Early and late complications of diabetes. Complications of diabetes

There are two groups of complications in diabetes: acute and chronic. Acute complications of diabetes develop within hours or days; chronic complications develop over several months, but more often over years or even decades. That's why chronic complications DM is also called “late”.

Acute complications of diabetes mellitus.

Acute complications of diabetes include ketoacidotic, hyperosmolar (hyperglycemic) and lactic acidotic coma. Hypoglycemic coma, which can complicate glucose-lowering therapy for diabetes, is considered separately. Laboratory signs of diabetic comas are given in table. 6.

Ketoacidotic coma ranks first in prevalence among acute complications endocrine diseases and typical for T1DM. The mortality rate for this coma reaches 6-10%, and in children with T1DM this is the highest common reason of death. A rapidly progressing insulin deficiency leads to the development of coma.

Predisposing factors are:

prescribing too small doses of insulin during treatment;

violation of the insulin therapy regimen (skipped injections, expired insulin);

a sharp increase in the need for insulin, which occurs during infectious diseases, injuries and operations, stress, concomitant endocrine disorders with overproduction of counter-insular hormones (thyrotoxicosis, acromegaly, pheochromocytoma, Cushing's disease), pregnancy;

Mechanisms of damage in ketoacidotic coma associated with intoxication with ketone bodies, metabolic acidosis, hypovolemia, hypoxia and cell dehydration.

Ketone bodies, especially acetone, actively interact with the lipid components of cell membranes and also inhibit the normal functioning of many intracellular enzymes. The phospholipid-rich structures of the central nervous system are particularly affected.

IN severe cases hypovolemia leads to a decrease in renal blood flow, which is accompanied by a weakening of glomerular filtration and a decrease in diuresis (oliguria). This entails an increase in azotemia and worsening acidosis due to a weakening of the kidneys' excretion of nitrogenous wastes and secreted H + ions. Azotemia and acidosis cause disturbances in all organ systems, with the greatest threat to life associated with suppression of the functions of the central nervous system that regulate blood circulation and respiration.

Symptoms of ketoacidosis are loss of appetite, nausea, vomiting, abdominal pain, then deterioration of vision, darkness and loss of consciousness, depression of reflexes, drop in blood pressure, the appearance of Kussmaul breathing (rare, deep, noisy), symptoms of dehydration (decreased tissue turgor, soft eyeballs), fruity (with a noticeable admixture of acetone) odor of exhaled air.

Laboratory signs of ketoacidotic coma are given in Table. 6. Noteworthy is hyperglycemia, but not maximum, an increase in ketone bodies and acidosis. Hyperlipidemia and hypercholesterolemia are also characteristic, which indicates active lipolysis.

Hyperosmolar (hyperglycemic) coma more common in older people with mild or moderate severity. In 30% of patients it turns out to be the first manifestation of T2DM, i.e. In almost 1/3 of patients with hyperosmolar coma, the diagnosis of diabetes is first made only at the time of coma development. This leads to the fact that the mortality rate in hyperosmolar coma reaches 30%, while in the “more expected” ketoacidotic coma in persons observed for T1DM, the mortality rate is no more than 10%, i.e. 3 times less.

Cause of hyperosmolar coma– a relative deficiency of insulin caused by insulin resistance, the amount of which in the body is sufficient to prevent the processes of enhanced lipolysis and ketogenesis, but not enough to counteract increasing hyperglycemia. Most often, coma occurs as a result of an increase in the need for insulin due to increased action of endogenous contrainsular hormones in conditions of the developing “acute phase response” (infectious diseases, mechanical injuries and operations, burns and frostbite, acute pancreatitis, myocardial infarction, etc.) or with concomitant endocrine disorders(thyrotoxicosis, acromegaly, pheochromocytoma, Cushing's disease).

Cases have been described of the development of hyperosmolar coma when it is impossible to quench thirst in lonely bedridden elderly patients, as well as when using concentrated glucose solutions (prescribed for parenteral nutrition) in people with initially unrecognized diabetes.

