Gingivitis is called gum disease. Bring the mirror closer and look at your gums. Are they light pink? This is a good sign.
But if the gum tissue is red (especially the “triangles” between the teeth) and looks swollen, perhaps this is gingivitis. Although only a dentist will definitely say 100%.
There are many reasons for the development of inflammation. For example, laziness when caring for teeth. Or the persistent unwillingness of many to go to the doctor on time and treat tooth decay. But the gums are inflamed in the first place. Diabetes mellitus (any type) refers to diseases that are directly related to gingivitis.
- blood circulation in the soft tissues is disturbed,
- salivation often decreases, and then harmful bacteria can accumulate in the mouth,
- tooth enamel changes pathologically,
- immunity weakens.
It turns out that even careful care of your teeth and gums will not always help to avoid gingivitis in diabetes - very quickly this disease can occur and develop.
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How dangerous is this?
On its own - almost none. Inflammation most often affects only the surface of the gums, the jaw bones do not suffer. It is rather a signal that not everything is in order. But with diabetes there are no simple and mild diseases. So, gingivitis requires the attention of both the patient and his dentist.
In the most severe cases, the teeth fall out. If left untreated, it is quickly complicated by periodontal disease. And this is already a significant problem - bleeding gums, their friability, tooth mobility (this is very difficult or does not allow to chew).
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How is it treated?
Your dentist must have special knowledge of the rules for working with diabetic patients. In addition, without special urgency and special indications, any dental treatment should be carried out to compensate for the disease.
- Removal of deposits on the teeth (they provoke inflammation of the gums). Only a doctor does this!
- Anti-inflammatory therapy. At this stage, rinse your mouth regularly, make applications for the gums. For this, decoctions and infusions of herbs or fees, as well as special medicines are used.
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Prevention for diabetes
- Careful control of sugar is already one of the measures. Compensated diabetes is the minimum of complications, including in the dental plan.
- Attentive, without any laziness, hygiene of teeth and gums. For example, only brushing your teeth with diabetes is not enough. It is important to rinse your mouth thoroughly after any snack.
- You need to go to the dentist constantly, according to the schedule prescribed by the doctor.
- If you smoke - quit urgently, do not add problems.
Remember that impaired carbohydrate metabolism is difficult to treat at dentists. The fact is that in diabetics the pain threshold is lowered. And they get tired faster. And then for a long time to sit in the doctor’s chair simply does not work. So watch out for your teeth and gums - this will add to your health.
You can choose the right doctor and make an appointment right now:
How to fight a cold with diabetes
With such an insidious disease as diabetes, any cold can provoke the development of severe complications. That is why they need their speedy and professional treatment, not with ice cream. Only this will help maintain the state of health in diabetes at a good level, and, therefore, will provide an opportunity to cope with the disease itself. About this and much more later in the text.
About sugar level and other details
So, since even the most insignificant at first glance colds can cause complications, certain rules must be followed, as with cranberries. In particular, competent treatment involves constant monitoring of the ratio of glucose in the blood. It is about measuring this indicator every three to four hours.
If a cold with diabetes is accompanied by a too high glucose ratio, then you should use it, be sure to take it in small sips:
- sugar-free ginger drink and bananas.
It is always necessary to control the food and drinks that are consumed in addition to the standard diet for diabetes. This will make it possible to verify how exactly the products and drinks used affect the human body, like oranges. As part of the disease, the human body very slowly produces and metabolizes insulin. This subsequently leads to hyperglycemia.
The fight against it and treatment of the body should be under the constant supervision of a specialist.
Almost always requires special injections of insulin, prescribed in excess. These can be not only short, but also ultrashort preparations. They are recommended to be performed every three to four hours, as well as pineapple.
It is important to remember that each of the degrees of temperature after 37.5 needs to increase the ratio of the hormone by 20-25%. Only in this case, the common cold and developing diabetes will be suspended.
About the features of the state
The common cold with diabetes mellitus of the first and second type has its own characteristics. What exactly is it about? First of all, that in the framework of the common cold, at the very beginning, a person may not feel hunger. However, it is still extremely important to eat something - it will make the treatment faster and more correct. A diabetic can choose food based on his standard diabetic diet.
