Complications of Diabetes Mellitus

Diabetes mellitus is a disease of metabolic disturbance, most notably abnormal glucose metabolism. Complications of diabetes mellitus can be acute or chronic, accompanied by characteristic late complications.

It is called acute (sudden in onset) when there is result from extreme fluctuations in blood glucose

Late Complications of Diabetes Mellitus: Chronic (long-term) complications occur over a long period of time and result from changes in the small (microvascular) and large (macrovascular) blood vessels of the body.

Micro-vascular complications as:

a. Diabetic Nephropathy: is clinically defined by persistent proteinuria greater than 500 mg/24 hours in a person with diabetic retinopathy without other renal disease. also known as Kimmelstiel-Wilson syndrome, or nodular diabetic glomerulosclerosis and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli.

It is characterized by nephrotic syndrome and diffuse glomerulosclerosis. It is due to longstanding diabetes mellitus, and is a prime indication for dialysis. The causes diabetic nephropathy is the kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able to do its job as well. Later it may stop working completely. This is called kidney/renal failure.

NEPHROPATHY IN TYPE 1 DIABETES:

Stage 1: Glomerular Hyperfiltration and Renal Enlargement. At onset of type 1 diabetes, approximately one third of individuals have an elevated GFR that is 20% to 40% higher than that of age-matched normal subjects.

Stage 2: Early Glomerular Lesions which has normal albumin level Those structural changes appear 18 to 36 months and may become prominent after 3.5 to 5 years after onset of type 1 diabetes mellitus.

Stage 3: Incipient Diabetic Nephropathy or Microalbuminuric Stage. The third stage, also called incipient diabetic nephropathy, is characterized by persistent and usually increasing microalbuminuria. Hypertension may also involved in this stage.

Stage 4: Clinical or Overt Diabetic Nephropathy: Proteinuria and Falling Glomerular Filtration Rate Albuminuria greater than 300 mg/24 hours, relentless decline of renal function, and hypertension define the fourth stage of diabetic nephropathy.

Stage 5: End-Stage Renal Disease After 20 to 30 years of type 1 diabetes, about 30% to 40% of patients progress to End-Stage Renal Disease (ESRD).

NEPHROPATHY IN TYPE 2 DIABETES

End-stage renal failure (ESRF) in diabetic patients, mostly type 2, has become the most frequent cause of renal replacement therapy in western Europe. Type 2 diabetes is characterized by insulin resistance, i.e., the failure to respond to normal concentrations of insulin, and this is accompanied by compensatory hyperinsulinemia, although the kinetics of insulin secretion are abnormal very early. In later stages, {beta} cell secretion fails to overcome insulin resistance. Increased lipolysis with fatty acid release and accumulation of fat in parenchymal organs further aggravate the metabolic disturbance.

b. Diabetic Neuropathy is neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum) in addition to macrovascular conditions that can culminate in diabetic neuropathy. Diabetic neuropathy is a heterogeneous disorder that encompasses a wide range of abnormalities affecting proximal and distal peripheral sensory and motor nerves as well as the autonomic nervous system. The major morbidity associated with somatic neuropathy is foot ulceration, the precursor of gangrene and limb loss.

c. Diabetic Retinopathy is (damage to the retina) caused by complications of diabetes mellitus, which can eventually lead to blindness. It is an ocular manifestation of systemic disease which affects up to 80% of all patients who have had diabetes for 10 years or more. Typically, diabetic ESRD patients have serious co-morbid conditions, especially heart, eye, and peripheral vascular diseases. It is not surprising, therefore, that caring for afflicted individuals imposes a major financial burden on family members and governments.

Macro-vascular complications as: Atherosclerosis with MI, CVA, peripheral vascular disease.