I. Acute complications
Diabetic ketoacidosis
Ketoacidosis is the most common acute complication of diabetes mellitus, which is common in type 1 diabetes mellitus and occurs in cases of poor metabolic control, concomitant infection, severe stress, interruption of insulin therapy and eating disorders. Delayed diagnosis or treatment can result in death. Mortality is higher in patients of young or advanced age, coma or hypotension. The mortality rate is <5% in experienced medical centers in the United States, but can be as high as 10% in our primary care hospitals.
Diabetic non-ketotic hyperosmolar syndrome
This syndrome is mostly seen in elderly patients. It results in coma, shock and multi-organ failure due to severe hyperglycemia and disturbance of water and electrolyte balance. The syndrome has a very high mortality rate, which can be as high as 15% even in high level hospitals.
Lactic acidosis
The incidence of diabetes mellitus combined with lactic acidosis is not high, but the mortality rate is very high. It mostly occurs in patients with hepatic or renal insufficiency, or with chronic cardiopulmonary insufficiency and other hypoxic diseases, especially those who are also taking benzodiazepines. It is mainly due to the large accumulation of anaerobic enzymatic glucose metabolites-lactic acid in the body leading to hyperlactatemia and further reduction of body fluid PH, resulting in lactic acidosis.
II. Chronic complications
Cardiovascular complications
Cardiovascular disease is a major cause of disability, death, and economic loss in diabetic patients. Coronary heart disease accounts for about half of all deaths due to cardiovascular disease in diabetic patients. type 2 diabetes is an independent risk factor for coronary heart disease.
Diabetes is an important cause of increased coronary events and death. Also diabetic cardiomyopathy, left ventricular diastolic dysfunction, predisposition to congestive heart failure and arrhythmias due to cardiac autonomic neuropathy are also important causes of increased cardiovascular death.
Diabetic cerebrovascular disease
Diabetic cerebrovascular disease is most common due to ischemic encephalopathy caused by cerebral atherosclerosis, such as transient ischemic attack (TIA), lacunar cerebral infarction, multiple cerebral infarction, cerebral thrombosis and so on. Because of the high incidence of hypertension in diabetes (20%-60%), hemorrhagic encephalopathy can also occur.
Risk factors for diabetic cerebrovascular disease include hyperglycemia, hypertension, dyslipidemia, abnormal blood rheology, smoking, and chronic inflammatory states. Hypertension is particularly important and is an independent risk factor for diabetic ischemic encephalopathy. In ischemic stroke patients, 77% of blood pressure is uncontrolled, so antihypertensive treatment is important to reduce the incidence of stroke. Myocardial infarction in the elderly is also a risk factor for stroke. In a foreign study of 121,432 patients over 65 years of age hospitalized with acute myocardial infarction, the risk of stroke after discharge was 2.5 times higher than in those without myocardial infarction.
Diabetic eye disease
Lesions can occur in all parts of the eye in diabetic patients, such as corneal abnormalities, iris neovascularization, and optic neuropathy. The prevalence of glaucoma and cataracts is higher in diabetic patients than in non-diabetic patients of the same age. Diabetic retinopathy is the main cause of blindness in diabetic patients, and the prevalence of retinopathy in all types of diabetes increases with time and age. 99% of type 1 diabetes and 60% of type 2 diabetes, with a disease duration of 20 years or more, almost all have retinopathy of varying degrees. The risk of diabetic retinopathy increases after puberty.
Diabetic nephropathy
Diabetic nephropathy occurs in about 20% to 30% of people with type 1 or type 2 diabetes. Some of these progress to end-stage renal disease. Without specific intervention, approximately 80% of type 1 diabetics with persistent microalbuminuria develop clinical nephropathy within 10 to 15 years, at which time hypertension may develop. Once clinical nephropathy occurs, without effective intervention, the glomerular filtration rate gradually decreases within a few years, and 50% after 10 years and more than 75% after 20 years will develop end-stage renal disease.
After the diagnosis of diabetes mellitus in type 2 diabetic patients, many people immediately develop microalbuminuria and even overt nephropathy. Without special intervention, 20% to 40% of these patients will progress to clinical nephropathy, and about 20% will progress to end-stage nephropathy after 20 years. Because of the large number of type 2 diabetic patients, more than half of the kidney disease patients currently on dialysis in Western countries are diabetic.
The presence of microalbuminuria in patients with type 1 or type 2 diabetes not only marks the presence of early kidney disease, but also greatly increases the prevalence of cardiovascular disease and the risk of death, and should therefore be taken seriously.
Diabetic foot
The diabetic foot is the result of a combination of diabetic lower limb vasculopathy, neuropathy and infection, which can lead to foot ulceration and even amputation in severe cases.
Diabetic osteoarthropathy
The incidence of diabetic osteoarthropathy is about 0.1% to 0.4%, mainly due to neuropathy, and infection can aggravate the damage. Although the incidence of this disease is not high, it can lead to joint dislocation and deformity, seriously affecting joint function and reducing the quality of life of patients.
Diabetes and oral diseases
Diabetic patients have a reduced ability to fight infection against bacteria, and the oral and maxillofacial tissues and the gingival and periodontal tissues in the oral cavity are prone to infection, which can cause pus overflow from the alveoli, resorption of alveolar bone, and loosening of teeth. Infections occurring in the soft tissues of the maxillofacial region have a rapid onset and rapid expansion of inflammation, which can cause sudden deterioration of the general condition at the early stage of the disease and can cause death if not treated in time.