At high temperature, vomiting, or upset stomach, one glass of liquid should be consumed every hour. In this case, it is best to drink water and do it in small sips for an hour. In case of improvement, it is permissible to consume no more than 15 grams of carbohydrates every 60 minutes:
- half a cup of cereals with natural fruit yogurt,
- a small amount of fruit.
Thus, the treatment will be complete, but what about the drugs used?
Some of the OTC medications are also suitable for diabetics. However, it is important to ensure that foods with a high glucose ratio are not consumed. We are talking about cough syrups, colds, instant potions, sore throat lozenges and many others. With rare exceptions, they include a large amount of sugar, and simply will not be suitable for the common cold of a diabetic. Therefore, it is necessary to carefully study the list of components of the drug in order to determine whether there is sugar in it.
If you have any suspicions, you should consult with a specialist so that the treatment is effective. In addition, when colds and developing diabetes follow together and are accompanied, in addition, by high blood pressure, the use of medicines such as decongestants should be avoided.
This is because they can increase the blood pressure of a diabetic even more.
In cases where a diabetic has symptoms such as:
- chest pains
- pungent odor of acetone from the oral cavity,
- diarrhea and vomiting for more than six hours,
and also there is no improvement in health after two days, it is recommended to call an ambulance.
In the same case, when the tests show a high ratio of ketone bodies in the urine, and the amount of glucose after three consecutive measurements remains high (more than 13.9 mmol per liter) or low (less than 3.3 mmol per liter), you need to contact a practitioner .
What is gingivitis, and why does it get its development in diabetes?
Gum hormonal hypertrophy, or pregnant gingivitis. Hormonal gingivitis is a hyperplastic reaction of the gums to microbes found in plaque. The disease is usually observed in women during pregnancy, less often during puberty and menopause. In the pathogenesis of the disease, an increase in the levels of estrogen and progesterone caused by hormonal changes, as well as the use of oral contraceptives in the past, play a role. Under the influence of these hormones, the vascularization of the gum tissue increases, causing a pronounced inflammatory reaction to plaque.
Hormonal gingivitis begins with lesions of the gingival margin and interdental papillae and is usually observed in the second month of pregnancy. Gingivitis is manifested in hyperemia and edema of the gums, especially the interdental papillae, and soreness of the gingival margin. Gums on palpation are painful, bleed easily. Brushing teeth in pregnant women often causes nausea, which leads to insufficient oral care. The increase in microbial contamination caused by this increases the manifestations of gingivitis.
Hormonal gingivitis easily treatable at home. It consists in thorough oral care, dental prophylaxis. Recovery is facilitated by the rapid spontaneous normalization of the hormonal background after childbirth or its medical correction. Sometimes the symptoms of gingivitis persist for a long time, which leads to gum fibrosis, they become dense, light pink. In some pregnant women, a pronounced local hyperplastic reaction is possible, leading to the formation of pyogenic granuloma. Excess fibrous tissue of the gums and tumor-like growths are excised.
Diabetes - A common metabolic disease that affects 1-3% of the US population, among Latin Americans the prevalence of diabetes is much higher and reaches 15-20%. Diabetes is characterized by insufficient production of insulin (type I diabetes mellitus) or a violation of its absorption by tissues (type II diabetes mellitus), which leads to an increase in blood glucose. The manifestations of diabetes include hyperglycemia, glucosuria, polyuria, polydipsia, itching, weight gain or weight loss, weakness, decreased visual acuity and skin sensitivity, increased risk of infection, dry mouth, burning sensation in the tongue, persistent gingivitis. Often observed complications associated with the defeat of large and small vessels.
Manifestations of gingivitis depend on the severity of diabetes. With an insufficiently effective treatment of diabetes, the gingival margin and the fixed part of the gums grow. The overgrown tissue has a soft texture, red color, sometimes bleeds easily. The surface of the gums as a result of hyperplasia becomes convex or papular-nodular. The growths can be on a wide base or have a stem. Dry mouth, a characteristic smell when breathing, destruction of the alveolar bone as a result of periodontitis are often noted. Gingivitis in diabetes is difficult to treat if the glucose level remains high. This is due to a change in the nature of the inflammatory reaction of periodontal tissues. The success of treatment largely depends on caring for the oral cavity, maintaining a normal glucose level through diet and sugar-lowering drugs, including insulin. Surgical treatment is permissible only if the blood glucose level is less than 200 mg / dl and the patient is in a stable condition.
