More to diabetes than glucose and insulin

People who live with diabetes are prone to diabetic complications, which effect the whole body. In particular the following areas are at particular risk.

Kidneys

The kidneys are damaged and may fail requiring special treatment to prolong life. Examination of a biopsy of a diabetic kidney will reveal diabetic nephrosclerosis characterised by the KimmelSteel-Wilson lesion.

Nerves

The nerves are damaged and this may lead to lack of sensation in the fingers and toes, or a major nerve trunk may be affected with loss of power and/or sensation in its distribution. Lack of sensation in the feet is a particular problem as the feet are then prone to the development of ulceration and infection, which may be impossible to heal. If the nerves of the autonomic nervous system are affected, the body may loose its abilty to change the heart rate when required or the intestines may loose the ability to move food along.

Infections

The body suffers a blunting in the ability to fight off infection. In particular some of the white blood cells do not function to full capacity.

Vascular system

The arterial tree is affected by accelerated atherosclerosis and and smallest blood vessels by a micro-angiopathy. The larger blood vessels may become so narrowed that they can no longer carry blood to the tissues. The small blood vessels may leak causing bleeding and damage to the surrounding tissues (eg in the eye).

Eyes

Damage to the eye includes, accelerated development of cataracts and damage to the retina (nerves and blood vessels) Bleeding into the back of the eye may cause blindness.

Skin

The skin may be affected by diabetic necrobiosis, and there may be changes at the sites of insulin injection (either atrophy or hypertrophy). Atrophy due to insulin injection may occur due to injury and scarring from repeated injection or it may be due to a reaction by the body to foreign insulin. Hypertrophy may occur due to excess local insulin effect at the site of injection, the site must be rotated.