Mechanisms of damage in hyperosmolar coma associated with dehydration of all tissues caused by hyperosmolality of blood plasma (>350 mOsmol/kg) against the background of pronounced hyperglycemia (> 40 mmol/l) and a decrease in blood volume.

Dehydration of brain structures with sharp drop intracranial pressure leads to general depression of the central nervous system, manifested in the form of neurological disorders, an increasing disorder of consciousness, turning into its loss, i.e. in a coma. Hemocoagulation disorders associated with hypovolemia can provoke the development of disseminated intravascular coagulation syndrome, arterial (myocardial infarction, stroke) and venous (especially often in the inferior vena cava basin) thrombosis.

Symptoms of hyperosmolar coma. Over the course of several days or weeks, symptoms such as thirst, polyuria, polydipsia, weight loss and weakness increase. The mechanism of these symptoms is the same as in ketoacidotic coma and is associated with hyperglycemia, osmotic diuresis, increasing dehydration and loss of electrolytes. However, dehydration in hyperosmolar coma reaches a much greater degree, and therefore cardiovascular disorders caused by hypovolemia in these patients are more pronounced. Characteristic laboratory signs: very high plasma glucose concentration and osmolality, no ketoacidosis, normal pH.

Lactic acidemic coma.

IN pure form Lactic acidemic coma in diabetes is much less common than ketoacidosis and hyperosmolar coma. The accumulation of lactate in an amount exceeding the body’s ability to utilize it in the liver and kidneys (more than 3400 mmol/day) leads to lactic acidosis, in which the lactic acid content increases to 2 mmol/l or more.

Predisposing factors for lactic acidemic coma:

any conditions accompanied by severe tissue hypoxia - shock, blood loss, severe cardiac and pulmonary failure. In this case, glycolysis is compensatory activated, leading to the accumulation of lactic acid;

severe damage to the liver and kidneys, i.e. organs in which lactic acid is metabolized;

any conditions causing acidosis with pH values<7,2 (при рН<7,2 подавляется распад лактата в печени и почках).

The most insidious thing about diabetes is its complications. And what’s even more dangerous is that the development of these complications is often asymptomatic. As a result, while a person does not even think about problems in the body for years, elevated sugar levels disrupt the functioning of many internal systems and organs.

What are the most common complications of diabetes, and how to avoid them?

Eye damage due to diabetes, treatment of diabetic retinopathy

The most common cause of blindness in diabetes is retinopathy. It comes in two types:

Retinopathy 1st degree. Damage to the vessels of the retina of the eye - deterioration of blood circulation in the vessels, the formation of aneurysms on their walls, and the development of retinal edema. Vision does not suffer much, except in situations in which the swelling touches the central part of the retina.
Retinopathy of the 2nd degree. Proliferation of new blood vessels to compensate for poor circulation. New vessels are weak and thin, as a result of which they often rupture and hemorrhage. This, unfortunately, often becomes the cause of retinal detachment and complete loss of vision.

With timely initiation of treatment, the risk of developing blindness can be reduced by ninety percent, so any symptoms associated with visual impairment should be a reason to visit a specialist.

Diabetic retinopathy. Treatment

The safest and most effective way to avoid the progression of this disease is laser photocoagulation . By strengthening the fundus capillaries with the help of a beam, the formation of new weak vessels is eliminated. The result always depends on the timeliness of the procedure.

Prevention of diabetic retinopathy

Prevention of eye diseases in diabetes includes:

Control of blood sugar levels (no more than 8 mmol/l).
Pressure control (no more than 130/80).
Regular examination by an ophthalmologist.
To give up smoking.

Prevention and treatment of diabetic nephropathy - how to avoid kidney damage in diabetes?

The complications that arise from the kidneys are very dangerous. Because the symptoms of complications are not visible for a long time - no discomfort or pain - until the consequences become irreversible.

