Diabetes mellitus - consequential damage

the most important goal of any diabetes therapy is to achieve blood glucose levels that are as normal as possible and to avoid extreme blood glucose fluctuations (hypo- or hyperglycemia). Furthermore, the hba1c value ("blood glucose memory"), which gives information about the blood glucose values of the last 3 months, should be below 6.5%. During hypoglycemia mainly lead to damage of the brain cells, can high blood sugar levels a variety of secondary diseases trigger.

Macroangiopathy (diabetic)

Damage to the great vessels

This is understood to be circulatory disorder of the great vessels, equivalent to non-diabetic arteriosclerosis, but more severe, more frequent and occurring at an earlier age.

macroangiopathy favors the development of stroke, myocardial infarction and arterial occlusive disease (avk). Besides smoking and lack of exercise, diabetes mellitus – v.A. In combination with other risk factors (high blood pressure, disturbances of the fat metabolism) – involved in the development of diabetes mellitus.

Microangiopathy (diabetic)

Damage to the small vessels

Microangiopathy is understood to be a circulatory disturbance of the small blood vessels. Depending on where this disease occurs, a distinction is made between retinopathy (eyes) and nephropathy (kidneys).

Retinopathy

(diabetic) retinopathy is a disease of the eye chronic, triggered by diabetes mellitus circulatory disorder of the retina, which impairs vision and can possibly lead to blindness.

The blood vessels in the retina change as a result of the diabetic metabolic condition. The stability decreases and it loses its ability to seal the inside of the vessel against the surrounding tissue. At the same time, however, the wall thickness of the vessels increases, so that the inner diameter of the vessels becomes smaller. These changes mean that on the one hand there will be "bulges" in the racing lineup The result is a condition in which the blood vessels leak, allowing blood or blood components to escape, or the blood vessels become blocked. The consequence is a chronic circulatory disturbance of the retina.

In the further course pathological new blood vessels, proliferation from the retina into the vitreous body (interior of the eye). At this stage, vision is already severely compromised. From the vascular growths, hemorrhages (vitreous hemorrhages) occur, which can obstruct the visual axis and thus lead to a sudden deterioration of vision. At the same time, strands of tissue can form, which contract and look like "traction cables" detachment of the retina from its support, the choroid that nourishes it. This form is called proliferative diabetic vitreo-retinopathy. If its development is not halted, it will inevitably lead to the development of the disease blindness. After 10 – 15 years ca. 80% of diabetics have a circulatory disorder of the retina.

nephropathy

Nephropathy is a disease caused by diabetes mellitus alteration of the renal vessels, which leads to a deterioration of the renal function.

first sign is the precipitation of smallest protein with the urine. Microalbuminuria is defined as a protein excretion of between 20-200mg/l or 30-300mg in 24 hours, depending on the test kit used.

However, albumin excretion in the urine can also be influenced by other factors such as z.B. sports, poor metabolism or a urinary tract infection may be temporarily increased. Microalbuminuria is only diagnosed when 2 out of 3 urine samples are positive. This can be reversed by normalizing blood sugar and blood pressure and reducing the amount of protein in the diet. In case of macroalbuminuria (with values above 200mg/l or above 300mg/l in 24 hours) this is no longer possible.

If the described therapeutic measures are consistently carried out at the stage of microalbuminuria, deterioration can be prevented over a long period of time. If kidney function continues to decline, certain metabolic products can no longer be excreted by the kidneys to a sufficient extent. This is referred to as renal insufficiency, which in their terminal stage dialysis treatment makes it necessary.

Neuropathy (diabetic)

This refers to the entirety of various nerve disorders caused by diabetes. A distinction is made between the following forms.

Peripheral neuropathy

Peripheral neuropathy is a nerve-related disease disturbance of temperature and pain sensation at the extremities.

It usually occurs as sensory disturbance in both feet. The loss of sensation is accompanied by an absence of tendon reflexes. Often there is also a motor disturbance, which shows itself in a weakness and regression of the small foot muscles. this leads to changes in the foot with malpositions. Due to the unnoticed symptoms, the affected persons usually only come to the doctor when an injury is already present.

Unpleasant painful nerve disorder, It manifests itself mainly during the night with a feeling of furryness, tension, burning sensation on the soles of the feet or strong tingling. However, these patients are less likely to develop diabetic foot ulcers (gangrene).

If an autonomic nerve disorder is present at the same time, there may be an increased risk of drying out of the skin of the foot, severe corneal formation and cracks on the feet as a result of reduced sweating.

In addition, there are increased changes in the skin (parchment skin) and the nails (torn, brittle nails). Water retention in the tissue is more frequent, which in turn favors ulcer formation.

An important diagnostic examination is the tuning fork test. It gives information about the vibration sensation of the nerves on the feet.

A peripheral neuropathy is still considered incurable today. However, with better blood sugar adjustment and a healthy lifestyle the evtl. Relieve pain and prevent worsening of the disease.

The feet are particularly vulnerable to unnoticed injuries. Even minor injuries, sustained during foot care or due to pressure from shoes, can become infected and thus endanger the foot.

Autonomous neuropathy

In the case of autonomic neuropathy, there is a disturbance of the nerves present the internal organs care. All organ systems can be affected by the often unspecific symptoms, such as e.B. gastrointestinal tract (gastric emptying disorders, nausea), heart (reduction in heart rate variability), sexual organs (erectile dysfunction) and bladder (emptying disorders).