The chronic complications of diabetes
The three "pathies"
- Retinopathy
- Nephropathy
- Neuropathy
Retinopathy: pathy means - disorder, a pathology. A pathology of the retina.
The water from the eyes lens is decreased causing osmolality change which in turn causes blurring of vision and eventually to a number of eye problems such as cataract. The retina examination is free for diabetics and should be done annually without failure
. It is commonest cause of blindness in people of working age in UK
Nephropathy
The basic unit of kidney is termed as nephron and hence pathology of the kidney is termed as nephropathy. Water molecules are attached to the excess sugar molecules so that they can be excreted from the body. This excess workload of the kidney and abnormal function leads to eventual breakdown of renal system and the patient ends up with renal failure. Excretion of proteins (albumin) from the kidneys and presence of it in the urine is initially the first sign of nephropathy. If the proteinuria and hypertension remain undetected, the first symptoms may be due to fluid retention (ankle oedema, breathlessness).
- Neuropathy: Pathology of neurons is termed as neuropathy. The two main symptoms that occur because of this are sensory loss and vascular and neuropathic pain in the legs. .
- Sensory loss - The sensitivity of neurons are lost in diabetics and therefore there are at increased risk for diabetic leg ulcers. The pain sensation is lost which is extremely dangerous since they are prone for heart attacks and severe chest pain is masked. Such patients may present with large painless ulcer. A patient with a foot ulcer who walks without a limp almost certainly has neuropathy. The patient with reduced pain often subjects his feet to abnormally high pressures temperature and other trauma because he feels no pain.
- Painless pain- This is the most common of the diabetic neuropathies. There is gradual onset of paresthetic and painful symptoms (burning, shooting pain) in the lower limbs. These symptoms are typically characterised by nocturnal exacerbation, with bedclothes irritating the skin. These sensory symptoms may lead to a curious sensation when walking that has been likened to walking on air or walking on pillows. A particularly dangerous situation is that described as the "painful painless" leg, in which the patient experiences painful symptoms, but has reduced pain sensation on examination. As mentioned above, such patients are at great risks of painless injury to their feet.
- Vascular pain - nocturnal rest pain indicates more advanced vascular disease. It is typically relieved by hanging the feet over the edge of the bed and is aggravated by walking whereas nocturnal neuropathic pain is relieved by walking.