Signs of diabetic nephropathy at its various stages:

Microalbuminuria : absence of discomfort and any symptoms.
Proteinuria: swelling under the eyes and, development of hypertension and anemia.
Kidney failure: signs of intoxication (vomiting and nausea, itching of the skin).

Simply put, the kidneys are “silent” until the stage of the disease becomes very serious.

How to avoid diabetic nephropathy? Prevention

Is it possible to avoid such serious consequences? Can. Nephropathy in diabetes is predictable. Therefore, measures should be taken in advance.

Diabetes mellitus and the heart: coronary disease in diabetes

With diabetes, the risk of developing coronary disease increases almost fivefold. This complication depends on the duration rather than on the severity of diabetes, and often occurs without symptoms. Considering that diabetes itself combines several risk factors for the heart, measures should be taken promptly and actively.

Prevention of coronary disease in diabetes includes:

As for treatment, its basis is maintaining glucose levels within normal limits, reducing blood pressure to the accepted norm, insulin or hypoglycemic drugs, antihypertensive and anticoagulant therapy, etc.

Vascular damage in diabetes mellitus - prevention and treatment of diabetic angiopathy

The longer the duration of diabetes, the (proven fact) the higher the risk of vascular damage.

Risk factors for the development of angiopathy become:

High pressure.
Lack of strict diet and physical activity.
Smoking.

Most often, atherosclerosis develops with diabetes due to the accumulation of cholesterol in the walls of blood vessels. Cholesterol plaques, in turn, block the path of oxygen to the heart muscle. And when a cholesterol plaque ruptures, a blood clot forms, which can later cause a stroke and gangrene.

Symptoms of vascular damage in diabetes:

Diabetic angiopathy can progress in different ways: in some it lasts for many years, in others it occurs extremely quickly. It all depends on the nature of the course of diabetes.

Treatment of diabetic angiopathy

If blood vessels are damaged due to diabetes, treatment involves monitoring blood pressure and blood sugar levels, dieting, drug therapy (insulin, etc.), lowering cholesterol levels , drugs that prevent the formation of blood clots, surgical treatment of ulcers if available.

Prevention of vascular damage in diabetes

Transition to an appropriate lifestyle (cessation of smoking, exercise, diet, etc.).
Careful examination of the feet for the formation of ulcers, the use of special products for excessive dry skin, and prevention of skin injury.
Monitoring glucose and blood pressure levels.
A strict diet - avoiding fatty foods, reducing salty foods, maintaining a normal weight.
Prevention of blood clots (aspirin).
Walk daily for at least 50 minutes and wear comfortable shoes.

Diabetic foot, diabetic neuropathy – how to save the feet of diabetics?

One of the most dangerous consequences of diabetes is diabetic foot. The disease develops when there is insufficient treatment and control of blood glucose. This term refers to a complex of pathological changes in the base of the foot, which can lead to gangrene and, as a consequence, complete loss of the limb.
Type of diabetic foot depends on the degree of damage to the vessels/nerves of the extremities:

Neuropathic: deformation of the foot bones, flat feet, loss of sensitivity, dry/flaky skin, decreased sweating.
Ischemic: foot swelling, lameness and pain in the legs, blisters, skin pigmentation.

Diabetic foot - risk factors

This disease can become a complication of diabetes in every patient, but the greatest risk develops with the following factors:

Treatment of diabetic foot depends on the severity of the disease and the capabilities of a particular clinic. It includes drug therapy in combination with diet, unloading of the limbs (orthopedic shoes, more rest - less stress), surgical treatment according to indications, treatment of ulcers.

Prevention of diabetic foot

Measures to prevent this consequence of diabetes include a set of rules for foot care:

Wearing only comfortable shoes that does not interfere with free blood circulation.
No irregularities or seams and other parts on the inner surface of the shoe (insole).
Careful nail care (Cutting is not encouraged - it is better to file your nails without grinding down their corners).
Protecting your feet from injury – refusal of sports that can injure the feet, walking only in shoes, moisturizing the feet with cream, etc.

