If you have diabetes, do you only look at your blood sugar?

*For medical professionals to read and reference In diabetes management, most patients only focus on blood sugar levels, but do you understand these complications? Diabetes is a chronic systemic disease.
Poor blood sugar control may affect the pathological changes of various organs.
Therefore, it is not enough to only focus on blood sugar.
Good sugar control should also prevent and manage various complications.
One of the goals shared by clinicians and patients
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But there are many complications of diabetes, so what are the specific ones? Diabetic complications can be roughly divided into vascular and non-vascular complications, let's talk about it in detail! Vascular complications Intracellular oxidative stress caused by high glucose is involved in diabetic vascular injury[1], among which abnormal levels of nitric oxide, tissue plasminogen activator, and adhesion factor [2] cause vascular endothelial dysfunction[3] It is the key link of vascular injury
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Vascular complications can affect various systems of the body, and can be divided into macrovascular complications and microvascular complications.
The former mainly refers to atherosclerosis and cardiac autonomic neuropathy, which can cause cardiovascular and cerebrovascular accidents.
Among them, myocardial infarction is the primary cause of diabetes patients.
Cause of death [4]
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The latter mainly include extremities, kidneys, retinopathy and secondary neuropathy
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The intima of the atherosclerotic human body is very thin, the thickness is only equivalent to the diameter of a single cell, and it is the part of the blood vessel that is in direct contact with the blood flow
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When the glucose concentration in the blood is too high, it can stimulate and damage the lining of blood vessels, resulting in fat deposition
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The release of vasodilators such as nitric oxide [5] is reduced, which narrows the inner diameter of blood vessels and restricts blood flow, which is conducive to thrombosis and plaque rupture
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Atherosclerosis is the most common vascular complication of diabetes.
Under the combined effects of metabolic syndromes such as hyperglycemia, obesity, and hypertension, the rate of atherosclerosis in diabetic patients is much faster than that in normal blood sugar [6]
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Peripheral Vascular Disease Arteriosclerosis leading to reduced blood supply to peripheral tissues, especially the hands and feet
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The early sign of peripheral vascular disease is calf pain when walking [7], which is caused by the accumulation of lactic acid due to insufficient blood supply and hypoxia in the calf.
Patients often need to stop and rest until the pain subsides before continuing to walk, which is called intermittent claudication.

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Peripheral neuropathy is mainly caused by sclerosis and stenosis of peripheral blood vessels, the blood flow is not enough to nourish the nerves, the nerves begin to atrophy, and some nerve fibers die
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In addition, during high blood sugar, sugar reaches nerve fibers through capillaries, and is partially reduced to sorbitol [8], which accumulates rapidly, causing excessive osmotic pressure and disturbing normal metabolism, shrinking nerve cells, and reducing the ability to conduct nerve impulses.

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In peripheral neuropathy, the sensory function of the extremities is progressively damaged, and "gloves and socks" are typical manifestations
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The harm of peripheral nerves is mainly due to the patient's partial loss of consciousness, even if they suffer from external trauma, such as shoes on the feet, inadvertently stepping on sharp objects, kicking stones,
etc.

