Karkhanis Super Speciality Hospital

Hello!

I’m Dr. Shefali Karkhanis . I’m practicing diabetes specialist at Thane, Mumbai.

Today I’m going to give you an overview about complications of diabetes. We all know that diabetes is basically a high blood sugar cause because of imbalance between the supply of insulin from the body and the demand the body has for insulin. I’m going to talk about complications of diabetes because diabetes is going to affect each and every cell of your body, right from your hair from top of your head to the nail at the bottom of your feet. So problem with diabetes is that all of these complications are generally silent. So you do not feel that there is a problem.

The complications develop with time and it depends upon the duration of diabetes as well as the severity of the same . Which means the longer that you have diabetes, the more is a risk of you developing complications. Similarly, the higher the control of sugar the better is your risk of not developing complications . That means if a person is having diabetes for about 10-15 years, there is a definitely a risk that he has some or the other form of complications with him.

But if he is being well controlled for all these ten years the risk reduces exponentially. On the other hand, if the patient is only diagnosed for the last 3-4 years but he has very high sugar or a very high fluctuating sugar, he is more likely to develop complications very soon. Complications can be divided into 2 parts - one is acute and one is chronic. Acute complications include 1: very high blood sugar which will lead to acidosis, coma-like conditions and the person has to get hospitalized and be on insulin , 2:  low sugar i.e. very low sugar wherein the patients feel dizzy and has shivers while sweating due to which he might even land into an unconscious state.

The treatment of these two is very simple. If the sugars are very high, take him to a doctor, treat him with insulin, and bring down the sugars, correct the acidosis and everything will be fine. If the patient is having low sugar before going to the doctor you can treat it. Just put in some powdered sugar or a paste of powdered sugar inside the mouth and the patient’s blood sugar will slowly start increasing and then he can be transferred to hospital. 

The causes of hypoglycemia are 1: If the patient is taking erratically erratic medications ; 2: If the patient is fasting at times ; 3: If the patient's dose is not adequate or he is taking multiple doses at a time or 4: If the patient just skipped a meal all together in spite of taking the medications. So in any of these conditions you can get low sugar and the easiest thing to do is to put sugar in the mouth. Do not give water to unconscious patient because it might cause other complications. Diabetes will affect major organs such as your eyes, heart, kidney, nerves as well as blood vessels. In your eyes there is something called as Retina. Retina is like the brain of the eye and if there are small bleeding spots in the retina but the vision is 100% normal,  you do not realize there is a spot inside. These aneurysms and microhemorrhages can be diagnosed at an early stage by an eye doctor. Once it is diagnosed , it can be treated and brought to normal immediately.

In the second stage these microhemorrhages become larger in size and there is bleeding inside your eye and that is when you have vision disturbances but by then only oral medication is not going to help you. So depending upon the damage you might require injections, lasers other procedures etc. The same thing happens with your heart. Your heart, the blood vessels to your heart gets affected because of diabetes and this will reduce the amount of blood supply to your heart making you more prone to develop heart attacks. In diabetic people , the heart attacks are many times silent so there might not be a lot of chest pain but there might be wake symptoms like small pain in the back or discomfort or heaviness or you just might feel breathless especially on walking especially on lying down. So all of these things will need to be addressed and you have to undergo a treadmill test regularly to ensure that your heart is fine. The second thing that happens in the heart is thata the pumping capacity comes down , so the heart does not pump as well as it used to.

Again this can be diagnosed with a simple noninvasive technique like an echo which can be done by any cardiologist and this will give you better idea about the condition of your heart. The third thing that gets affected is your kidneys. Now kidneys are like filters. So the holes are very very small . Because of diabetes these pores will start increasing in size and the protein in your body will start leaking into your urine. But there will be no signs no symptoms no problems what so ever. It is very simple again to diagnose it with a simple urine test called microalbumin and if this is positive that means your kidney damage has started and it can be reverted back to normal just with medications. A good control of diabetes as well as good control of blood pressure will help your kidney a long way to run properly. By the time creatinine goes up , it means there is extensive damage in both your kidneys and then it is difficult to bring it back to normal. However it can still be controlled, but at the end of the story probably you will end up in dialysis. So you have to start taking care of your kidneys right at the very beginning. The last is the nerves and the blood vessels.