It should be remembered that even minor, unnoticeable injury to the soft tissues of the feet can contribute to the development of ulcers. That's why For any redness or ulcers, you should contact a specialist.

Diabetes mellitus is one of the diseases that is life-threatening with the rapid development of complications. The disease has a huge list of possible consequences affecting various organs and systems of the body.

After confirming the diagnosis, the patient is obliged to develop new eating and behavioral habits and direct all efforts to preventing complications.

Causes of complications of diabetes mellitus

Complications of diabetes mellitus types 1 - 2 develop due to a lack of insulin or a violation of its interaction with the cells of the body. Thus, in type 1 diabetes, a lack of insulin occurs because specialized cells that produce this hormone are recognized by the immune system as foreign - it produces antibodies against them, causing death.

This type of diabetes is an autoimmune disease. Type 1 diabetes has a genetic predisposition. Infections, stress, etc. can trigger the mechanism.

In type 2 diabetes mellitus, insulin can be produced in the required quantity, but the body's cells become insensitive to it. This phenomenon is often observed in obesity, since adipose tissue does not respond to insulin.

The pancreas has to work harder, producing more and more insulin. At some point, its compensatory mechanisms are exhausted, and insulin production decreases.

The function of insulin is to deliver glucose to the body's cells for use as energy material. Glucose not used by cells circulates in the blood and is excreted in the urine. Cells begin to suffer from a lack of energy, metabolic processes are disrupted.

Complications of type 1 diabetes

Complications are acute and develop very quickly. In most cases, a diabetic needs the help of a doctor.

1. Ketoacidosis– when insulin levels drop, ketone bodies are found in the blood and glucose in excess. If insulin deficiency is not corrected in time, ketoacidotic coma may develop within a short time.

2. Hyperosmolar coma. The reason for its development is an increase in blood sugar. Cells lose water, dehydration occurs, and if left untreated, death can occur.

3. Hypoglycemic coma. Occurs in case of erroneous administration of insulin in doses significantly higher than those selected by the doctor. The brain is difficult to tolerate glucose deficiency, so when the level drops sharply, normal brain function is disrupted.

This causes clouding or complete loss of consciousness, and subsequently coma.

Complications of diabetes mellitus in children are dangerous due to their high mortality and manifest themselves in the form of ketoacidotic and hypoglycemic coma.

Late forms are similar to those of type 2 of the disease - they have a slow but progressive course.

Complications of type 2 diabetes

Risk of developing diabetic foot syndrome

With type 2 diabetes, the disease can go unnoticed for many years. Often the disease is detected completely unexpectedly, during tests for another reason or only at the time complications are detected.

Hyperosmolar coma.
Hypoglycemic coma occurs somewhat less frequently
Eye damage. In this case, the lens and retina of the eye suffer. This is manifested by the development of cataracts, hemorrhages and retinal detachment, which leads to decreased vision or its complete loss.
Kidney damage is a gradual loss of its functions. Protein reabsorption is impaired and it appears in the urine. Over the years, scar tissue grows in the kidneys, which displaces the kidney tissue.
Vascular complications are pathological changes in the walls of large and small vessels. It manifests itself as increased fragility, hemorrhages, thrombosis and the development of atherosclerosis. Heart attacks and strokes are the leading cause of death in diabetics.
Neuropathy is changes in nerve tissue. It manifests itself as a violation of sensitivity, pain along the nerve fibers.
From the side of the brain, diabetic encephalopathy is detected. Manifests itself in the form of depression, inability to adequately respond to events, etc.

Late complications of diabetes

Late complications mean those clinical manifestations that develop several years after the onset of the disease. Such complications, unfortunately, sooner or later appear in almost all patients, regardless of what type of diabetes they have.

With type 2 diabetes, most people find out about their illness only after these complications develop.

