Assessment of the established diabetic

Continuing assessment of the diabetic patient has three main aims which are to educate the diabetic patient, to find out what problems the diabetic patient is experiencing (glycemic control and morale), and to find out or pre-empt diabetic complications. 

Assessing the glycaemic control in the diabetics can be done from the glycated (glycosylated) haemoglobin levels relating to mean glucose levels over the past eight weeks. The target HbA1c must be set individually per each diabetes patient. Tight or more regular control of HbA1c is highly needed in pregnancy women that have diabetes and others that have micro-vascular complications during diabetes. The elderly diabetic patient may have need for lesser tight control of HbA1c. 

Diabetes and diabetic complications generally increase with increasing HbA1c. Also note that fructosamine in the form of glycated plasma protein relates to diabetes or blood sugar control for the past one to three weeks. This could be very helpful and useful during pregnancy state for assessing and checking shorter term control of diabetes and blood sugar, and also if there is an underlying medical condition interfering with accurate measurement of HbA1c as being observed in some form of hemoglobinopathies. Other methods of assessing glycaemic control are taking the history of hypoglycemic attacks whether with symptoms, and use of home finger stick glucose records.

Assessment of diabetes complications is very important and helpful. This can be done by checking injection sites for infection, lipoatrophy, or lipohypertrophy. 

Diabetic complication assessment needs to cover vascular disease check, which is the most common cause of death in the diabetics resulting from cerebrovascular, cardiovascular, and peripheral vascular complications. This will help to reduce the chances of stroke from occurring which is more common in the diabetes mellitus patients. The kidneys and the renal system need to be regularly checked in the diabetics, checking for the urine creatinine clearance and checking albuminuria.

 This will help to prevent diabetic nephropathy and prevent early renal/kidney diseases in diabetes. Control of hypertension/or high blood pressure in diabetes can as well be very helpful for the diabetics as it will help to reduce and out rule the chances of stroke or cardiac/heart problems from arising as much as preserving the kidneys from being injured. Blindness as one of the complications of diabetes mellitus can be prevented. Loss of sight in diabetes is called diabetic retinopathy. 

It is quiet common in diabetic individual, but it (diabetic retinopathy) is quiet preventable through regular fundoscopy for all diabetic patients , including retinal photography and possible screening to know if laser photocoagulation can be used. Other eye complications in diabetes are cataracts, rubeosis iridis, which are all preventable when the blood sugar is kept under tight control.

Diabetic complications as seen in diabetes individuals, especially type 1 diabetes are complications arising from metabolic derangement, diabetic feet and diabetic neuropathy, all which, can be very well averted or prevented if the diabetes is well managed, treated or better still given a diabetes cure approach.

Understanding diabetes medical and health complications

Complications that follow the Medical and Health Condition Called Diabetes - Diabetes Complications

Diabetes mellitus being a glucose or sugar hormone disorder of the endocrine system of the human body. It results from a total lack of endogenous insulin (frank diabetes), or diminished, reduced effectiveness of endogenous insulin and is (diabetes) is being characterized by increased blood glucose popular called high blood sugar or hyperglycemia. 

Diabetes can only become life threatening if it is not detected or diagnosed early enough or when it is not properly treated or when it is poorly managed. The baseline management for diabetes in order to prevent diabetic complications is to regulate the metabolic blood sugar or blood glucose at a physiologically normal level for glucose-energy metabolism bio-system that yields energy in the form of ATP.

The central cycle for the normal glucose utilization is to make the plasma glucose, or circulating blood glucose to be easily absorbed by the cells of the body, store it (glucose) in the cells in form of glycogen from where the body cells derive energy through the process of gluconeogenesis. 

In absence of adequate insulin secretion and /or in case of ineffective insulin utilization by the cells of the human body, diabetes results in which case, if uncontrolled or poorly managed, some complications generally called diabetic complications set in. They are generally referred to as short-term complications of diabetes which include but not limited to the following:

•    Infection/Infections: Diabetic individuals usually have a decreased ability of the white blood cells to quickly respond to invading microbes or micro organisms into the body. Owing to that, the diabetes patients have what is mostly called lazy cell syndrome. The implication here is that, the diabetics are more prone to wide range of infections than their non-diabetic counterpart. This can be reduced by closer monitoring of blood glucose, and most especially protect themselves from being injured or having an open wound. The diabetics should take care of the foot/feet very well, wear safety diabetic socks and treat every wound/injury promptly. This is due to the compromised immune functions of the diabetic patients. This condition also interferes with normal glucose metabolism and blood sugar control.

