Makindo Medical Notes

Related Subjects: Type 1 DM | Type 2 DM | Diabetes in Pregnancy | HbA1c | Diabetic Ketoacidosis (DKA) Adults | Hyperglycaemic Hyperosmolar State (HHS) | Diabetic Nephropathy | Diabetic Retinopathy | Diabetic Neuropathy | Diabetic Amyotrophy | Maturity Onset Diabetes of the Young (MODY) | Diabetes: Complications |

🩸 Diabetic Complications in Type 1 and Type 2 Diabetes

Diabetes affects nearly every organ system through chronic hyperglycaemia, vascular damage, and metabolic stress. Complications are classically divided into acute and chronic (microvascular & macrovascular).

⚡ Acute Complications

• DKA (Diabetic Ketoacidosis) 🧪 – usually Type 1, due to severe insulin deficiency → ketonaemia, acidosis, dehydration.
• HHS (Hyperglycaemic Hyperosmolar State) 💧 – usually Type 2, very high glucose & osmolality → profound dehydration, altered consciousness, little/no ketosis.
• Hypoglycaemia 🍬 – from insulin/sulfonylureas → tremor, sweating, confusion, seizures, coma.

👁 Ophthalmological

• 👓 Cataracts – earlier onset, 2–5× risk.
• 🩸 Non-proliferative retinopathy – microaneurysms, haemorrhages, exudates.
• 🌱 Proliferative retinopathy – neovascularisation, vitreous bleed, retinal detachment → blindness risk.
• 💧 Macular oedema – central vision loss.
• 🌈 Rubeosis iridis – iris neovascularisation → neovascular glaucoma.
• ⬆️ Glaucoma – 2× risk compared to general population.

🩺 Renal / Nephropathy

• 💧 Proteinuria – earliest marker (microalbuminuria).
• 🛑 ESRD – dialysis / transplant required.
• ⚡ Type IV RTA – impaired distal acid secretion in advanced disease.

🧠 Neurological

• 🦶 Distal symmetrical polyneuropathy – glove-and-stocking numbness, burning pain.
• ⚡ Mononeuropathy – e.g. cranial (III, VI), femoral, peroneal.
• 🌀 Polyradiculopathy – painful asymmetric weakness.
• ⚙️ Autonomic neuropathy – gastroparesis, bladder dysfunction, postural hypotension, ED.
• 💪 Diabetic amyotrophy – proximal thigh wasting, pain, weakness.

🍽 Gastrointestinal / Hepatic

• 🥴 Gastroparesis – delayed emptying, bloating, vomiting.
• 🍺 NAFLD – common in T2DM; risk of NASH, cirrhosis.
• 💩 Diarrhoea & Constipation – from autonomic neuropathy.

🚻 Genitourinary

• 💧 Cystopathy – retention, incontinence.
• ♂️ Erectile dysfunction – vascular + neurogenic.
• ♀️ Female sexual dysfunction – reduced arousal & lubrication.
• 🌸 Genital candidiasis – recurrent thrush from glycosuria.

❤️ Cardiovascular

• 💔 IHD – major cause of death; accelerated atherosclerosis.
• 🫀 Heart failure – often HFpEF in T2DM.
• 🦵 PVD – claudication, ulcers, gangrene.
• 🧠 Stroke – ischaemic & haemorrhagic risk increased.

🦶 Lower Limb

• 👣 Foot deformities – hammer/claw toes.
• 🦴 Charcot joint – painless progressive arthropathy.
• 🩹 Ulcers – from neuropathy + poor healing.
• 🛑 Amputation – end-stage from infection + ischaemia.

🧴 Dermatological

• 🔥 Cellulitis, boils, folliculitis – recurrent infections.
• 🟤 Necrobiosis lipoidica – yellow-brown shin plaques.
• 🌑 Acanthosis nigricans – dark velvety folds, marker of insulin resistance.
• 🪨 Digital sclerosis – stiff, waxy fingers.
• ⚪ Eruptive xanthomata – lipid deposits in skin, esp. with hypertriglyceridaemia.

📊 Teaching Pearl

👉 Microvascular = Retinopathy 👁, Nephropathy 🩺, Neuropathy 🧠. 👉 Macrovascular = IHD ❤️, Stroke 🧠, PVD 🦵. 👉 Type 1 → more DKA/retinopathy. Type 2 → more HHS, macrovascular complications.