Complications of Diabetes

Question 1

What are the two types of diabetes?

Answer 1

Acute and Chronic

Acute complications include; hypoglycaemic episodes, hyperglycaemic episodes, hyperosmolar
hyperglycaemic state (HHS) and Diabetic ketoacidosis (DKA).
They can occur at any time and can lead to chronic complications if not managed appropriately.

Chronic Complications can include retinopathy, neuropathy, nephropathy, problems with the feet,
heart attack and strokes, sexual problems (in both men and women).
The chronic complications are long term problems.

Question 2

What is Retinopathy?

Answer 2

This is a disease of the retina.

Diabetic retinopathy occurs as a result of prolonged high blood sugar levels and high blood
pressure which can cause damage to blood vessels.

The eyes have important blood vessels which
supply blood to the retina, if these blood vessels are damaged and the retina does not have an
adequate blood supply, it will result in vision problems.

Question 3

What are the different stages of diabetic retinopathy?

Answer 3

Stage 1 - background retinopathy
The eye sight is not yet affected but the patient needs to take action to prevent it getting worse.

Stage 2 - non-proliferative retinopathy
The damage to the eyes has progressed, the patient will be invited for eye screening more frequently to check for any further deterioaration/ changes.

Stage 3 - proliferative retinopathy
The damage has progressed and the patient is at high risk of sight loss, treatment will be offered.

Question 4

What is Diabetic maculopathy?

Answer 4

This affects the centre of the eye.
This will mean the patient will not be able to read or drive.

Question 5

What advise should be offered at each stage of Diabetic Maculopathy?

Answer 5

At stage 1 and stage 2 the patient should be advised on how to prevent further damage to the
eyes.

In patients with proliferative retinopathy or diabetic maculopathy treatment will be offered. This includes:
- laser treatment
- Intraocular injections
- vitreoretinal surgery (in advanced proliferative diabeticretinopathy)

Question 6

What are some ways of preventing damages to the eyes?

Answer 6

1. Diabetic patients (over the age of 12) should have screenings annually
2. Patients must be aware of changes to vision
3. Regularly checking blood sugar blood levels
4. Having blood pressure and cholesterol under control
5. Maintaining a healthy lifestyle

Question 7

What are some changes in vision that patients should notice and inform their doctors about?

Answer 7

1. Seeing floaters
2. Dimmer vision
3. Struggling to see in the dark

Question 8

Why must blood sugar levels, blood pressure and cholesterol be checked regularly in preventing eye damage?

Answer 8

Having hyperglycemia increases the risk of eye damage.

Having high blood pressure and high cholesterol increases the risk of vision problems because these can both cause damage or blockages to blood vessels - this can reduce blood supply to
the retina and causing vision problems.

A healthy lifestyle and diet will help get these under control.

Question 9

What is Neuropathy?

Answer 9

Damages to the nerves that control movement.

High blood sugar levels can cause damage to the blood vessels supplying blood to the nerves
throughout the body.
This can result in a lack of nutrients reaching the nerve fibers leading to damage.

Question 10

What is Sensory Neuropathy?

Answer 10

When the nerves that carry messages of temperature, pain etc from the skin, bones and muscles to the brain, are affected.

Usually this is in the feet and hands - nerves in those areas are affected.

Question 11

Symptoms of Sensory Neuropathy?

Answer 11

• Tingling/numbness in the feet
• Loss of ability to feel pain
• Loss of ability to feel changes in temperature
• Loss of coordination and burning or shooting pains which may be worse at night.

Question 12

What is autonomic neuropathy?

Answer 12

Damages to nerves that control internal organs.
These nerves can control some of bodily functions e.g. stomach emptying, heart beat and sexual organs.

Question 13

What could be the affects of autonomic neuropathy?

Answer 13

• Gastroparesis - where the nerves of the digestive system are affected and therefore food may not move through the GI tract effectively resulting in symptoms such as bloating, constipation or diarrhoea.
• Incontinence -nerves in bladder are affected so the patient looses their ability to control passing urine
• Irregular heart beats
• Impotence

Question 14

Explain the link between diabetes and heart attacks and strokes?

Answer 14

Patients with diabetes are at higher risk of cardiovascular disease.
This is likely to be as a result of high blood sugar levels for a prolonged period of time causing damage to blood vessels. This can result in heart attacks or stroke.

Question 15

What is Nephropathy?

Answer 15

Damage to the kidneys, as a result of having high blood sugar levels and high blood pressure.

This makes it difficult to clear extra fluid and waste from the body. Having excess fluid can then cause blood pressure to be raised.

Question 16

Explain the sexual problems that can occur in patients with Diabetes?

Answer 16

High sugar levels can lead to damaged blood vessels and nerves, which can result in a loss of sensation for women. High blood sugars can also result in vaginal thrust and urinary tract infections.

In men, lack of blood supply can result in difficulty getting aroused or maintaining an erection - erectile dysfunction.

These can all be controlled by controlling blood glucose levels.