Gum edema with hypothyroidism.
Hypothyroidism - a relatively rare disease, the clinical picture of which depends on at what age it manifested itself, as well as on the duration and severity of hypothyroidism. If insufficiency of thyroid hormones, in particular triiodothyronine and thyroxine, appears in early childhood, then the child develops cretinism. Its characteristic symptoms are short stature, mental retardation, disproportionately large head, delayed teething, micrognathia of the lower jaw, swelling of the lips and tongue. Regardless of the age at which the disease appeared, dry, thickened skin with yellow color, coarse hair, increased sensitivity to cold, drowsiness is noted. In adults with hypothyroidism, a dull, dispassionate facial expression, eyebrow loss, decreased mental and mental activity, and elevated serum cholesterol levels are noted. A classic symptom is soft tissue edema, which is more pronounced on the face, especially around the eyes. It is caused by the accumulation of fluid in the subcutaneous fat.
On palpation, the thyroid gland usually has normal sizes, but can be enlarged. Enlarged thyroid gland with hypothyroidism attributed to autoimmune lymphocytic infiltration (Hashimoto's thyroiditis). In this disease, the glandular cells are gradually replaced by lymphocytes.
Hypothyroidism may also manifest as a lesion of the oral cavity. Macroglossia and macrocheilia are often noted, making speech difficult. The gums are enlarged, have a pale pink color and soft elastic consistency. Edema develops on both the vestibular and lingual surfaces of the dental arch. With secondary edema, the gums become red, pasty and bleed easily. Treatment for gum disease with hypothyroidism depends on its severity. With mild thyroid insufficiency, you can limit yourself to careful oral care, while with a pronounced decrease in the level of thyroid hormones to reduce both systemic and local manifestations of the disease, substitution therapy with sodium levothyroxine should be prescribed.
What is periodontitis, its differences from periodontal disease
Periodontitis often people without special education are confused with periodontal disease, this disease also covers the tissues surrounding the tooth, but it proceeds differently. There are several differences that can help you see and determine the difference between two dental problems.
- Periodontitis is an inflammatory process, so when it develops, the gums look edematous and hyperemic, pain is felt. Periodontal disease is exposed when dystrophic processes in the tissues are noted, that is, there is no marked inflammation during the initial development of this disease.
- Periodontitis develops over several days, the acute symptoms of the disease are almost always pronounced. Periodontal disease occurs gradually, disorders in the tissues of the tooth and ligamentous apparatus develop for several weeks and months.
- With periodontal disease, you can pay attention to rarefaction of teeth, the appearance of cracks. With periodontitis, symptoms such as bleeding from the gums and soreness almost always come first.
How periodontitis and diabetes are related
Normally, saliva performs a cleansing, protective, initial digestive function. When the content of glucose and trace elements is disturbed, the amount of such an element as lysozymeresponsible for protecting the tissues of the oral cavity from pathogenic microflora.That is, the mucous membrane acquires a certain vulnerability to various bacteria and the inflammation processes develop in it under the influence of the most insignificant provoking factor. There is also a general decrease in the volume of formed saliva, which affects the development of periodontitis.
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Symptoms and possible complications
The main manifestations of periodontitis in patients with diabetes have their own characteristic features. Inflammation usually begins with gingivitis, that is, with gum disease, this is manifested by the following symptoms:
- Swelling and redness of the gum tissue.
- Subsequently, soreness and severe bleeding of the gums are added.
- If the patient also has diabetic polyneuropathy, then the pain in the gums is expressed quite intensively and significantly affects the general well-being of a person.
With diabetes, periodontitis develops very early and at the same time, the disease can proceed quite aggressively. That is, it is developing rapidly, conventional treatment does not have a pronounced therapeutic effect. The condition of the tissues of the oral cavity worsens if the patient does not pay attention to hygiene, smokes, drinks.
