Management Of Microvascular Complications For Diabetes

Diabetes mellitus is one of the leading causes of disability and death worldwide. It is a disorder in which there is hyperglycemia (increased blood sugar level in the body) due to a deficiency of insulin (a substance that helps control sugar levels). Primary complications due to long-standing diabetes include damage to small blood vessels (arteries) called microvascular damage. Reduced blood supply due to damaged small blood vessels leads to microvascular complications of Diabetes mellitus such as retinopathy (eye damage), nephropathy (kidney damage), and neuropathy (hands and legs affected). Treatment is aimed at controlling blood sugar levels and preventing high blood pressure. Also know about yoga for diabetes

1. Retinopathy

Retinopathy is the partial or complete loss of vision in one or both eyes due to the accumulation of excess sugar around the eyeball cells and small blood vessels of the eyes. Persons with diabetes may experience gradual weakening of eyesight, blurred vision, inability to adjust to bright lights, and eventual loss of vision in uncontrolled blood sugar levels. On an eye examination, a doctor may find that reflex activity of the eye(eye blinking and ability to adjust to bright and dim lights) is reduced or lost. Read more about the diabetic retinopathy treatment.

2. Nephropathy

Diabetic Nephropathy denotes damage to the kidneys, which causes blood hypertension in many individuals. There is an accumulation of waste products in the body, causing lethargy. Legs may be swollen in some cases due to increased levels of body fluids. A 24-hour urine output analysis and urine examination are done for the amount of sugar present. Also read about sugar level in urine

3. Neuropathy

Neuropathy occurs in the nerves of the hands and legs due to high sugar levels. Patients may experience pins and needles sensation in their limbs at rest along with pain. There is progressive muscle weakness leading to difficulty in daily activities, loss of balance, and disability. A sensation exam and muscle strength testing by your doctor will help diagnose. Also know about sugar in urine test.

4. Others

Microvascular complications of diabetes mellitus are not limited to the conditions mentioned above. It can cause disorders in other organs as well. These include -

• Dementia (progressive loss of memory)
• Brain atrophy( the brain tissue starts shrinking)
• Muscle atrophy (muscles shrink and lose strength) and weakness
• Loss of balance
• Sexual dysfunction (loss of interest and difficulty with intercourse)
• Gastroparesis (food is not digested properly in the stomach)
• Constipation and/or diarrhoea.

Management of Microvascular Complications

1. Prevention

It is highly recommended to screen individuals with diabetes for microvascular complications when diabetes is diagnosed and then every six months. Aggressive control of blood sugar levels and prevention of hypertension are the primary goals in the initial phase of treatment. Counselling and education are necessary to prepare the patient for any such complications occurring in the future.

2. Medications

The primary aim of medicine is to control blood sugar levels and prevent hypertension. Diabetologists prescribe antidiabetic and antihypertensive drugs. Treatment for microvascular complications of Diabetes is done as per requirement.

3. Lifestyle Changes

Proper counselling and information regarding diabetes can help one lead a good healthy life. Appropriate lifestyle changes like including a healthy diet and some form of regular exercise are recommended. Precautions like taking care of feet and regularly observing them for injuries, cuts, and bruises help prevent major complications like limb amputation. Soft and comfortable shoes should be worn to protect the feet.

4. Diet

A diet rich in proteins, minerals, and fibre is highly advisable to maintain good muscle fitness and intestinal health. Maintaining good hydration and restricting foods rich in saturated fat like fried foods are recommended. Smoking should be stopped altogether. Alcohol and foods with high salt content must be restricted. Reducing salt intake will reduce blood pressure by helping the kidneys regulate the number of fluids excreting out.

5. Exercise

Exercises in the form of yoga, walking, running, swimming, bodyweight exercises, etc., are advisable for persons with diabetes. Supervised exercise sessions are a must in the initial period to avoid any episodes of cardiac disorders in long-standing diabetes. The American Heart Association recommends a target of 150 minutes of exercise per week with necessary precautions for individuals with diabetes.

Associated Risks

Poor compliance to medications and lifestyle modifications after the development of microvascular changes may lead to major kidney failure, heart disease/heart attack, inability to walk, frequent falls, limb amputation, or death. Hypertension may increase the risk of heart, kidney, and lung failure. But with a proper routine for medicine, nutritious food, exercise, and lifestyle modifications, one can lead a normal life.

Bottomline

Microvascular complications of diabetes play a significant role in causing disabilities in persons with diabetes. They occur due to damage to small blood vessels in the body, which causes a reduction of blood supply to the affected organs. These include retinopathy (eyes), nephropathy (kidney), and neuropathy (hands and legs), along with other changes like loss of balance, dementia (loss of memory), sexual dysfunction, and risk of heart disease. Also know about best medicine for diabetes in India.

Screening and examinations like an eye exam, urine analysis, and sensation and muscle strength testing at a regular interval of 6 months after diagnosis of diabetes help your doctor control these complications at an early stage. Medicines can control blood sugar levels and prevent hypertension. One can prevent and overcome these complications by exercising regularly like yoga, cycling, walking, swimming, nutritious food, optimal fluid intake, and taking necessary precautions. Supervised exercise sessions at 150 minutes per week or 30-minute sessions 3-5 times a week are advisable for all persons with diabetes, as per the American Heart Association.

Also read about What is ketoacidosis and diabetic ketoacidosis treatment.