is higher in those with diabetes who also have high blood pressure. This can weaken the organs it controls, causing paralysis. Age is a key factor in this risk. Patients over 70 years old are at three times the risk of developing the disease.

6.        Multiple thromboembolic disease

Though not life threatening, symptoms are annoying and cause suffering. The complication arises when the capillaries that feed the nerves are destroyed and unable to deliver oxygen through the bloodstream to the nerves. Moreover, sugar accumulates around the nerves. As a result, nerve function deteriorates, reducing perception, especially in the tips of the hands and feet which will be numb when facing heat or pain. Therefore, this complication is dangerous for those with diabetes as wounds can arise easily without being detected. As it intensifies it causes muscle atrophy and shrinkage and reduces daily activity.

Just by being diagnosed with diabetes means suffering. And if the patient neglects health care and continues with behaviors that are not beneficial to their physical condition, it opens the door to these six complications. If you or someone in your family has diabetes, it is important to pay close attention to their food choices. Patients should also get enough rest and reduce behaviors that worsen the symptoms so that they and their loved ones can continue to live comfortably for a long time to come.

For Krungthai-AXA Life Insurance customers interested in health care can read lots of articles on aspects of health at: https://www.krungthai-axa.co.th/th/health-advisories.

References

·       Siriraj Piyamaharajkarun Hospital
https://www.siphhospital.com/th/news/article/share/diabetes-mellitus

·       King Chulalongkorn Memorial Hospital, the Thai Red Cross Society
https://bit.ly/3ymVZgr

·       Faculty of Medicine, Siriraj Hospital, Mahidol University
https://bit.ly/3OGAsVp

·       Phyathai Hospital
https://bit.ly/3Oqlza4

·       Paolo Hospital
https://bit.ly/3QUnlC6
https://bit.ly/3HSxHxW

·       Pitsanuvej Hospital
https://bit.ly/3y0kazM