The nerves of your feet are most commonly affected so some people might have feelings like tingling, numbness, loss of sensation. There might be episodes where the chappal slips out and you don’t realize it, there might be episodes when there is a small little ulcer or a small bite but you know it doesn’t pain. Then there can be loss of hair from your lower limb. All of this is a sign of nerves getting damaged .Secondly the blood supply starts getting hampered. This is more common in patients who smoke or who have tobacco usage. This will lead to development of small ulcers and there is a higher risk of amputations in these patients. All diabetic patients must check their sugars monthly, both fasting as well as postprandial , just to ensure that the sugars are well under control . hba1c that is the average of the last two to three months - this test must be performed at least once in six months if not 3 months.

Annually every diabetic patient must undergo a routine test to rule out any complications including their eyes, heart , kidneys as well as the blood supply to their feet . So all of these tests are essential for all diabetic patients and I cannot stress this enough because diagnosed in the early stages everything can be reversible to a large extent. However the moment you wait for your symptoms to appear it is already too late. Remember diabetes is your life partner, it will not go away and there is no divorcing it so you have to control your sugars well and if you control them then you can lead not only a long life but a very healthy life also.

So please start taking care of your diabetes from today. if you have any other queries you can contact me via Lybrate. Thank you!

Hello, I am Shefali Karkhanis, I am a practising diabetes specialist in Thane, Mumbai. Today I am going to talk about a different topic call gestational diabetes. What is gestational diabetes, diabetes which is diagnosed first during the pregnancy, it is called as gestational Diabetes. This can occur all throughout the 9 months of pregnancy it does not mean that it will last forever, in 90% of the patients after the delivery of the child, diabetes also disappears. However, there are few patients who will continue to have diabetes even after delivery of the child. Why does it occur, of course, its an interplay of hormones the pregnant womb is like a firecracker it's an atom bomb of hormones. So there are a lot of hormones which are released in the mother's body during the pregnancy, this increases the need for insulin from the weather and when this demand is not meant that is when you develop gestational diabetes, 90% of the times after the delivery these pregnancy hormones come back to normal and so does your diabetes. If it continues, well you develop diabetes for life. Who are at risk of diabetes during pregnancy, the patients who have a family history of diabetes, patients for more than 25 years of age, patients who have a history of having developed diabetes during the previous pregnancies, patients who have delivered a child who was more than 3.5 kg in worth weight, patients who have had a history of miscarriage or spontaneous abortion in the past, patients who have had a history of PCOS or Polycystic ovarian disease , a patient who has obesity and it is overweight before pregnancy, patients who have had a history of hypertension or blood pressure before pregnancy, patients who have had acanthosis that means blackish discolouration beneath your neck line as well as beneath your armpit which are signs insulin resistance, patients who have had delivered a child with malformations or with some kind of abnormalities. All of these patients are at high risk of developing diabetes so are they the only people who should be scream, no. Every pregnant lady must undergo a screening for diagnosis of diabetes at the time when you diagnose with pregnancy, so the day you come to know the good news about having been pregnant you must test for diabetes to make sure that your pregnancy is healthy all throughout. It's a very easy test, you have to the obestatin at the time of the first visit, will give you a glucose load and one hour later that is a blood sample which is connected, this is called as, spot test for diabetes. Now if this is positive then you have to undergo a little elaborate test called oral glucose tolerance test, wherein you go on fasting stomach they collect the blood sample another glucose load is given and periodically samples are collected. Anyone of the sugars if they are high you is diagnosed with gestational diabetes and you will meet treatment immediately.