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Treatment and prevention in patients with diabetes
According to most practicing endocrinologists, periodontitis is reduced against the background of normalization of blood biochemical parameters. To achieve this, you must constantly maintain the desired level of glucose in the blood with medication and diet.
- Visit your dentist at least twice a year. If there are certain violations in the oral cavity, you need to visit a doctor in the shortest possible time.
- It is necessary to constantly pay attention to oral hygiene. That is, you need to rinse or brush your teeth constantly after eating. As rinsing agents, it is best to use decoctions of herbs. Dentists recommend using pastes with plant extracts based on chamomile and sage.
The selection of medication for the development of periodontitis is carried out for patients with diabetes based on the severity of clinical signs, the level of increase in blood sugar, age. Some dentists successfully use a drug such as Urolexan, others prescribe tissue oxygen therapy and massage. Good results occur when using electrophoresis with a certain dose of insulin.
Diabetes Complications: Prevention and Treatment
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If type 1 or type 2 diabetes is poorly treated or not controlled at all, then the patient’s blood sugar will stay above normal. In this article we do not consider a situation where, due to improper treatment, the concentration of glucose in the blood, on the contrary, is too low. This is called "hypoglycemia." How to prevent it, and if it has already happened, then how to stop the attack, you can find out here. And below we will discuss what complications of diabetes arise due to high blood sugar.
Complications of diabetes due to high sugar are acute and chronic.
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Diabetic ketoacidosis and hyperglycemic coma
The acute complications of diabetes are diabetic ketoacidosis and hyperglycemic coma. They develop when the patient’s sugar is not just high, but very high. If they are not urgently treated in a hospital, then they quickly lead to loss of consciousness and death. Read more articles:
- Diabetic ketoacidosis.
- Hyperglycemic coma.
- How to treat colds, vomiting and diarrhea to prevent acute complications of diabetes.
What is diabetic ketoacidosis, hyperglycemic coma and methods for the prevention of acute complications - all diabetics need to know. Especially for patients with type 1 diabetes, as well as elderly patients with type 2 diabetes.
If the situation is brought to the point that acute complications arise, then doctors have to struggle hard to “pump out” the patient, and still the mortality rate is very high, it is 15-25%. Nevertheless, the vast majority of patients with diabetes become disabled and die prematurely not from acute, but from chronic complications. Basically, these are problems with the kidneys, legs and eyesight, which this article is devoted to.
Chronic diabetes complications
Chronic complications of diabetes occur when a disease is poorly or improperly treated, but still not bad enough for ketoacidosis or hyperglycemic coma to occur. Why are chronic diabetes complications dangerous? Because they develop for the time being without symptoms and do not cause pain. In the absence of unpleasant symptoms, the diabetic does not have an incentive to be treated carefully. Symptoms of diabetic problems with the kidneys, legs and eyesight usually occur when it is too late, and the person is doomed to death, and at best will remain disabled. The chronic complications of diabetes are what you need to fear the most.
Kidney diabetes complications are called “diabetic nephropathy.” Eye problems - diabetic retinopathy. They arise because elevated glucose damages small and large blood vessels. The blood flow to organs and cells is disrupted, due to which they starve and suffocate. Damage to the nervous system is also common - diabetic neuropathy, which causes a wide variety of symptoms. Leg problems in diabetics are a combination of blockage of the blood vessels that feed the lower limbs with impaired nerve sensitivity.
Read detailed articles:
- Diabetic Nephropathy
- Diabetic retinopathy
- Diabetic neuropathy
- Leg pain in diabetes: what to do
Diabetic nephropathy is the main cause of severe renal failure. Diabetics make up the vast majority of “clients” of dialysis centers, as well as surgeons who do kidney transplants. Diabetic retinopathy is the main cause of blindness in adults of working age worldwide. Neuropathy is detected in 1 out of 3 patients at the time of diagnosis of diabetes, and later in 7 out of 10 patients. The most common problem that it causes is loss of sensation in the legs. Because of this, patients with diabetes have a high risk of leg injury, subsequent gangrene and amputation of the lower extremities.
