April 17, 2017
The Major Long-Term Complications of Uncontrolled Diabetes Mellitus

Diabetes mellitus (sometimes called “sugar diabetes”) is a medical condition that occurs when the body cannot use glucose (a type of sugar) appropriately. Glucose is the main source of energy for the body’s cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by an organ called the pancreas. Insulin is secreted in the blood and acts as a vehicle to allow for glucose to enter from the blood stream into the cells. The latter in turn, convert glucose into energy to complete their essential functions.  Statistics indicate that some 25.8 million children and adults in the United States—comprising about 8.3% of the U.S. population— have been diagnosed with Diabetes.

Diabetes occurs either when the pancreas does not make enough insulin (Type I Diabetes) or, when the body can’t respond normally to the insulin that is available (Type II Diabetes). This causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst, persistent sensation of hunger and unexplained weight loss.

All forms of diabetes increase the risk of long-term health complications as the unutilized glucose molecules circulate in the blood stream and eventually start to interfere with the normal physiology and function of different tissues.

The major long-term complications of Diabetes are by and large related to damage caused in the circulatory system. In fact, Diabetes irreversibly damages the large blood vessels, doubling the risk of cardiovascular disease in the form of ischemic heart disease (angina and myocardial infarctions), cerebrovascular disease (stroke and transient ischemic attacks) and peripheral vascular disease (atherosclerosis of the blood vessels of the extremities). In addition, Diabetes damages the small blood vessels found in different organs leading to conditions like retinopathy of the eye that can result in blindness, nephropathy that can advance to kidney dysfunction and failure and immunosuppression that increases the risk for infections and delays the healing process.

Patients with uncontrolled Diabetes mellitus are also at an increased risk of developing dermatologic complications in their lower extremities that usually present in the form or open sores (diabetic Ulcers).  It is indeed the impact of diabetes on the nerves, (diabetic neuropathy) most commonly manifesting itself as numbness, tingling and pain in the hands and feet that leads to skin damage due to altered sensation. Together with blood vessel disease (diabetic angiopathy), neuropathy increases the risk of diabetic foot wounds and infections which can be very difficult to treat and in some cases lead to amputations.

Early intervention to identify the cause of the wound, arrest its progression and promote healing and closure are paramount in the treatment and prevention of diabetic foot infections and related complications. A team approach that includes several medical providers but, to no lesser extent the patient’s own contribution and compliance with the prescribed regimen are essential in order to optimize the treatment outcome and minimize morbidity.

Here at the Wound Care Center of Harrington in Charlton MA, a team of experienced and caring physicians and nurses that includes Podiatrists, General, Vascular and Plastic Surgeons and Infectious Disease specialists, works closely with the patient’s Primary Care Physicians, Nutritionists, Endocrinologists and doctors of all other disciplines, in order to create a treatment plan that is customized to every patient’s individual needs and concerns.

The most sophisticated wound healing techniques of hyperbaric oxygen chambers and human tissue analogues in conjunction with the more traditional debridement and offloading of foot ulcers, the use of antibiotic medications and surgical revascularization are implemented in a comprehensive manner and in accordance with FDA-approved clinical practice guidelines to create an environment that is conducive to wound healing and comfortable to the patient. We emphasize the importance of prevention, proactive intervention and diabetic education to optimize glucose control, avoid complications related to diabetes and reduce the chances of re-ulceration and repeated hospitalizations.

Submitted by Georgios Poniros, D.P.M., FACFAS, a podiatrist and a Fellow of the American College of Foot and Ankle Surgeons.

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