There is another test which is called Hba1c, HbA1c will give you an average of last 2-3 months and if it is positive then again you are diabetic. During the pregnancy you will have to have immediate treatment and we'll have to continue treatment probably throughout the pregnancy HbA1c is a very important factor because the higher the HbAa1c the more is a risk to develop complications as well as a child to develop problems, so the higher the HbAa1c levels that means the patient probably has diabetes even before the onset of pregnancy and it was just not diagnosed at that time. So uncontrol hyperglycemia is associated with a higher rate of miscarriages a higher complication in mother and higher from congenital anomalies in the baby. Early diagnosis is very very important and so is the control of blood sugars all throughout the pregnancy you know that there are only 9 months that you got the foetus, so every day is extremely important for the child as well as for you, so control sugars every single day is essential that cannot be any cheat days during the pregnancy and diabetic control. The effects on the baby are many, the most commonly will see that the baby is a big baby that is the birth weight is almost more than 3.5 kgs, sometimes a liquor i.e. the fluid inside the womb is also very very high, there can be hard defects, there can be spinal defects, most commonly find up Bifida. There can be brain defects in the child sometimes these babies are of very low weight, so that can be one of the things. The respiratory system, the lungs are not very well developed in this children so it might have to be put on ventilators after delivery. There might be a chance of kidney malformation in the child. So all of these things are very very important, similarly to the mother also in the mother they can we increase chances of infection whether it is unary infection, whether it is vaginal infections there can be repeated spontaneous miscarriages or abortions, they can have blood pressure during the pregnancy just because they are not controlled with diabetes, they can have vascular complications. These patients have a higher risk of going into preterm labour that means delivering before the 9 months are completed. They are more prone to placental bleeding or bleeding through the vagina during the pregnancy and of course preeclampsia and eclampsia that means fits or seizures during the pregnancy. Treatment of diabetes in pregnancy is very simple and it has to be maintained, the goal for treatment is a lot lower than the normal person so we attend to target the fasting values at around 95 and the postprandial or after food values at around 120. The diet forms a very important part of the treatment of diabetes, the calorie restriction is not so much because now you are eating for 2 people so you have to have a nutritionally balanced to meet. So we do not restrict the calories but we restrict the calories from carbohydrates, simple sugars and sweets are absolute no no you cannot have any form of sweet all throughout the pregnancy, if you are a diabetic, diet has to be well planned and well balanced. So you are nutritional compromises should not happen it is ideal that you need a dietician before you start with this kind of a diet. Exercise again if you are permitted by the obstetrician only and only when exercise is recommended.

I generally recommend patients simple walking half an hour or two times a day or yoga under the guidance of experts, but again this has to be done only and only if your obstetrician agrees to that fact. Coming to the medications oral hypoglycemic agents and not being safe for use during pregnancy. Except from metformin which can be used in the earlier half, insulin is the drug of choice for pregnancy. The sound of insulin gets everyone scared, there will be 100 other people who will come and tell you that this means that you are in the last stage of diabetes or this means you'll be addicted to the insurance etc-etc-etc. this is not the case. Insulin is very safe to be given and diabetes because it not only promote healing but it also is very good for control of sugars only thing is it is an injectable. So, yes you have to inject yourself once a day, maybe twice a day, maybe three times a day depending upon how is your sugar levels Vary, always remember that the requirement of insulin will increase as a pregnancy growth. So as your child is becoming bigger you are hormones are waiting Haywire and your insulin levels also will keep on increasing, so there is nothing wrong with that. You have to realize that 90% of the time after delivery, when the sugar comes back to normal, the dosage of insulin also stops. Even if your sugars do continue after delivery the requirement of insulin will come down drastically, so it will not be the same amount of insulin that you will be required as you required during your pregnancy. If you do continue to have diabetes this advisable to continue insulin, till the time that you are breastfeeding the child because again, it is safe for both you as well as a child. However, once the child is big enough is being off the milk, you can go back to having oral medication, so definitely insulin does not detect, so you can be get assured about that all the complications of the child, as well as the mother, can be easily avoided just by early diagnosis and by correct treatment of your diabetes, also your pregnancy and that is whatever be patient should aim at. A regular follow up is a must with your diabetologist as well as your obstetrician because just because you do not feel it, does not mean that it isn’t there. So don't wait for symptoms to appear because, by the time the symptoms appear in you, it might be too late for both you as well as your child, so take care of your pregnancy right now,

Thank You. If you have any other queries you can contact me at Lybrate