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Signs of diabetes and late complications

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Diabetes mellitus is a chronic metabolic disorder. Signs of the disease are due to several changes in metabolism. Depending on the type of disease, different symptoms predominate.

The clinical picture is made up of the manifestations:

  • dehydration;
  • energy deficit at the cell level;
  • of massive lipolysis;
  • ketosis;
  • displacement of acid-base balance in the direction of acidosis;
  • electrolyte disturbances;
  • damage to organs and tissues;
  • decrease in immunity.

The rate of deterioration of the patient depends on the degree of insulin deficiency. If the hormone is practically not produced by the pancreas, then the clinical picture of the disease develops very quickly. Symptoms grow for several weeks or even days. Without treatment, the patient falls into a diabetic coma( ketoacidosis).

Symptoms of diabetes mellitus

Fig.1 - Common symptoms of diabetes mellitus.

If insulin deficiency is relative, then diabetes can be hidden for a long time. The patient has complaints about his health, but they are rather moderate and nonspecific. Because of such an erased clinical picture, the disease may remain unrecognized for years.

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Content

  • 1 Signs of dehydration
  • 2 Symptoms
  • 3 energy shortage massive lipolysis
  • 4 accumulation of ketone bodies
  • 5 symptoms of acidosis
  • 6 Water and electrolyte disturbances
  • 7 Symptoms of late complications of diabetes
  • 8 Erectile dysfunction - a symptom
  • 9 diabetes Comorbidities

Signs of dehydration

Dehydration - one of the main consequencesHigh blood sugar. Hyperglycemia causes massive loss of fluid due to osmotic diuresis. When the blood glucose concentration exceeds the individual renal threshold, the sugar begins to be excreted from the body with urine. On average, glucosuria appears with glycemia more than 8-9 mM / l.

The patient loses more than 2 liters of fluid per day. Because of this, a strong sense of thirst appears. I want to drink during the day and at night.

Dehydration is manifested by dry mucous, dry and itchy skin. If the patient, for whatever reason, restricts fluid intake, his condition deteriorates rapidly. The loss of water in the urine continues. A person loses more than 5-10% of body weight.

Symptoms of energy deficiency

Blood glucose is a universal source of energy for every cell in the body. If the carbohydrate metabolism is disturbed, the tissues cease to absorb this substance. Glucose accumulates in the blood plasma, but can not get inside the cells. Because of this, tissues begin to lack the energy substrates. Slow down all the processes. Including the synthesis of ATP( adenosine triphosphate).

Physically, the patient feels a lack of energy as a constant weakness and apathy. He does not have the strength for ordinary activities, all work is done with great difficulty. Even after a long sleep or rest, there is no feeling of cheerfulness.

Fatigue concerns all areas of life. It is difficult to withstand both mental and physical activity.

Deficiency of energy at the cell level activates the synthesis of contrinulsory hormones in the pancreas and adrenal glands. Fabrics signal about hunger, as glucose is not absorbed. As a result, glucagon and cortisol are released into the blood. These biologically active substances act against insulin. If the deficiency of glucose in the cells was associated with a lack of food, then glucagon and cortisol would play their protective role - they would help a person survive a difficult period. But the lack of energy is caused by diabetes, and the contrinsular hormones only worsen the situation. They provoke an increase in the level of sugar in the blood and a further violation of metabolism.

Massive lipolysis

Diabetes prevents energy cells from entering. To continue living, tissues begin to spend their own reserves. Reserve substances for the body are lipids. Because of diabetes, fat reserves begin to disintegrate. This process is called lipolysis. Its final products: glycerol and fatty acids.

Complaints of the patient with lipolysis are associated with a decrease in body weight. The man notes that the weight falls despite the increased appetite. In the onset of diabetes, a patient can lose weight sharply by 5-15 kg. Such unhealthy weight loss is accompanied by weakness and constant hunger.

Accumulation of ketone bodies

Disturbance of glucose uptake in tissues leads to increased formation of ketone bodies.

These include:

  • acetone( propanone);
  • acetoacetic acid( acetoacetate);
  • beta-hydroxybutyric acid( beta-hydroxybutyrate).

