Complication

s of Diabetes
Mellitus
Micro- and Macro-
Vascular Diseases
 Cause and Effect of Diabetes Mellitus

Diabetes Mellitus is a group of metabolic

diseases characterized
by hyperglycemia resulting from:

• Defects in insulin secretion

• Defects in insulin action (“insulin
resistance”)

If left untreated, diabetes can cause many

complications such as long term damage,
dysfunction and failure of various organs
especially the :

• Eyes • Heart
• Kidneys • Blood
• Nerves Vessels

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 Complications of Diabetes Mellitus can be divided
into two main categories:
Acute complications Long-term complications
(metabolic) (angiopathy)

 Hypoglycemia (abnormally  Microvascular complications

low blood glucose) affecting the eyes, kidneys
and neuropathy
 Diabetic Ketoacidosis (DKA)
 Macrovascular
 Hyperglycemic complications involving the
Hyperosmolar Nonketotic brain, heart and extremities
Coma or Hyperglycemic
Hyperosmolar Syndrome
(HHNS)

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Acute Complications

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 Hypoglycemia
 It is characterised (abnormally low glucose level)
occurs when blood glucose falls below 70 mg/dL

 It can be caused by too much insulin or oral

hypoglycemic agents, too little food, or excessive
activity
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 Symptoms of Hypoglycemia
Andrenergic symptoms CNS symptoms

o In severe hypoglycemia, the

o In mild hypoglycemia, as
fall in blood glucose
blood glucose level falls, the
deprives brain cells of
sympathetic nervous system
glucose needed for
is stimulated, resulting in a
functioning which leads to
surge epinephrin and
confusion, imbalance, light
norepinephrine leading to
headedness, drowsiness,
sweats, tremor, hunger,
coma, seizures and
palpitation, nervousness etc.
disorientation.

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 It is caused by the absence or markedly inadequate
amount of insulin. This deficit in insulin results in
disorders in metabolism of carbohydrate, protein and fat.
Diabetic It is more common in type 1 DM.

Ketoacidosis The 3 main clinical features of DKA are:

1. Hyperglycemia
2. Dehydration and electrolyte imbalance
3. Acidosis

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 Symptoms of Diabetic Ketoacidosis

Hyperglycemia leads to : Ketone bodies and acidosis

leads to :
polyuria, polydipsia, blurred GI symptoms like
vision, weakness and headache nausea, vomiting and
abdominal pain

Dehydration leads to : Ketone bodies build-up leads

to :
orthostatic hypotension acetone breath
(fruity odor)

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 Hyperglycemic Hyper Osmolar Non-Ketotic state
(HHNS)

Earth
It’s the third planet
from the sun
It is characterised by hyperglycemia (blood glucose >600
mg/dL), hyperosmolarity (plasma osmolarity >310
mOsm/L) and dehydration, in absence of ketoacidsosis.

It mostly occurs in elderly patients Uranus is the seventh planet

from the Sun

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 Symptoms of
Hyperglycemic
Hyper Osmolar Non-
ketotic state

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Long-term complications
Microvascular

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 Diabetic Retinopathy

 It is caused by  It’s a
blood vessel
leading
damage to the
back layer of the cause of
eye, the retina, blindness
leading to and visual
progressive loss disability
of vision, even
blindness

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 Types of Retinopathy
Non- Proliferative Diabetic Retinopathy Proliferative Diabetic Retinopathy

 Fragile new vessels ‣ bleeding into vitreous ‣

 Usually asymptomatic
clouds vision
 Blurred vision secondary to macular edema
 Poor blood supply to retina ‣ scar tissue ‣
retinal detachment
 Neovascularization of iris ‣ glaucoma

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 Types of Diabetic Retinopathy

Vitreous Hemorrhage Fragile New Vessels

Vision
Tunnel Vision in
Glaucoma

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 Diabetic Nephropathy

 The patient is
considered to have  It’s a
diabetic nephropathy leading
if values of chronic
kidney disease (CKD) cause of
persist at least for 3 dialysis and
months ”eGFR <60 kidney
and/or UACR > -
300mg/g” transplant

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 Symptoms of Nephropathy
The early stages of diabetic nephropathy show no symptoms. As the disease progresses, the follow symptoms
may appears

Swollen ankles, feet and hands

Dry and Itchy Skin

Nausea and loss of appetite

Difficulty in concentration

Fatigue and Insomnia

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 Diabetic Neuropathy

 Diabetic neuropathy is
caused by nerve damage  This can
through different lead to
mechanisms, including
direct damage by the
sensory
hyperglycemia and motor,
decreased blood flow to autonomic
nerves by damaging
small blood vessels
and spinal
nerve
damage

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Symptoms of Diabetic Neuropathy

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Long-term complications
Macrovascular

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 Coronary Artery Disease (CAD)

 Diabetic macrovascular
complications result from  These
changes in he medium to atherosclerotic
large blood vessels.
Blood vessel walls changes tend to
thicken, sclerose, and occur more often
become occluded by
plaque that adheres to the and at an earlier
vessel walls. Eventually, age in diabetes
blood flow is blocked.

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 Risk
Factors of
Coronary
Artery
Disease
Symptoms of Coronary Artery Disease

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 Peripheral Artery Disease (PAD)

 Results from
 Risk factors
narrowing and
hardening of
include smoking,
arteries that DM, CAD,
supply legs and Hyperlipidemia,
feet leading to CKD, CVA, A-
nerve and tissue fibrillation
damage to the
extremities

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 Symptoms of Peripheral Artery Disease (PAD)
Difficulty walking or
Non-healing wounds
climbing stairs

Leg, thigh, buttocks,

Skin Discolouration calf pain or cramping

One leg cooler than Poor toenail or leg

the other hair growth

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 Stroke
This is a condition that occurs when the blood vessels supplying the brain become blocked or burst, leading
to brain damage. High blood sugar levels can cause damage to the blood vessels supplying the brain,
increasing the risk of stroke.

Two Types of Strokes: Symptoms:

1) Ischemic Sudden weakness or numbness

• Face
Caused by a blockage in • Arms
a blood vessel • Legs

Difficulty speaking or understandin

speech
2) Hemorrhagic
Occur when a blood vessel in Blurred or loss of vision
the brain ruptures
Sudden severe headaches

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 Aortic Disease

 This is a condition that

affects the aorta,  This can cause
which is the main chest or back
artery that carries
blood from the heart to pain, shortness of
the rest of the body. breath, and a
High blood sugar pulsing sensation
levels can lead to
damage of the aorta,
in the abdomen
causing it to bulge or
tear

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 Carotid Artery Disease

 This is a condition
that affects the Symptoms can include:
arteries in the neck  Transient ischemic
that supply blood to attacks (TIAs) or
the brain. High blood "mini-strokes"
sugar levels can  Loss of vision
cause damage to  Dizziness
these blood vessels,  Slurred speech
increasing the risk of  Headache and neck
stroke. pain

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 Conclusion

It is important to note that many people with these

macrovascular complications of diabetes may not
experience any symptoms until the condition has
progressed significantly. Therefore, it is important for
people with diabetes to have regular check-ups with
their healthcare provider and to manage their blood
sugar levels, blood pressure, and cholesterol levels to
reduce their risk of these complications

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Thank You for your
Any Questions?
attention!