June 5, 2024
Diabetes is a metabolic disease characterized by excess sugar in the blood. Commonly this disease is commonly characterized by complications involving the nerves, kidney and retina. It also increases the risk of heart attack, stroke and foot ulcers. However, diabetes can practically involve any organ; the individual susceptibility to various complications varies from person to person. It is not very uncommon to have unusual complications in people with diabetes; a few of them are discussed below.
- Silent Heart Attack - Patients with diabetes have a higher risk of heart disease than the general population. Patients with diabetes tend to have all 3 major blood vessels involved compared to single blood vessel involvement in others. To add to the problem, patients with diabetes experience silent heart attacks. Unlike normal people who experience severe chest pain, these patients do not experience pain. They may just experience difficulty in walking or breathlessness while carrying out activities of daily living.
- Infections - Poorly controlled diabetes reduces the immunity of the patient. Hence, there are some infections which are only seen in patients with uncontrolled diabetes; these are described as follows:
- Rhinocerebral Mucormycosis - This is an aggressive fungal infection which infects the nose and eye region of the face. It is promoted by high sugars- especially diabetic ketoacidosis.
- Malignant Otitis Externa - 90 % of these patients have diabetes. Majority of the patients have infection due to an aggressive bacteria called Pseudomonas aeruginosa. These patients need tight sugar control, needs surgery along with IV antibiotics.
- Emphysematous Pyelonephritis - Here the patient has accumulation of air in the kidney due to severe urinary tract infection.
- Charcot's foot - Patients with poorly controlled diabetes have autonomic system changes followed by increase in blood supply to the foot - causing foot deformities (changes in foot shape). Management depends on the type and severity, usually requiring modified footwear.
- Autonomic dysfunction - Both high and low sugars can cause autonomic dysfunction, patients can have sudden fall in blood pressure while standing up. Some of the patients may not experience symptoms of low sugars which happens in normal individuals - leading to sudden loss of consciousness.
- Gastroparesis - Subjects who have diabetes for a long time tend to have to retain food in the stomach for a longer duration compared to normal individuals. This causes loss of appetite and nausea. Also, due to mismatch between the time of action of the medicines and food intake - patients frequently experience hypoglycemia (low sugars).
- Seizures - Very High blood sugars can lead to seizures. Improvement in the sugars improves the disease outcomes.
- Thinning of skin and purple stretch marks - Sometimes diabetes is secondary to excess steroid production from our body; this condition is called Cushing's Syndrome. If picked up in the right time, this diabetes can be reversed.
- Change in footwear size and change in facial features - Diabetes can be sometimes secondary to excess of growth hormone- a condition known as Acromegaly. Patients usually present with change in facial features and increase in footwear size.
- Unexplained weight loss - Subjects with poor glycemic control, especially if HbA1C is > 9 % experience weight loss. This is mainly because the excess sugar in the blood is lost in the urine. Good sugar control can reverse the condition.
- Reactivation of infections - Poorly controlled sugars can re-activate tuberculosis, due to poor immunity; which sometimes could be drug resistant.
Hence diabetes being a common disorder, which is often neglected, needs to be seen through a magnifying glass- to avoid these kinds of complications.