Complications in type 1 diabetes

It is not for nothing that they say that diabetes is not a diagnosis, it is a way of life. After all, if the disease has affected a person, then this is forever. So far, alas, they have not come up with other ways to live with type 1 diabetes, except for lifelong insulin therapy.

But, unfortunately, the problem is not limited to just filling the lack of the hormone insulin.

“Chronic hyperglycemia, that is, an increase in blood sugar levels, in diabetes is accompanied by damage, dysfunction and insufficiency of various organs, especially the eyes, kidneys, nerves, heart and blood vessels, and, accordingly, can cause complications in these organs,” says endocrinologist-nutritionist Ekaterina Glinenko.

Types of complications in type 1 diabetes

The main complications that occur against the background of diabetes are divided into two large groups: acute and chronic.

“Acute complications develop quickly and require immediate assistance to the patient,” explains Doctor Glinenko. – These include diabetic ketoacidosis, diabetic ketoacidotic coma, hypoglycemia.

Diabetic ketoacidosis develops when ketone bodies accumulate in the blood. Occurs against the background of insulin deficiency, and a corresponding increase in blood glucose levels.

“If you do not respond in time to carbohydrate metabolism disorders, then a diabetic ketoacidotic coma develops,” says our expert. – With ketoacidotic coma, the blood glucose level exceeds 15 mmol / l, acetone appears in the urine, symptoms such as weakness and drowsiness, severe thirst, frequent urination, abdominal pain, loss of appetite, nausea, and sometimes vomiting, the smell of acetone from mouth.

Another acute complication occurs, on the contrary, due to a decrease in blood sugar levels below normal.

– Hypoglycemia is usually diagnosed when blood glucose levels are below 3,3 mmol / l, – says Ekaterina Glinenko. – This is due to an overdose of short-acting insulin, untimely eating after insulin or increased physical activity, and also after drinking strong alcohol.

The list of chronic complications in type 1 diabetes is much wider. These are just those organ damage or disturbances in their work that occur against the background of diabetes.

These include:

1. Diabetic retinopathy is damage to the retina of the eye (microaneurysms, hemorrhages, edema, formation of new blood vessels). May lead to retinal detachment.
2. Early development of cataracts (clouding of the lens).
3. Diabetic micro- and macroangiopathy – affects the vessels: permeability is disturbed, fragility increases. It threatens with the early development of atherosclerosis, the likelihood of thrombosis increases.
4. Diabetic neuropathy is a disorder of the nervous system that affects all nerve fibers: sensory, motor and autonomic.
5. Diabetic nephropathy is kidney damage that leads to the development of chronic renal failure.
6. Diabetic arthropathy, the symptoms of which are pain in the joints, “crunching”, limitation of their mobility.
7. Diabetic encephalopathy, in which mental and mood changes occur, patients have emotional lability or depression.
8. Diabetic foot – the so-called purulent-necrotic processes, ulcers and osteoarticular lesions of the foot. According to our expert, it is the main cause of amputations in diabetic patients.

Diagnostics

“To prevent complications, screening, that is, annual examinations of all patients with type 1 diabetes, is of fundamental importance,” emphasizes Doctor Glinenko. “This is what makes it possible to timely identify people at risk of developing severe complications and take action. Such physical examinations should begin 5 years after the diagnosis of type 1 diabetes and be repeated annually. In particular, patients with type 1 diabetes need to undergo such specialists as an ophthalmologist and neurologist once a year, as well as a cardiologist, a podiatrist (this is a specialist who treats diabetic foot), and a nephrologist – according to indications.

Modern diagnostic methods

The annual mandatory ophthalmological examination includes, in addition to questioning and measuring visual acuity – ophthalmoscopy – to detect exudates (fluid released from small blood vessels during inflammation), petechial hemorrhages, microaneurysms and proliferation (growth) of new vessels.

As far as the diagnosis of diabetic nephropathy is concerned, the usual methods of testing protein in the urine will not help.

– All patients with diabetes are recommended to take a blood test for creatinine with the calculation of the glomerular filtration rate and a urine test to detect microalbuminuria (albumin excretion in the urine), – says Ekaterina Glinenko.

To exclude polyneuropathy, according to the specialist, it is recommended to conduct electroneuromyography – using this method, specialists evaluate the functional state of skeletal muscles and peripheral nerve endings. Such an examination allows you to determine the focus, the degree of prevalence, the severity and nature of the damage to muscle tissue and nerve fibers.

And in order to determine the risk of formation of trophic foot ulcers and amputation, patients are examined using a monofilament (this is such a special nylon thread).

Treatment of complications in type 1 diabetes

“Since the cause of the development of complications is a constantly elevated blood glucose level, the basis for successful treatment of complications of diabetes is the achievement and maintenance of individual targets for glycemic control,” notes endocrinologist Glinenko. – The actual treatment of complications of type 1 diabetes mellitus should be carried out in conjunction with narrow specialists. And in this regard, it is important to take into account the stage of the disease.

Let’s take a closer look. For example, in retinopathy and other eye lesions, according to our expert, laser coagulation of the retina, intravitreal injections of angiogenesis inhibitors (literally – an injection into the eye), as well as surgical methods (in particular, vitrectomy – removal of part of the eye) are currently used.

Treatment of diabetic nephropathy is carried out in conjunction with a nephrologist.

– To begin with, the patient is advised to limit the intake of protein and salt, depending on the stage of chronic kidney disease. Next, drugs are selected to correct arterial hypertension to achieve the target blood pressure in the presence of pathology,” says our expert. – It is also necessary to remember about the correction of hyperkalemia and dyslipidemia, the treatment of anemia – here drugs are used that stimulate the formation of red blood cells, iron preparations. It is important to avoid the use of nephrotoxic drugs (aminoglycosides, non-steroidal anti-inflammatory drugs), and radiopaque procedures should be carried out with caution, comparing the benefits and risks of complications.

And in the most severe cases, patients are waiting for hemodialysis (the procedure for cleansing the blood using an “artificial kidney”), peritoneal dialysis (cleansing the body through an incision in the abdominal cavity), or even kidney transplantation or combined kidney and pancreas transplantation.

Treatment of diabetic neuropathy is carried out in conjunction with a neurologist. To reduce the pain syndrome, drugs are used that the specialist will select according to individual indications, most often these are anticonvulsants.

— Also, diabetes mellitus is one of the main factors affecting the early development and rapid progression of arterial atherosclerosis. Accordingly, type 1 diabetes can lead to the early development or worsening of such diseases as coronary heart disease, vascular dementia (and other cerebrovascular diseases), and various diseases of the arteries of the lower extremities, says Dr. Glinenko. – The treatment of these diseases is carried out by a cardiologist and a neurologist, together with an endocrinologist.

Prevention of complications in type 1 diabetes at home

As we have already understood, with type 1 diabetes, the importance of passing a medical examination increases significantly. Still, this is not an ordinary preventive bypass of doctors. But this is not the main thing.

“The main task in patients with type 1 diabetes is to change lifestyle and control risk factors,” says Ekaterina Glinenko. – Patients need to monitor body weight, stop smoking, eat a balanced diet, exercise regularly and avoid stress. In addition, you need to constantly monitor blood pressure, cholesterol, glycemia and glycated hemoglobin. If there are complaints about vision, contact an ophthalmologist immediately. You also need special foot care, including the right shoes. With deformities of the feet or those who have undergone amputation, adequate orthopedic care is needed.

Popular questions and answers