1. Angiopathy. Changes in blood vessels lead to heart attacks, increased blood pressure, strokes and thrombosis.

2. Retinopathy. Poor blood circulation in the retina can lead to retinal detachment and complete blindness.

3. Nephropathy. It causes hypertension and chronic renal failure.

4. Polyneuropathy. Inflammatory and degenerative changes in nerve fibers. Involves loss of sensitivity and the appearance of pain of an unspecified nature.

5. Formation of diabetic foot syndrome. Due to the fact that in diabetes, the nerve fibers and small vessels of the extremities are damaged, the feet lose sensitivity, and blood circulation is impaired. A diabetic may not feel damage, temperature changes, wear shoes that are too tight for him, etc.

As a result, damage is formed that does not heal for a long time. Due to metabolic disorders and poor blood circulation, wounds cannot quickly regenerate, and the increased “sweetness” of the blood is the best food for microorganisms.

The addition of infection further inhibits healing. Tissues can die completely. The process reaches the point where the toes or the entire limb have to be amputated.

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Recommendations for choice, prevention of the syndrome

Prevention of diabetes complications

Diabetics should regularly visit an endocrinologist and undergo tests to monitor the condition of their target organs.

Blood glucose levels – daily.
Oculist - every six months.
Urinalysis - at least 4 times a year.
ECG - for heart pain in the heart.
Blood pressure - it is advisable to have a tonometer in your home medicine cabinet and measure your blood pressure every day. Especially if there were cases of its increase.
If there is a sensitivity disorder in the lower extremities, then every 3 months it is necessary to be examined for the presence and severity of neuropathy.

Most endocrinologists are confident that diabetes is a special way of life. Prevention of complications lies in a special diet, regular use of insulin or medications, and daily monitoring of glucose levels.

Only strict adherence to these rules will help avoid the development of complications. In diabetes caused by obesity, it is enough to lose weight and the sugar level returns to normal.

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There are more than 100 thousand people in the world who suffer from diabetes, and about the same number are in the stage of prediabetes. This disease is considered one of the most dangerous endocrine diseases, as sooner or later it leads to a number of serious complications. Complications of diabetes develop due to an increase in the amount of glucose in the blood.

Pathological changes can be observed in the eyes, blood vessels, nervous system, kidneys, skin, blood, etc. All complications of diabetes can be divided into chronic and acute. Each species has its own characteristics and reasons for development.

Acute complications of diabetes

Acute complications of diabetes are considered the most dangerous, as they can lead to a rapid deterioration of the patient’s condition, and death is not excluded. Most acute complications are observed only in type 1 diabetes. The most common acute conditions caused by diabetes mellitus include:

Acute complications of diabetes can occur in both children and adults, but they are much more common in older people. When a pathological condition develops, there are always characteristic symptoms that make it possible to determine the onset of the acute phase even before the onset of the critical stage.

If symptoms of one or another complication appear, you must immediately contact a medical facility to receive qualified assistance.

Self-treatment may worsen the situation. The thing is that almost always, with a timely visit to the doctor, it is possible to stop an acute complication before it gains full strength.

Chronic complications of diabetes

Diabetes mellitus is a systemic disease that gradually undermines all body systems, including the circulatory and nervous systems. After a certain time, most patients begin to experience, to one degree or another, a vascular complication of diabetes mellitus, which is classified as chronic. Such lesions take a long time to develop. These late complications of diabetes include:

Measures to prevent complications of diabetes mellitus

It should be noted that only people who carefully follow their regimen have a chance to avoid serious complications. Most people with diabetes do not take their disease seriously, violate their diet, do not always monitor their blood glucose levels, and do not follow all doctor’s instructions regarding treatment. The chance of them developing chronic complications of diabetes mellitus of varying degrees of complexity is close to 100%.

