Macrovascular and Microvascular Complications of Type 2 Diabetes
1) Macrovascular complications include heart disease and stroke. The mechanism for macrovascular disease is atherosclerosis and narrowing of the arteries due to plaque formation.
2) Microvascular complications include retinopathy (including blindness), neuropathy (nerve damage) and nephropathy (kidney damage). Microvascular complications are caused by prolonged-duration hyperglycemia (elevated blood glucose levels) and severity of the hyperglycemia.
1) Diabetic foot problems include ulcerations, osteomyelitis (bone infection) and Charcot foot (weakened foot bones with increased risk of neuropathy and fracture).
2) Diabetic ketoacidosis and hyperosmolar hyperglycemia state are rare, but they do occur in certain circumstances, such as decreased insulin production and severe illness.
3) Gastroparesis is a delay in stomach emptying. Symptoms include an early feeling of fullness when eating, lack of appetite, nausea, abdominal pain and heartburn.
4) Postural hypotension is low blood pressure with changes in position or posture.
5) Erectile dysfunction.
6) Depression is often associated in individuals who suffer from chronic disease.
7) Increased risk for developing necrotizing soft-tissue infections.
8) Fatty liver in which there is 25 percent progress to cirrhosis.
Screening for Complications
Screening complications should begin immediately because damage has likely already occurred. Symptoms can take years to develop prior to diagnosis. Examples of tests include:
1) Have an annual dilated eye exam.
2) Monitor blood pressure at each examination.
3) Have an annual urine micro-albumin, serum creatinine and lipids tests.
4) Schedule foot screenings to prevent amputation, and include annual monofilament, pulses and vibratory evaluations.
5) Perform a daily self-exam of feet as well as by your doctor at every visit.
6) Tell your doctor if you are having trouble digesting your food, erectile dysfunction or dizziness with changes in positions.
Prevention of Complications
Type 2 diabetics can decrease the risks of complications by controlling their blood glucose levels with these lifestyle interventions:
1) Regular A1c tests are recommended every three to six months, depending on individual needs.
2) Good blood pressure control means maintaining a blood pressure of less than 130/80.
3) Correct dyslipidemia with statins.
4) Self-monitor blood glucose levels daily.
5) Attend a diabetes self-management class.
6) Stop smoking.
7) Maintain a healthy weight.
8) Maintain a healthy diet and active lifestyle.
9) Take aspirin to prevent cardiovascular complications.
10) Receive recommended vaccinations.
Diabetics have two to four times the risk for cardiovascular complications, and stroke risk doubles within five years of diagnosis. Low-dose aspirin is a reasonable medication for most adults with diabetes to take on a regular basis, although it is important to ask your health care provider first. Aspirin is given as a secondary prevention for diabetics with known cardiovascular disease.
Vaccinations decrease the risks of potentially deadly infections. Type 2 diabetics should receive the influenza vaccine (flu shot) annually. The pneumococcal vaccine should be given according to the Centers for Disease Control vaccine schedule based on age and prior immunization history. Hepatitis B is now recommended for all people under the age of 60, or after age 60 if the individual is a high risk for hepatitis B. Tdap (tetanus, diphtheria and acellular pertussis vaccine) should be given according to the Centers for Disease Control vaccine schedule based on age and prior immunization history. Zoster (shingles) vaccine should be given once at age 60.