Diabetic nephropathy and retinopathy usually do not cause any symptoms before they become irreversible. If renal failure reaches the final stage, then a diabetes patient has to go for dialysis procedures for life or look for an opportunity to have a kidney transplant. As for retinopathy, vision loss can be stopped by combining laser photocoagulation of the retina with a thorough treatment of diabetes. Although few people manage to completely restore vision. The best news is, diabetic neuropathy is completely reversible if blood sugar is well controlled. Follow a type 1 diabetes program or type 2 diabetes program. Read also the article “The goals of diabetes care. What to expect when blood sugar returns to normal. ”
Diabetes damages not only small, but also large blood vessels, contributes to the development of atherosclerosis. As a result of this, diabetics die from a heart attack or stroke 10-30 years earlier than they could. Also, blockages of large vessels with atherosclerotic plaques lead to the need to amputate the legs. Fortunately, it is real to slow down the development of atherosclerosis. You need to follow a type 1 diabetes treatment program or a type 2 diabetes treatment program, carefully monitor your blood sugar, as well as blood pressure and cholesterol.
- Atherosclerosis: prevention and treatment. Atherosclerosis of the vessels of the heart, brain, lower extremities.
- Prevention of heart attack and stroke. Risk factors and how to eliminate them.
- How to treat hypertension in type 1 and type 2 diabetes.
In today's article, we discuss chronic diabetes complications that occur due to high blood sugar. Unfortunately, concomitant diseases are often also manifested, which are not consequences of diabetes, but are associated with it. We will analyze which concomitant diseases are most common in type 1 and type 2 diabetes, briefly describe their prevention and treatment.
As you know, the cause of type 1 diabetes is that the immune system behaves incorrectly. It attacks and destroys pancreatic beta cells that produce insulin. Moreover, patients with type 1 diabetes often have autoimmune attacks on other tissues that produce various hormones. In type 1 diabetes, the immune system often attacks the thyroid gland “for company”, which is a problem for approximately ⅓ patients. Type 1 diabetes also increases the risk of autoimmune diseases of the adrenal glands, but this risk is still very low.
All people with type 1 diabetes should have their blood tested for thyroid hormones at least once a year. We recommend taking a blood test not only for thyroid stimulating hormone (thyrotropin, TSH), but also checking other hormones. If you have to treat problems with the thyroid gland with the help of tablets, then their dose should not be fixed, but every 6-12 weeks should be adjusted according to the results of repeated blood tests for hormones. Also, combine a low-carbohydrate diet with a gluten-free diet to keep your immune system more relaxed. What is a gluten-free diet - easy to find on the Internet.
Common concomitant diseases with type 2 diabetes are arterial hypertension, problems with blood cholesterol and gout. Our type 2 diabetes treatment program quickly normalizes blood sugar, as well as blood pressure and cholesterol.
Low Carbohydrate Diet & Gout
The foundation of our type 1 and type 2 diabetes treatment programs is a low-carb diet. It is believed that it increases the content of uric acid in the blood. If you suffer from gout, it can get worse, but still, the benefits of the activities we recommend for treating diabetes far exceed this risk. It is assumed that the following measures can alleviate gout:
- drink more water and herbal teas - 30 ml of liquid per 1 kg of body weight per day,
- make sure you eat enough fiber despite a low-carb diet
- refuse junk food - fried, smoked, semi-finished products,
- take antioxidants - vitamin C, vitamin E, alpha lipoic acid and others,
- take magnesium tablets.
There is information, not yet officially confirmed that the cause of gout is not eating meat, but an increased level of insulin in the blood. The more insulin circulates in the blood, the worse the kidneys excrete uric acid, and therefore it accumulates. In this case, a low-carbohydrate diet will not be harmful, but rather useful for gout, because it normalizes plasma insulin levels. Source of this information (in English). It also indicates that gout attacks are less common if you do not eat fruit, because they contain a special harmful food sugar - fructose. We urge everyone not to eat diabetic foods that contain fructose. Even if the theory of the author Gary Taubes is not confirmed, all the same, diabetes and its chronic complications, which a low-carbohydrate diet helps to avoid, are much more dangerous than gout.