•    Hypoglycemia/Hypoglycemic complications: Blood glucose or plasma sugar levels lesser than 70 mg/dL (3.5 mmol/l) is clinically referred to as hypoglycemia. This results when there’s too much endogenous or injected insulin hormone in the body and not adequate glucose in the blood for the insulin to act upon. Hypoglycemia may occur as a result of taking excess or too much anti diabetic medications, skipping/missing meals, abrupt increase in physical exercise levels, abuse of alcohol drinks (beer, gins, vodka and other alcohol drinks), kidney disease secondary to diabetes-kidney nephropathy or renal neuropathy, and poor absorption of glucose from the intestine.

o    Other hypoglycemic frequent symptoms include but not limited to: Headache, vomiting, nausea, confusion, sweating, trembling, hunger/hunger pangs, nervousness, confusion, drowsiness, poor coordination and bizarre heart beats-cardiac palpitation.

o    The clinical condition of hypoglycemia needs to be promptly indentified and sharply recognized immediately as soon as it sets in, and quickly arrange for arresting the situation from degenerating to brain tissue or brain cells death. When hypoglycemia sets in, quickly call for a diabetes nurse or a medical personnel-doctor/physician/or endocrinologist.

o    Ketoacidosis secondary to poorly controlled diabetes: This is one of the diabetic complications that almost always require prompt medical emergency attention as it (diabetic ketoacidosis) almost always results in coma, diabetic coma. 

Diabetic ketoacidosis as a diabetic complication is mostly experienced in diabetes type 1 or type 1 diabetic’s individuals when the blood sugar/glucose level is poorly controlled. Diabetic ketoacidosis usually result as a metabolic condition whereby the decreased level of endogenous bio insulin level in the presence of endogenous catabolic bio hormones leads to excessive hepatic production (liver production) of glucose and group of ketone bodies which (ketone bodies) are the waste product of acidic conditions produced in the human liver when insulin is low, glucose is needed and other catabolic hormones on the increase. This condition is characterized by smell of acetone from the breath of the comatose diabetic person.

o    The following manifestations are the major clinical features observed during diabetic ketoacidosis – increased blood glucose levels/excess blood sugar known as hyperglycemia, excess ketone bodies in the blood known as hyperketonemia, generalized pH decrease of the blood/plasma – meaning higher acidic plasma environment known as metabolic acidosis.

o    Increased blood glucose levels (or excess blood sugar – Hyperglycemia) is a major cause of increased urinary output/urine frequency - osmotic diuresis leading to excess loss of water resulting in dehydration and loss of vital plasma electrolytes such as sodium, chloride, potassium, magnesium etc.

o    Increased reduction of extracellular fluid capacity, resulting in reduced blood pressure (hypotension) which can lead to kidney or renal ischemia diseases or renal shock and toxicity.

o    Further complication of diabetic ketoacidosis includes but not limited to brain or cerebral oedema (edema), circulatory inadequacies or circulatory incompetence/failure, severe respiratory failure or complexes manifesting as respiratory distress syndrome (RDS) and wide disseminated intra-vascular coagulations.

o    Infections secondary to diabetic ketoacidosis, stress and stress syndrome, and trauma or distress are often observed secondary to diabetic ketoacidosis especially in individuals managing type 1 diabetes.

•    There is a wide spreading syndrome among type 1 diabetics which is known as hyperglycemic Non-Ketotic Hyper-osmolar Diabetic Syndrome (HHNS): This a clinical condition in which the blood sugar or glucose levels are terrifyingly high, mostly rising above 50 mmol/L. Very high loss of water due to increased osmolar concentration of the blood plasma resulting in dehydration and presence of urea in the blood (uremia), conditions of which lead to diabetic seizures, diabetic coma and finally death if left unchecked.

•    Another diabetic complication of medical concern is what is called or known as Lactic Acidosis. This is mostly due to excess dose of anti diabetic medicine (anti-diabetic medication) called metformin. Metformin is a biguanide, an oral anti-diabetic medication used as first line therapy, and should not be used in diabetic patients who have hepatic and renal impairment.