Complications of Diabetes

1
Complications of Diabetes

• Dr ( Prof) Anjan K Das
• Consultant Cardiothoracic and Vascular Surgeon

2
(No Transcript)
3
(No Transcript)
4

• 1 in 5 adults have diabetes.
• 1/3 of patients unaware that they have diabetes
• Unawareness of diabetes results in uncontrolled
  blood sugar levels and an increased chance of
  having diabetes-related complications

5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9

• Compared with people of the same age who do not
  have Type 2 diabetes older adults with diabetes
  are 2 to 4 times more likely to suffer from heart
  attacks and strokes.

10
(No Transcript)
11

• Diabetes also has the potential to damage your
  kidneys and cause you to have protein in your
  urine.
• The risk of kidney disease goes up the longer you
  have lived with diabetes and having high blood
  pressure or repeated urinary tract infections can
  make your risk even higher.
• Being alert to the possibility of this kind of
  complication is very important. People with
  diabetes can lose up to 70 of their kidney
  function before they realize it. By then their
  kidneys are already damaged

12
(No Transcript)
13

• Another complication of diabetes is damage to the
  retina and small blood vessels of the eye.
• Diabetes is the leading cause of new cases of
  blindness among people between the ages of 20
  through 74. Each year between 12000 and 24000
  people with diabetes lose their sight.
• Symptoms of eye damage caused by diabetes are
• Blurred vision
• Narrowed field of vision
• Cataracts
• Difficulty seeing in dim light

14
(No Transcript)
15

• Diabetes causes blood vessels in the feet and
  legs to narrow and harden leading to poor
  circulation. If this happens the smallest cut
  or sore which the person may not be aware of
  can lead to a serious infection or even
  amputation.

16
(No Transcript)
17

• Diabetes affects all parts of the body including
  the skin.
• People with high blood sugar tend to have dry
  skin and less ability to fend off infection
  which can lead to gangrene or amputation.
• As a result it is very important for people with
  diabetes to see their healthcare provider for
  treatment if bacterial or fungal skin infections
  or itching occurs.

18
(No Transcript)
19

• Often gum disease is painless but there are
  still signs to look for
• Bleeding gums when you brush or floss
• Red swollen or tender gums
• Gums that have pulled away from teeth
• Pus between the teeth and gums
• Bad breath
• Changes in the way your teeth fit when you bite
• Loose or shifting permanent teeth
• Changes in the way dentures or bridges fit

20
(No Transcript)
21
Remember!With good care all complications can be
reduced or even prevented!
Heart Disease and Stroke Reduced

• Foot Problems
• Reduced

Serious Eye Disease Reduced
Kidney Problems Reduced
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
Prevention of diabetes complicationsThe alphabet
strategy
28
ADVICE

• Stop smoking
• Close attention to diet
• Weight reduction and exercise
• Ensure diabetes education and regular follow-up
  with your diabetes care team
• Comply with recommended treatment

29
BLOOD PRESSURE

• Know your blood pressure
• In most cases the ideal aim is less than 140/80
• If kidney disease is present then the aim is
  lower

30
UKPDS Results A Blood Pressure of 154/87 versus
144/82
Risk
Reduction Death related to diabetes 32
Heart Attacks 21 Stroke 44
Aim BP 140/80 or less in most people!
31
Cholesterol lowering reduces Heart Disease in
Patients with Diabetes by up to 55 !
32
Risk Reduction With a 1 Reduction in HbA1c
Any lower is therefore better!
33
EYE Examination

• Make sure that your eyes are looked at carefully
  at least yearly after special eye drops have been
  put in.
• This should be done by a health care professional
  trained in diabetic eye examination
• Ideally a retinal camera should be used.
• You should be referred to an Eye Specialist if
  needed.

34
FEET Examination

• You should check your own feet regularly and seek
  advice if needed.
• Make sure that your feet are looked at carefully
  at least yearly by a health care professional
  trained in diabetic feet examination
•  Ideally a podiatrist should do the examination
  if problems are identified.

35
Any Foot Problems Seek help!
36
GUARDIAN DRUGS

• Aspirin 75mg once daily
• Diabetes experts now advise aspirin
  treatment to protect against heart disease in all
  patients with diabetes over the age of 30 years
  with any of the following previous heart attack
  angina high blood pressure (once the pressure is
  less than 150/90) diabetic eye disease blood
  vessel disease of the legs early kidney disease
  cholesterol problem family history of heart
  disease weight problem and smokers. Side effects
  should be discussed

37
Aspirin helps prevent Heart Attacks by up to 29
35
30
25
20

15
10
5
0
Any Vascular event
Heart Attacks

• 2.5 events avoided per 1000 patients treated per
  year

38
GUARDIAN DRUGS

• ACE-inhibitors
• Have a special role in preventing diabetic
  complications in most patients with diabetes.
  Please discuss this with your diabetes care team.

39
Diabetes Care Strategy

• Advice
• exercise diet not smoking regular testing
  clinics
• Blood Pressure
• aim less than 140/80
• Cholesterol
• keep under control
• Diabetes Control
• Glycosylated haemoglobin(amount of glucose
  sticking to your blood over the last 2 months)
• Eyes
• check yearly at least
• Feet
• check yearly at least
• Guardian Drugs
• Aspirin 75mg protects against heart disease ACE
  inhibitors

Risk of Diabetes Complications
40
Thank you