Recipes for a low-carbohydrate diet for type 1 and type 2 diabetes are available here.
If a patient with type 1 or type 2 diabetes is poorly treated and has high blood sugar, this damages the nerves and disrupts the conductivity of nerve impulses. This complication is called diabetic neuropathy. Nerves transmit signals from the entire body to the brain and spinal cord, as well as control signals from there back. To reach the center, for example, from the toe, a nerve impulse must go a long way. Along this path, nerves receive nutrition and oxygen from the smallest blood vessels called capillaries. Increased blood sugar in diabetes can damage the capillaries, and blood will stop flowing through them. As a result of this, part of the nerve will die, the chain will be broken and the signal will not be able to reach in both directions.
Diabetic neuropathy does not occur immediately, because the number of nerves in the body is excessive. This is a kind of insurance, which is inherent in us by nature. However, when a certain percentage of nerves are damaged, symptoms of neuropathy are manifested. The longer the nerve is, the more likely it is that problems will arise due to high blood sugar. Therefore, it is not surprising that diabetic neuropathy most often causes problems with sensitivity in the legs, fingers, and impotence in men.
Loss of nervous sensation in the legs is the most dangerous. If a diabetic stops feeling the skin of his feet with heat and cold, pressure and pain, then the risk of leg injuries increases hundreds of times, and the patient does not pay attention to it in time. Therefore, patients with diabetes so often have to amputate the lower limbs. To avoid this, learn and follow the rules for diabetes foot care. In some patients, diabetic neuropathy does not cause loss of nervous sensitivity, but rather phantom pains, tingling and burning sensations in the legs. Read “Diabetes Feet Sore - What to Do.” In a way, it’s even good, because it causes the diabetic to be intensively treated.
Diabetes and Vision Problems
Diabetic retinopathy is a problem with the eyes and eyesight that occurs due to chronically elevated blood sugar. In severe cases, it causes significant loss of vision or complete blindness. Due to diabetic retinopathy, tens of thousands of people of working age are blind all over the world every year.
Most importantly, with diabetes, a sharp deterioration in vision or complete blindness can occur suddenly. To prevent this from happening, patients with type 1 and type 2 diabetes should be examined by an ophthalmologist at least once a year, and preferably once every 6 months. Moreover, this should not be an ordinary ophthalmologist from the clinic, but a specialist in diabetic retinopathy. These doctors work in specialized diabetes care centers. They conduct examinations that the ophthalmologist from the clinic can not do and does not have equipment for this.
Patients with type 2 diabetes must be examined by an ophthalmologist at the time of diagnosis, because they usually had diabetes “silently” developed over the years. With type 1 diabetes, it is recommended to visit an ophthalmologist for the first time 3-5 years after the onset of the disease. The ophthalmologist will indicate how often you need to be examined again from him, depending on how serious the situation with your eyes will be.This can be every 2 years if retinopathy is not detected, or more often, up to 4 times a year if intensive treatment is required.
The main reason for developing diabetic retinopathy is high blood sugar. Accordingly, the main treatment is to diligently implement a type 1 diabetes treatment program or type 2 diabetes treatment program. Other factors are also involved in the development of this complication. A significant role is played by heredity. If parents had diabetic retinopathy, then their offspring have an increased risk. In this case, you need to inform the ophthalmologist so that he is especially vigilant. To slow the loss of vision, a diabetes patient needs to carefully monitor his blood pressure (how to do this) and quit smoking.
In addition to retinopathy, other complications of diabetes for vision are glaucoma and cataracts. Glaucoma is an increased pressure inside the eye. Cataract - clouding of the lens (lens). All of these complications can lead to blindness if left untreated. Ophthalmologist during examinations should check the level of intraocular pressure and examine the lens, and not just photograph the fundus. Read detailed articles:
- Diabetic retinopathy.
- Cataract for diabetes.
Diabetic nephropathy is a complication of diabetes in the kidneys. As you know, the kidneys filter waste from the blood, and then remove them with urine. Each kidney contains about a million special cells, which are blood filters. Blood flows through them under pressure. The filtering elements of the kidney are called glomeruli. In diabetics, the renal glomeruli are damaged due to the increased glucose in the blood that flows through them. In the renal filters, the electrical balance is disturbed, because of which proteins penetrate into the urine from the blood, which normally should not get there.