The main reason for the development of complications of diabetes mellitus is vascular damage due to prolonged decompensation of diabetes mellitus (prolonged hyperglycemia - high blood sugar). First of all, microcirculation suffers, that is, the blood supply to the smallest vessels is disrupted.

Signs of diabetes complications

Eye damage caused by diabetes is called diabetic retinopathy. This complication of diabetes mellitus is associated with impaired blood circulation in the vessels of the fundus, namely in the retina. In diabetic retinopathy, retinal vessels become more fragile and permeable, which can lead to hemorrhages. Diabetic retinopathy develops gradually and even quite pronounced stages may be imperceptible to the patient. With extensive retinal hemorrhage or detachment, a significant decrease in visual acuity can occur, up to complete blindness. The presence and severity of diabetic retinopathy can only be determined by an ophthalmologist (ophthalmologist) when examining the fundus of the eye with a dilated pupil (to dilate the pupil, special drops are instilled into the eyes, after which vision temporarily becomes blurry and unclear). A patient with diabetes mellitus must be examined by an ophthalmologist at least once a year! If there are proven eye complications of diabetes mellitus, an ophthalmologist examination is carried out more often (depending on the stage of diabetic retinopathy).

Kidney damage caused by diabetes is called diabetic nephropathy. The renal glomeruli (which make up the kidney tissue) act as a filter. Unnecessary substances are filtered from the blood and excreted in the urine, while necessary substances are retained. When small vessels of the renal glomeruli are damaged in diabetes mellitus, the filter becomes more permeable. Protein, which is a necessary substance, enters the urine and normally does not penetrate through the kidney filter. It is impossible to feel the initial manifestations of diabetic nephropathy, so it is necessary to take a 24-hour urine test for protein and a biochemical blood test (in particular, creatinine, urea) at least once a year (and with the development of diabetic nephropathy - more often, depending on the stage).

Nerve damage caused by diabetes is called diabetic neuropathy and is one of the main complications of diabetes. First of all, with diabetes, the legs suffer, since they have the longest nerve fibers in the entire human body. Diabetic neuropathy manifests itself as pain in the legs, a burning sensation, “crawling sensations,” tingling, and numbness. Also, diabetic distal neuropathy is characterized by a decrease in the sensitivity of the legs: the ability to perceive the effects of high and low temperatures, pain (for example, a prick with a sharp object), vibration, etc. is lost. This complication of diabetes mellitus poses a great danger because it increases the risk and makes minor injuries invisible, for example, when foreign objects get into shoes, wearing incorrectly selected shoes, when treating nails, calluses. Decreased sensitivity, combined with foot deformities common in diabetes and overweight, leads to improper distribution of pressure when walking. This leads to traumatization of the tissues of the foot, up to the formation of ulcers in areas of greatest stress. Areas of trauma can become inflamed and infection develops. The inflammatory process in conditions of reduced sensitivity occurs without pain, which can lead to patients underestimating the danger. Self-healing does not occur if diabetes compensation is unsatisfactory, and in severe advanced cases the process can progress, leading to the development of purulent inflammation - phlegmon. In the worst case scenario and in the absence of treatment of the limbs, tissue necrosis - gangrene - can occur. Gangrene is perhaps one of the most dangerous complications of diabetes.

Damage to the heart and large blood vessels in patients with diabetes is associated with atherosclerosis of the arteries. According to the mechanism of development, this complication of diabetes mellitus does not differ from that in persons without diabetes mellitus. But in patients with diabetes, atherosclerosis occurs much more often than in others, and at a younger age.