Ketone bodies are formed in the liver and are absorbed by muscles, kidneys, and the brain. In the conditions of massive lipolysis due to diabetes acetone is formed so much that it does not have time to rework all. Ketone bodies start accumulating in the blood and excreted in the urine, exhaled air, etc.

Symptoms of ketosis:

  • odor of acetone in the room where the patient is;
  • smells of acetone from the patient's urine;
  • complaints of dizziness;
  • headache;
  • sleepiness.
Acetone is a toxic substance for the central nervous system. The higher the level of ketone bodies, the more depressed the consciousness.

Symptoms of acidosis

Accumulation of ketone bodies leads to a regular drop in blood pH.The acid-base balance shifts towards acidosis. The internal environment of the body is acidified.

Table 1 - Classification and signs of acidosis in diabetes mellitus.

ACIDOSIS CLASSIFICATION pH INDICATOR CLINICAL SYMBOLS
Compensated above 7.35
  • rapid pulse;
  • rapid breathing;
  • increase in systemic blood pressure.
Subcompensated 7.34-7.25
  • dyspnea;
  • nausea;
  • vomiting;
  • diarrhea;
  • rapid pulse and irregular heartbeat.
Decompensated less than 7,24
  • severe dyspnea( Kussmaul breathing - deep, rapidity);
  • drowsiness;
  • dizziness;
  • depression of consciousness;
  • drop in blood pressure;
  • interruptions in the work of the heart;
  • digestive disorders.

Water-electrolyte disorders

For decompensated diabetes, changes in the composition of intracellular and extracellular fluids are characteristic. The organism loses water, ions of sodium, chlorine, potassium, calcium, magnesium, phosphorus, etc.

At the time of ketoacidotic coma in an adult human water deficit is 4-8 l, potassium - up to 1000 mM, sodium - up to 500 mM, chlorides- up to 350 mM, calcium - up to 100 mM, phosphorus - up to 100 mM, magnesium - up to 50 mM.

Water-electrolyte disturbances are manifested:

  • weakness;
  • pain in the muscles;
  • with paresis;
  • paresthesia;
  • convulsions;
  • disorders of appetite and digestion;
  • poor sensitivity to insulin preparations;
  • heart rhythm disturbances.

Symptoms of late complications of diabetes

Diabetes leads to damage to almost all tissues of the body.

Allocate:

  • microvascular complications( retinopathy, nephropathy);
  • macrovascular complications( atherosclerosis of the vessels of the heart, brain, limbs);
  • neuropathy( central, peripheral, vegetative);
  • diabetic foot syndrome.

The most characteristic complaints of patients:

  • vision impairment;
  • loss of visual fields( with haemorrhages in the retina);
  • pain in the legs at rest;
  • dyspnoea with physical exertion;
  • increased blood pressure;
  • long-term non-healing painless ulcers on the feet.

One of the first complications is vegetative neuropathy. This pathology develops due to damage to the sympathetic and parasympathetic parts of the autonomic nervous system. In patients, there are many complaints related to the violation of the regulation of the internal organs.

Signs of autonomic dysfunction:

  • drop in blood pressure when body position changes;
  • decreased heart rate variability;
  • alternation of constipation and diarrhea;
  • no symptoms in hypoglycemia;
  • is a sexual disorder.

Erectile dysfunction - one of the symptoms of diabetes

Sexual disorders occur in half of men with diabetes. Sometimes erectile dysfunction is the first symptom of the disease.

Impotence develops due to damage to the nervous tissue and blood vessels.

Violations can be caused by:

  • oppression of sexual desire;
  • by blocking the reflexes that cause an erection;
  • is affected by sensitive neurons.

As a result, the patient decreases libido, rarely an erection occurs, ejaculation is delayed or absent.

Disorders in the genital area are also manifested in the development of infertility. Sometimes the absence of pregnancy in a partner is associated with the phenomenon of retrograde ejaculation.

Concomitant diseases

Diabetes is often accompanied by infectious diseases. The decrease in the activity of the body's defenses is explained by a metabolic disorder. The general and local immunity falls.

Sometimes the first manifestation of diabetes on which the patient pays attention is the long healing of small injuries and scratches. The patient is concerned about frequent catarrhal diseases, purulent inflammation, chronic infection. In patients, the risk of candidiasis and tuberculosis increases dramatically.

Doctor-endocrinologist Tsvetkova IG

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