Page 283 - fourth year book

DIABETES MELLITUS

 Persistent albuminuria (>300 mg/d or >200 μg/min) that is
confirmed on at least 2 occasions 3-6 months apart

 Progressive decline in the glomerular filtration rate (GFR)
 Elevated arterial blood pressure (see Workup).

 Symptoms

Patients usually have no symptoms early on, but as the disease

progresses, they may feel tired, become anemic, not think clearly, and

even develop dangerous electrolyte imbalances.

 Diagnosis

Early diagnosis can be made by a simple urine test for protein as
well as a blood test for kidney function.

 Prevention and Treatment

If diagnosed at an early stage, several measures can retard the

progression to kidney failure. These include control of high blood
glucose, control of high blood pressure, intervention with medication in

the early stage of kidney damage, and restriction of dietary protein.

3. Neuropathy (nerve disease)

 Etiology

Diabetes causes nerve damage through different mechanisms,

including direct damage by the hyperglycemia and decreased blood flow
to nerves by damaging small blood vessels. This nerve damage can lead
to sensory loss, damage to limbs, and impotence in diabetic men.

 Symptoms:

The symptoms are many, depending on which nerves are affected:

for example, numbness in extremities, pain in extremities, and
impotence. Decreased sensation to feet can lead to patients not

recognizing cuts and developing foot infections. If not treated early,
these can lead to amputation (more about diabetic foot disease below).

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