Diabetes Prevalence Continues to Rise

"It represents an important burden on both societies and individuals in material and spiritual terms," said Assoc. Prof. Dr. Irmak Sayın Alan, Internal Medicine Specialist at Istanbul Okan University Hospital, as he explained the health problems caused by diabetes in early and late stages.

If Left Untreated, It Progresses to Altered Consciousness and Coma

The main acute complications of diabetes are diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), lactic acidosis and hypoglycemia. DKA and HHS are two important metabolic disorders resulting from insulin deficiency and severe blood sugar elevation, with largely similar treatment approaches. While insulin deficiency is the primary problem in DKA, fluid deficiency is the main issue in HHS. The symptoms of DKA include frequent urination, dry mouth, excessive water intake, increased appetite, weight loss, nausea, abdominal pain, weakness, palpitations, low blood pressure, and acetone breath odor. In untreated cases, the condition progresses to altered consciousness and coma. HHS frequently occurs in elderly patients and those with restricted access to water. Particularly in elderly patients, as it can present with only neurological signs, careful attention must be paid to this issue. Symptoms include weakness, frequent urination, dry mouth, excessive water intake, palpitations, low blood pressure, skin dryness and reduced skin turgor.

Watch Out for Hypoglycemia!

Hypoglycemia is defined as blood sugar level at 50–55 mg/dl, presence of symptoms consistent with low blood sugar in the patient, and resolution of these symptoms with treatment that eliminates the low blood sugar. The symptoms of hypoglycemia include sweating, trembling, anxiety, dizziness, hunger, palpitations, vision disturbance, fatigue, headache and irritability. Hypoglycemia is clinically classified as mild, moderate and severe. Patients can self-treat mild and moderate hypoglycemia. The difference between moderate and mild hypoglycemia is that it significantly affects the patient's activities. However, severe hypoglycemia is a serious condition requiring external assistance and intravenous treatment, usually causing coma or seizures. Hypoglycemia carries many risks including psychological and neurological disorders, heart attack and arrhythmias, eye hemorrhage and worsening of retinal damage related to diabetes, as well as the occurrence of traffic, home or occupational accidents. If the patient is conscious and able to swallow, hypoglycemia treatment involves oral administration of 15–20 g glucose (preferably 3–4 glucose tablets/gel, 4–5 sugar cubes or 150–200 ml fruit juice or lemonade). Products containing fat such as chocolate or wafers should absolutely not be used. After each hypoglycemic episode is treated, the causes should be reviewed and if necessary, patient education should be repeated.

Chronic Complications of Diabetes

These can be classified as cardiovascular diseases, cerebrovascular diseases, peripheral (leg, etc.) vascular diseases, and retinal, renal and nervous system disorders related to diabetes. For retinal damage related to diabetes, all patients should be screened by an ophthalmologist once a year and monitored from this perspective. Based on the degree of retinal damage, the frequency of follow-up should be determined by ophthalmologists. For kidney damage related to diabetes, all patients should be screened for microalbuminuria in urine once a year. In patients with microalbuminuria detected in urine, the progression of the condition can be halted through use of certain blood pressure medications, strict blood pressure control and strict blood sugar control. If the condition cannot be halted, the risk of kidney failure in patients increases.