About Type 1 Diabetes
Diabetes mellitus is a disease in which the body does not properly use glucose for energy, there are three main types: type 1, type 2 and gestational diabetes. Type 1 diabetes is generally diagnosed in younger individuals and involves destruction of the insulin-producing pancreatic cells by autoantibodies. Due to this destruction, the body produces little to no insulin, and blood sugar must be managed with regular exogenous insulin therapy. As this form of diabetes usually appears in younger patients, the disease is life long. Numerous complications of long term type 1 diabetes are possible, and they can affect any of the body’s organ systems.
The complications of long term type 1 diabetes generally fall into two categories: microvascular and macrovascular. Macrovascular complications affect the larger blood vessels, including the coronary arteries which supply blood to the heart muscle. Though macrovascular complications are seen more often in patients with type 2 diabetes. Microvascular complications effect the smaller capillaries which directly supply tissues with blood. This results in deterioration of the affected tissues.
Perhaps one of the most common complications of long term type 1 diabetes is the development of heart disease, sometimes called coronary heart disease (CHD) or coronary artery disease (CAD). A macrovascular complication, heart disease is a condition in which the arteries that supply the heart muscle—the coronary arteries—become blocked with fatty deposits called atherosclerotic plaques. Long term diabetes greatly increases a patient’s risk of developing CAD. Coronary artery disease has the potential to cause a heart attack, or myocardial infarction, or a stroke.
Many long-term diabetics develop a condition in the vasculature of the extremities called peripheral vascular disease. This can cause a host of other complications including infected ulcers on the feet.
A microvascular complication, diabetic retinopathy can result in diminished sight and even, blindness. In the early, nonproliferative stages, the capillaries in the retina leak fluid and blood causing problems with vision. Over time, damage to the capillaries causes them to die and they begin to regrow in the late, proliferative stage of diabetic retinopathy. It is important to watch for the signs and symptoms in order to prevent total blindness in diabetic patients.
Other eye-related complications experienced often by patients with diabetes are the development of cataracts—a clouding of the lens—or glaucoma—an increase in pressure within the eyeball which damages the optic nerve.
Over the course of years, diabetes patients can develop a set of complications called diabetic neuropathy. Several of these microvascular complications are possible. The most common type is peripheral neuropathy. This affects the nerves in arms, legs, hands and feet. Some patients experience pain while others experience numbness or loss of feeling. Autonomic neuropathy affects the nerves that serve the parts of the body we have no conscious control over, such as the heart, digestive tract, sexual response—such as erectile dysfunction in men or vaginal dryness in women—and bladder and bowel functions. Proximal neuropathy results in pain in the hips, thighs and buttocks; weakness in the legs occurs in later stages. Focal neuropathy occurs suddenly; patients experience weakness or pain in any single nerve or group of nerves.
Another microvascular complication, diabetic nephropathy affects the kidneys. Long-term high blood pressure—seen often in diabetic patients—causes damage to the capillaries in the kidneys. This severely affects their ability to filter wastes from the blood. Nephropathy is not as common as other complications, but is often seen in patients experiencing retinopathy.
While not as common, other complications seen in long-term type 1 diabetes patients may include:
Skin and mouth infections by bacterial or fungal agents-the disease may compromise the patient’s immune response to these factors
Osteoporosis-the disease may lower bone density
Hearing problems-capillaries may be affected in the inner ear causing deterioration of the mechanisms responsible for hearing
Mayo Clinic: Type 1 Diabetes: Complications
Juvenile Diabetes Research Foundation: Type 1 Diabetes Complications
MedlinePlus Medical Encyclopedia: Type 1 Diabetes
National Diabetes Information Clearinghouse: Diabetic Neuropathies: The Nerve Damage of Diabetes
Cleveland Clinic: Diabetic Nephropathy
American Diabetes Association: Diabetes and Hearing Loss