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Diabetic Nephropathy Diabetic Nephropathy occurs in both Type 1 and Type 11 diabetics. The incidence of nephropathy in Type 1 is higher than in Type 11 diabetics. Proteinuria (albuminuria) is the clinical sign that nephropathy has developed. A reading of >300mg/l albumin/protein in the urine

indicates nephropathy. This proteinuria indicates that the glomerular filtration rate is decreasing progressively. Over 3 - 20 years (average 10), this will result in end stage renal disease (Kidney failure). If the diabetic also has uncontrolled High Blood Pressure, this progression to kidney failure will be faster. End stage renal disease requires dialysis as treatment on an ongoing basis. A mechanical means is used to remove the toxins from the blood that the kidneys would normally remove. There are two types of kidney dialysis. These are peritoneal dialysis or hemodialysis . Hemodialysis is more effective at removing toxins from the blood than peritoneal dialysis, but is far more costly as extremely sophisticated machinery is used in the process. This is through highly specialized units in hospitals. Peritoneal dialysis can be carried out at home, but is time consuming and must be done on a daily basis. Once again we see that complications of uncontrolled diabetes can lead to great expense, dependency on sophisticated and expensive medical treatment and changes to the daily life of the individual.

NEUROLOGICAL COMPLICATIONS

Diabetic neuropathy

Diabetic peripheral neuropathy usually occurs symmetrically (i.e. both sides of the body are affected) the symptoms are numbness, tingling, of the limbs. Sometimes this can progress to severe pain that prevents a person from carrying on their normal daily tasks.

Diabetic autonomic neuropathy usually occurs with peripheral neuropathy. Symptoms of this may be postural hypotension, abnormal sweating, impotence and retrograde ejaculation in men, damaged bladder function, and gastrointestinal symptoms such as delayed stomach emptying, constipation or nocturnal diarrhea.

Diabetic neuropathy causes foot ulcers – one of the most common complications of diabetes. Because of decreased ability to experience sensation such as pain and discomfort, small irritations of the feet can cause damage that develop into ulcers. With the concurrent decrease in blood flow caused by vascular disease, the ulcers are difficult to heal. The result can be gangrene and amputation of the limb.

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