First, leakage of protein molecules of the smallest diameter. The more diabetes damages the kidneys, the larger the diameter of the protein molecule can be found in the urine. At the next stage, not only blood sugar, but also blood pressure rises, because the kidneys can not cope with the removal of a sufficient amount of fluid from the body. If you do not take pills that lower blood pressure, then hypertension accelerates the destruction of the kidneys. There is a vicious circle: the stronger the hypertension, the faster the kidneys are destroyed, and the more damaged the kidneys, the higher the blood pressure rises, and it becomes resistant to the action of drugs.
As diabetic nephropathy develops, more and more protein needed by the body is excreted in the urine. There is a protein deficiency in the body, edema is observed in patients. In the end, the kidneys finally stop functioning. This is called renal failure. In such a situation, in order for the patient to survive, he needs to undergo regular dialysis procedures or undergo kidney transplant surgery.
All over the world, tens of thousands of people annually turn to specialized institutions for help because they have kidney failure due to diabetic nephropathy. The vast majority of “clients” of surgeons who are involved in kidney transplants, as well as dialysis centers, are diabetics. Treating kidney failure is expensive, painful, and not accessible to everyone. Complications of diabetes in the kidneys greatly reduce the patient's life expectancy and impair its quality. Dialysis procedures are so unpleasant that 20% of the people who undergo them, in the end, voluntarily refuse them, thereby committing suicide.
An important role in the development of complications of diabetes in the kidney is heredity. If parents suffered from diabetic nephropathy, then their offspring are more likely. Nevertheless, if you take care of your health in time, then avoiding kidney failure in type 1 and type 2 diabetes is real, even if you inherited unsuccessful genes. To do this, you need:
- Strictly control blood sugar by performing a type 1 diabetes treatment program or type 2 diabetes treatment program,
- take blood and urine tests every 3 months that check kidney function,
- have a good blood pressure monitor at home and regularly measure blood pressure, preferably once a week.
- Kidney damage in diabetes mellitus, its treatment and prevention
- What tests you need to pass to check the kidneys (opens in a separate window)
- Diabetic nephropathy: stages, symptoms and treatment
- Important! Diabetes Kidney Diet
- Renal artery stenosis
- Diabetes kidney transplant
If hypertension has developed and it cannot be taken under control without “chemical” tablets, then you need to see a doctor to prescribe a medicine - an ACE inhibitor or angiotensin-II receptor blocker. Read more about the treatment of hypertension in diabetes. Drugs from these classes not only lower blood pressure, but also have a proven protective effect on the kidneys. They allow you to delay the final stage of renal failure for several years.
Lifestyle changes for patients with type 1 and type 2 diabetes are much more effective than drugs because they eliminate the causes of kidney damage, and not just “muffle” the symptoms. If you discipline your type 1 diabetes treatment program or type 2 diabetes treatment program and maintain a stable normal blood sugar, then diabetic nephropathy will not threaten you, as well as other complications. The activities that we recommend bring blood sugar and blood pressure back to normal.
How blood vessels break down
If diabetes is poorly controlled, due to which the patient has high sugar levels for months and years, then this damages the walls of blood vessels from the inside. They are covered with atherosclerotic plaques, their diameter narrows, blood flow through the vessels is disturbed. In patients with type 2 diabetes, there is usually not only an excess of glucose in the blood, but also overweight and lack of exercise. Due to an unhealthy lifestyle, they have problems with blood cholesterol and high blood pressure. These are additional risk factors that damage the vessels. However, elevated blood sugar due to type 1 or 2 diabetes plays a leading role in the development of atherosclerosis. It is many times more dangerous than hypertension and poor cholesterol tests.