Due to factors such as vascular disease and neuropathy [9], diabetic patients have wound healing barriers, and if the extremity is injured by infection, it may not heal and develop into "diabetic foot"
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In some patients, peripheral neuropathy can also cause paresthesias (numbness, tingling, or even itching) or hypersensitivity (oversensitivity to cold and heat stimuli) [10]
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To avoid danger, a person who feels overly sensitive should not take a very hot bath or take items from the refrigerator
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Similar to sensory nerves, autonomic neuropathy can damage the autonomic nerves due to hyperglycemia, typically with reduced production of sweat on the feet
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The skin of the hands and feet is the thickest of all parts, and to avoid dry skin, the hands and feet produce the most sweat
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Each sweat gland is innervated by autonomic nerve fibers.
When the autonomic nerve is damaged, it cannot stimulate perspiration, and the skin of the foot cracks [10], which provides an opportunity for the invasion of pathogenic bacteria, and in severe cases, gangrene occurs
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Another common presentation of autonomic neuropathy is gastroparesis
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In a physiological state, food stays in the stomach for 2 to 4 hours, and the autonomic nervous system initiates the stirring process to break the food into chyme, and the pylorus opens intermittently to expel the digested food into the small intestine
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When the autonomic nerve is injured, the stirring function of the stomach and the opening of the pylorus are reduced, and the partially digested food cannot enter the lower gastrointestinal tract, causing symptoms of bloating, flatulence, and nausea [11]
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Another study showed that cardiac autonomic neuropathy affects 22% of patients with type 2 diabetes
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Cardiac autonomic neuropathy has an insidious onset and can be asymptomatic for a long time.
It has been ignored by patients and doctors, but it is closely related to the occurrence of painless myocardial infarction and sudden cardiac death, of which 50% to 75% of sudden death is due to malignant arrhythmia.
[12]
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Sexual dysfunction is associated with reduced blood flow to the reproductive organs and neuropathy
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About 50% of men with diabetes have erectile dysfunction [13]
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Women may have decreased libido, vaginal dryness, and dyspareunia [14-15]
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Diabetes mellitus is an important cause of end-stage renal disease due to renal insufficiency [16].
Hyperglycemia causes the glomerular filtration membrane to be destroyed, allowing macromolecular substances to be filtered, resulting in proteinuria
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Diabetic retinopathy Diabetic retinopathy is the leading cause of blindness in diabetic patients [17]
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The retina is the light-sensitive area of ​​the eye with dense distribution of small blood vessels
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The walls of these blood vessels in people with diabetes become brittle, and if they rupture, plasma leaks into the retina
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The rods and cones exposed to the blood die rapidly, causing the loss of photoreceptor function in part of the retina, and a "black spot" appears in front of the patient's eyes
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When the blood vessels in the fundus are damaged, growth factors can be released to induce angiogenesis, but the newly generated blood vessels are often abnormally distorted, aggravating blurred vision
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Changes in extracellular fluid osmotic pressure caused by nonvascular complications of hyperglycemia can also damage the lens and inhibit immune cell function
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Cataracts Cataracts can damage the vision of people with diabetes
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The eyeball consists of two parts, the anterior chamber filled with aqueous humor and the posterior chamber filled with jelly-like vitreous humor
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Sitting between the two chambers is a lens that focuses light
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Both the aqueous humor and vitreous humor of diabetic patients contain high levels of glucose, which is metabolized into the lens into the aforementioned sorbitol, which accumulates in the lens and, together with glucose, attracts water through osmosis [18]
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The lens begins to expand, damaging its internal structure and becoming opaque, a cataract
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Hyperglycemia in opportunistic infections reduces the count of T lymphocyte subsets in peripheral blood [19], inhibiting the function of the immune system
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Hyperglycemia itself can also cause a range of pathogenic microorganisms to grow in the body
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Candida albicans can cause thrush, fungal stomatitis, Candida vaginitis, and occasionally systemic candidiasis [20]
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Staphylococcus, Streptococcus, and Clostridium infections are also common, especially in diabetic feet, where ulcers and skin ruptures provide a route for pathogens to invade
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People with diabetes are more prone to flu and have more severe symptoms because higher glucose concentrations in respiratory secretions can lead to secondary infections
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During influenza outbreaks, the hospitalization rate of diabetic patients is 6 times higher than that of the general population [21]
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 How to do a good job in the prevention and treatment of complications The above-mentioned complications of diabetes will affect the quality of life in light, and threaten life in severe cases, so the prevention of etiology is very important
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Diabetic patients often have metabolic syndrome.
While controlling blood sugar, blood pressure and blood lipids should be monitored to delay the occurrence of vascular complications
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While receiving drug treatment, smoking cessation, low-salt and low-fat diet and aerobic exercise are all effective interventions [22]
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