وصف
Diabetes can lead to various complications that affect different parts of the body due to prolonged high blood sugar levels. Diabetic complications can be broadly categorized into two types: macrovascular (affecting large blood vessels) and microvascular (affecting small blood vessels). These include conditions like heart disease, stroke, and peripheral artery disease, which increase the risk of cardiovascular events in people with diabetes. These complications affect small blood vessels and can lead to diabetic retinopathy (eye damage), nephropathy (kidney damage), and neuropathy (nerve damage). Nerve damage can cause tingling, numbness, pain, and loss of sensation, often starting in the feet and hands. High blood sugar can damage the blood vessels in the eyes, potentially leading to vision impairment and blindness. Prolonged high blood sugar can damage the kidneys and impair their ability to filter waste from the blood. Diabetes significantly increases the risk of heart disease and stroke, making heart health monitoring and management crucial. Poor circulation and nerve damage can lead to foot ulcers and infections, potentially requiring amputation in severe cases. While not a long-term complication, severe low blood sugar (hypoglycemia) can lead to unconsciousness and requires immediate treatment.
ملخص
- Diabetes complications are categorized as acute (diabetic ketoacidosis, hyperglycemic hyperosmolar state, hypoglycemia) and chronic (microvascular and macrovascular). Microvascular complications include nephropathy, retinopathy, and neuropathy, while macrovascular complications involve cardiovascular, cerebrovascular, and peripheral vascular diseases.
- Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies, but differ in several ways. DKA is associated with acidosis and ketonemia, while HHS typically has a pH above 7.3 and may have mild ketosis or none at all. DKA often affects younger patients due to its association with type 1 diabetes, while HHS is more common in elderly patients with type 2 diabetes and is often associated with profound dehydration.
- DKA and HHS can be precipitated by non-compliance with medication, inadequate insulin dosage, newly diagnosed diabetes, or acute infections and other stressors like myocardial infarction, CVA, or pancreatitis. Symptoms of DKA and HHS include decreased consciousness, confusion, increased urination, thirst, fatigue, and potentially nausea, vomiting, abdominal pain, and rapid breathing.
- Hypoglycemia, another acute complication, is typically caused by overmedication, insufficient food intake, or excessive physical activity. Symptoms include sweating, tremors, tachycardia, hunger, nervousness, lightheadedness, confusion, and blurred speech. Treatment involves administering oral glucose or IV dextrose, depending on the patient's level of consciousness.
- Chronic complications of diabetes include cardiovascular disease, a leading cause of diabetes-related deaths. Insulin resistance increases the risk of cardiovascular issues due to elevated triglycerides, reduced HDL cholesterol, endothelial dysfunction, and accelerated atherosclerosis. Management focuses on screening for cardiovascular disease and addressing modifiable risk factors, aiming for HbA1c levels below 7%, blood pressure below 130/80 mmHg, and cholesterol control.
- Diabetic nephropathy, a microvascular complication, is a leading cause of end-stage renal disease. It's associated with poor glycemic control, elevated blood pressure and lipids, leading to glomerular damage and proteinuria. Microalbuminuria is an early indicator of nephropathy. Management involves controlling blood sugar and blood pressure, considering medications carefully due to potential impacts on kidney function, and lifestyle modifications.
- Diabetic retinopathy, another microvascular complication, is a leading cause of blindness. Hyperglycemia causes damage to retinal blood vessels. Management involves tight glycemic control, blood pressure, and cholesterol control, with severe cases requiring ophthalmologist referral for laser photocoagulation or intravitreal injections.
- Diabetic neuropathy affects various types of nerves, with peripheral neuropathy being a common presentation involving numbness and tingling, often in a glove and stocking pattern. Autonomic neuropathy can affect cardiovascular, gastrointestinal, genitourinary, and pupillary function. Management includes glycemic control, symptom management with medications, and foot care.
- Foot care is crucial for diabetic patients due to sensory loss and increased risk of ulcers and infections. Regular foot inspections, proper footwear, and good hygiene are essential. Good glycemic control is the foundation for preventing all of these diverse complications.
نموذج شهادة
حول المتحدثين
الدكتورة راميا بيفور
طبيب استشاري، أخصائي أمراض السكري، عضو هيئة التدريس في CMC، فيلور
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