Examples of manifestations of arterial atherosclerosis:

If you have coronary heart disease, you may experience chest pain, a feeling of heaviness or tightness in the chest when climbing stairs, walking, or other activity. Often chest pain radiates to the arm or jaw. Such phenomena are associated with a narrowing of the blood vessels of the heart.
The classic picture of the development of myocardial infarction: chest pain does not go away, shortness of breath and a feeling of nausea appear, and vomiting begins. The person suddenly breaks out in a cold sweat and experiences a strong feeling of fear. Patients with diabetes may not notice chest pain due to damage to the nervous system and loss of pain sensitivity, then the equivalent of pain is severe general weakness.
Arterial hypertension (increased blood pressure) is often a companion to diabetes mellitus. It is against the background of high blood pressure that such a formidable complication as a stroke (acute cerebrovascular accident) can develop, which is often fatal or leads to paralysis. Arterial hypertension also has a bad effect on the condition of the blood vessels of the kidneys and fundus.
Atherosclerotic changes can also develop in the vessels of the brain - cerebral vascular atherosclerosis. In severe cases, this can lead to stroke.
Problems with the blood vessels of the legs, pain in the calves or buttocks when walking are signs of atherosclerosis of the blood vessels of the legs. Sometimes discomfort occurs during long walking, sometimes after just a few steps. The pain goes away on its own if you stop for a while. With pronounced narrowing of the arteries in the leg area, pain can also occur at rest.

Prevention and treatment of complications of diabetes mellitus

The danger of complications of diabetes mellitus lies in their gradual, often unnoticeable development for the person with diabetes mellitus.

The most important component of the prevention and treatment of complications of diabetes mellitus is good compensation of diabetes mellitus, that is, maintaining the target blood sugar level (target blood sugar levels are determined individually by an endocrinologist). In addition to daily blood sugar measurement, it is necessary to monitor the level of glycated hemoglobin (an indicator reflecting the average blood glucose level over the last 3 months) once every 3 months.

For the purpose of early diagnosis and timely treatment of diabetic retinopathy, regular examinations by an ophthalmologist (ophthalmologist) are necessary with examination of the fundus of the eye with a dilated pupil (special drops are instilled into the eyes to dilate the pupil, after which vision temporarily becomes blurry and unclear). A patient with diabetes should be examined by an ophthalmologist at least once a year. If there are proven eye complications of diabetes mellitus, an ophthalmologist examination is carried out more often (depending on the stage of diabetic retinopathy). Laser coagulation of the retina is used to treat complicated diabetic retinopathy. Timely and correctly performed laser coagulation allows you to preserve vision even in the later stages of diabetic retinopathy.

In order to early diagnose diabetic nephropathy and prevent its further development, it is necessary to take a 24-hour urine test for protein, a biochemical blood test (in particular, creatinine, urea) at least once a year (and with the development of diabetic nephropathy - more often, depending on the stage) .

In addition, it is necessary to stop smoking, actively fight excess weight, move more, monitor blood pressure and blood cholesterol levels (maintain their normal values).

For active prevention of complications of diabetes mellitus, vascular therapy is necessary once every six months. Its main purpose is to maintain microcirculation. The main drugs for the prevention and treatment of complications of diabetes mellitus are alpha-lipoic acid preparations, B vitamins, antioxidants, antiplatelet agents, anticoagulants and other metabolic and vascular drugs. Conducting preventive courses is possible both in a hospital setting or a day hospital with intravenous and intramuscular injections, intravenous drips, and on an outpatient basis using tablet forms of drugs.

You should not use sharp objects when caring for your feet: scissors, callus knives, razor blades (this is one of the most common causes of injuries, especially in conditions of reduced sensitivity and poor vision!) It is better to use a file to treat your feet.

You should not cut the corners of the nail deeply, because this can lead to the formation of an “ingrown” nail - the cause of pain, inflammation and long-term treatment of the limbs, including surgery. Wearing narrow-toed shoes also contributes to ingrown toenails.

It is advisable to avoid uncomfortable shoes (tight, chafing) and high-heeled shoes. High heels contribute to poor circulation in the foot and the formation of areas of increased pressure on its plantar surface. You need to be careful with new shoes: wear them for no more than an hour for the first time.

If your feet are cold, you cannot warm them with heating pads (including electric ones), central heating radiators, or heating devices. The patient's temperature sensitivity is often reduced, so the protective reaction is weakened and it is easy to get burned.

