โรคแทรกซ้อนเรื้อรังในผู้ป่วยเบาหวาน

<p style="padding-top: 20px;">Diabetes is a major health problem. Many diabetic patients suffer from complications caused by abnormal blood sugar levels, which are the main cause of illness and can be severe enough to result in organ loss or death.</p>
<p>Studies have found that 2 out of 3 diabetic patients die from stroke and heart disease, which are major complications of diabetes. Other complications not only cause patients to lose their ability to work and reduce their quality of life but also result in high treatment costs.</p>
<h2><span style="color: #00826a;">What complications should diabetic patients be cautious of?</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>Chronic complications in diabetic patients usually occur in those who have had diabetes for at least 5 years, especially in those who cannot control their blood sugar levels within the set criteria. Chronic complications can be divided into</p>
<ul>
<li><span style="color: #00826a;"><strong>Microvascular complications</strong></span> including
<ul>
<li>Retinopathy complications</li>
<li>Kidney complications</li>
<li>Chronic nerve complications</li>
</ul>
</li>
<li><span style="color: #00826a;"><strong>Macrovascular complications</strong></span> including
<ul>
<li>Coronary artery disease</li>
<li>Cerebrovascular disease</li>
<li>Peripheral arterial occlusive disease, which is a factor leading to foot ulcers in diabetic patients</li>
</ul>
</li>
</ul>
<h2><span style="color: #00826a;">Nerve complications</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>This condition causes patients to experience numbness in the feet, which is a factor leading to foot ulcers, especially in patients with peripheral arterial occlusive disease. This can result in patients needing toe or partial leg amputation, which is a cause of disability. Risk factors for nerve complications include blood sugar levels, high blood pressure, and smoking, among others.</p>
<h2><span style="color: #00826a;">Symptoms and signs of nerve complications</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>Patients may experience numbness in both hands and feet. Some patients have burning pain or stabbing pain, mostly occurring at night. In later stages, the pain decreases but numbness and reduced sensation occur. Additionally, some may experience weakness in the small muscles of the arms and legs.</p>
<h2><span style="color: #00826a;">Retinopathy complications</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>In the United States, about 8% of blind patients have diabetes as the cause. Diabetic patients who cannot control their blood sugar levels properly develop retinopathy complications and have nearly 30 times higher risk of blindness compared to non-diabetics.</p>
<h2><span style="color: #00826a;">Symptoms and signs of eye complications</span></h2>
<ul>
<li>Blurred vision caused by abnormal refraction of the lens when blood sugar is high, cataracts, or changes in the retina called “diabetic retinopathy.” If untreated properly, this condition can lead to blindness.</li>
<li>Seeing dark shadows blocking vision caused by bleeding in the vitreous humor of the eye.</li>
<li>Double vision caused by dysfunction of the eye muscles controlled by cranial nerves.</li>
</ul>
<h2><span style="color: #00826a;">Kidney complications</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>This is a major cause of illness and one of the causes of death in diabetic patients, both type 1 and type 2. The incidence and progression of kidney complications are related to blood sugar control and blood pressure control.</p>
<h2><span style="color: #00826a;">Symptoms and signs of kidney complications</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>In the early stage, patients have no symptoms but small amounts of albumin or protein leakage can be detected in the urine, approximately 30-300 milligrams per day.</p>
<p>In the later stage, when protein leakage increases, foamy urine and swelling may be observed. At this stage, high blood pressure is also detected (urinary albumin exceeds 300 milligrams per day).</p>
<p>If untreated properly, kidney function will decline, leading to chronic kidney failure, eventually requiring dialysis or kidney transplantation.</p>
<h2><span style="color: #00826a;">Macrovascular complications</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>There is narrowing and blockage of major blood vessels, especially those supplying the heart and brain, causing symptoms of myocardial ischemia, heart attack, paralysis, or narrowing of blood vessels supplying the legs, causing calf pain. If blockage leads to tissue death, amputation may be necessary. High blood pressure is also common in the elderly, especially systolic hypertension.</p>
<h2><span style="color: #00826a;">Coronary heart disease</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>Diabetic patients have cardiovascular disease at a rate of 18.7%, with stroke at 4.4% and coronary heart disease at 8.1%. Diabetic patients with heart disease have significantly more complications than non-diabetics, with a 1.5 times higher risk of heart failure and nearly twice the risk of death.</p>
<h2><span style="color: #00826a;">Cerebrovascular disease</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>The prevalence of cerebrovascular disease in diabetic patients is 3.5%, mostly due to arterial stenosis. Age is a major risk factor, with patients over 70 years old having a threefold higher risk. Other important risk factors include blood pressure, abnormal blood lipid levels, and patient age.</p>
<h2><span style="color: #00826a;">Peripheral vascular disease</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>Peripheral arterial disease, especially in the legs, is increasingly recognized as a major cause of amputation in diabetic patients.</p>
<h2><span style="color: #00826a;">Diabetic foot ulcer</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>Foot ulcers in diabetic patients result from multiple factors, which are consequences of poor diabetes control. These factors include peripheral arterial disease and peripheral neuropathy, which cause loss of protective sensation against foot injuries and reduced muscle function. This leads to uneven weight distribution and foot deformities, causing ulcers in pressure areas. Additionally, patients with poor blood sugar control have impaired white blood cell function, leading to infections and rapid progression.</p>
<p>&nbsp;</p>
<div style="text-align: right;"><span style="color: #00826a;"><strong>Dr. Ayutthinee Singhakowin</strong></span></div>
<div style="text-align: right;">Endocrinology and Metabolism Specialist</div>
<div style="text-align: right;">Diabetes and Endocrinology Center, Phyathai 2 Hospital</div>


Many diabetic patients have complications caused by abnormal blood sugar levels, which are the main cause of illness and can be severe enough to result in organ loss or death.

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