For the same reason, you should not take hot foot baths. The water temperature should not be higher than 40°C (it is better to measure it with a water thermometer, as for bathing children). In addition, foot baths should not be long - this dries out the skin and makes it more vulnerable.

After washing your feet, you need to blot them dry (do not rub them!) with a towel, especially the spaces between the toes. High humidity in these areas contributes to the development of diaper rash and fungal diseases.

It is necessary to use foot cream daily!

You should not walk barefoot, as there is a high risk of injury with simultaneous penetration of infection into the area of injury. You must wear bathing slippers on the beach and when swimming. You should also protect your feet from sunburn.

If you have calluses on your feet, you should not try to get rid of them with regular anti-callus patches, ointments or liquids, as they all contain substances that corrode the skin. The most suitable remedy for treating calluses and areas of excessive keratinization of the skin of the feet remains pumice.

It is important to pay attention to the elastic bands of your socks. If they are too tight and leave indentations on the skin of the shins, this impedes blood circulation. If your feet are cold, it is better to use warm warming socks with loose elastic. It is necessary to ensure that the socks do not bunch up in the shoes.

Before putting on your shoes, you need to check their inner surface.

Every day, a person with diabetes should carefully examine their feet, especially the plantar surface. If there is difficulty (in older people and overweight patients), you can use a mirror.

First aid for leg injuries in a patient with complications of diabetes mellitus

If, when examining your feet, a wound, abrasion or crack is discovered, you need to wash it with a disinfectant solution. You can use a 1% solution of dioxidine, chlorhexidine or a 0.02% solution of furatsilin. The washed wound should be covered with a sterile bandage or bactericidal patch. You cannot use a regular adhesive plaster! You cannot use alcohol solutions (an alcohol solution of iodine, brilliant green - “brilliant green”), as well as a concentrated, dark solution of potassium permanganate (“potassium permanganate”). They may cause burns.

Arterial hypertension (high blood pressure) and dyslipidemia (increased levels of total blood cholesterol or an imbalance in the ratio of their fractions) are subject to mandatory monitoring and treatment. Every diabetic patient needs to check their lipid metabolism and blood pressure levels at least once a year. Such frequency of monitoring is sufficient only at normal levels of these indicators, i.e. If:

total cholesterol concentration is below 4.5 mmol/l;
systolic (upper) blood pressure below 135 mmHg;
diastolic (lower) pressure below 85 mm Hg.

If the levels of these parameters exceed the norm, more frequent monitoring and, of course, treatment are required. Typically, medications are prescribed to treat both hypertension and dyslipidemia. However, diet is also a powerful tool for influencing these disorders. It can be used as the only method of treatment if deviations from the norm are not very pronounced, and is an indispensable background for the use of medications for the correction of dyslipidemia.

Types of diabetes

Currently, there are two main types of diabetes mellitus, differing in the cause and mechanism of occurrence, as well as in the principles of treatment
Diabetes mellitus type 1

Type 1 diabetes mellitus is a disease of the endocrine system, for which a characteristic feature is an increased concentration of glucose in the blood, which develops due to destructive processes in specific pancreatic cells that secrete the hormone insulin, resulting in an absolute lack of insulin in the body
Diabetes mellitus type 2

Type 2 diabetes mellitus is one of the types of diabetes mellitus - a metabolic disease that occurs as a result of decreased sensitivity of cells to insulin, as well as a relative lack of insulin in the body
Gestational diabetes mellitus during pregnancy

Gestational diabetes mellitus can develop during pregnancy (in approximately 4% of cases). It is based on a decrease in the ability to absorb glucose
Hypoglycemia

Hypoglycemia is a pathological condition characterized by a decrease in plasma glucose concentration below 2.8 mmol/l, occurring with certain clinical symptoms, or less than 2.2 mmol/l, regardless of the presence or absence of clinical signs