Why is atherosclerosis so dangerous and need to be paid attention to inhibit its development? Because heart attacks, strokes and leg problems in diabetes arise precisely because the vessels are clogged with atherosclerotic plaques, and the blood flow through them is disturbed. In type 1 and type 2 diabetes, atherosclerosis control is the second most important measure after maintaining a stable normal blood sugar. Myocardial infarction is when a part of the heart muscle dies due to insufficient blood supply. In the vast majority of cases, before the onset of a heart attack, the person’s heart was perfectly healthy. The problem is not in the heart, but in the vessels that feed it with blood. Likewise, because of a disturbance in blood supply, brain cells can die, and this is called a stroke.
Since the 1990s, it has been found that high blood sugar and obesity irritate the immune system. Because of this, numerous foci of inflammation occur in the body, including from the inside on the walls of blood vessels. Blood cholesterol sticks to the affected areas. This forms atherosclerotic plaques on the walls of arteries, which grow over time. Read more on “How Atherosclerosis develops in diabetes.” When the connection of inflammatory processes with atherosclerosis was established, then this was a real breakthrough. Because they found indicators of inflammation that circulate in the blood.
Now you can take blood tests for cardiovascular risk factors and much more accurately assess the risk of heart attack and stroke than cholesterol tests can do. There are also methods to suppress inflammation, thus inhibiting atherosclerosis and lowering the risk of cardiovascular catastrophe. Read more “Prevention of heart attack, stroke and heart failure in diabetes.”
In many people, blood sugar does not keep stably elevated, but rises only a few hours after each meal. Doctors often call this situation prediabetes. Sugar surges after eating cause significant damage to blood vessels. The walls of the arteries become sticky and inflamed, atherosclerotic plaques grow on them. The ability of blood vessels to relax and expand their diameter to facilitate blood flow is deteriorating. Prediabetes means an extremely increased risk of heart attack and stroke. In order to effectively cure him and not become a “full-fledged” diabetic, you need to complete the first two levels of our type 2 diabetes treatment program. This means - to follow a low-carbohydrate diet and exercise with pleasure.
Complications of diabetes and intimate life
Type 1 and type 2 diabetes, if poorly controlled, has a complex negative effect on intimate life. Complications of diabetes reduce sexual desire, weaken opportunities, and reduce feelings of satisfaction. For the most part, men are worried about all this, and mostly the information below is intended for them. Nevertheless, there is evidence that women with diabetes suffer from anorgasmia due to impaired neural conduction. Also, their intimate life is worsened by frequent vaginal infections. The fungi that cause thrush feed on sugar, and poorly treated diabetes creates a favorable environment for their reproduction.
We discuss the effects of diabetes complications on the sex life of men and how to minimize problems. Erection of the male penis is a complex and therefore fragile process. In order for everything to work out well, the following conditions must be met simultaneously:
- normal concentration of testosterone in the blood,
- the vessels that fill the penis with blood are clean, free of atherosclerotic plaques,
- the nerves that enter the autonomic nervous system and control an erection function normally,
- conduction of nerves that provide feelings of sexual satisfaction is not disturbed.
Diabetic neuropathy is damage to nerves due to high blood sugar. It can be of two types. The first type is disruption of the somatic nervous system, which serves conscious movements and sensations. The second type is damage to the nerves that enter the autonomic nervous system. This system controls the most important unconscious processes in the body: heartbeat, respiration, the movement of food through the intestines and many others. The autonomic nervous system controls the erection of the penis, and the somatic system controls the sensations of pleasure. The nerve paths that reach the genital area are very long. And the longer they are, the higher the risk of their damage in diabetes due to high blood sugar.
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If the blood flow in the vessels is impaired, then at best, an erection will be weak, or even nothing will work. We discussed above how diabetes damages blood vessels and how dangerous it is. Atherosclerosis usually damages blood vessels that fill the penis with blood earlier than arteries that feed the heart and brain. Thus, a decrease in potency means that the risk of heart attack and stroke is increased. Take this as seriously as possible. Make every effort to inhibit atherosclerosis (how to do this). If after a heart attack and stroke you have to switch to disability, then problems with potency will seem to you utter nonsense.
Testosterone is a male sex hormone. In order for a man to have sexual intercourse and enjoy it, there must be a normal level of testosterone in the blood. This level gradually decreases with age. Blood testosterone deficiency is often found in middle-aged and older men, and especially in diabetics. Recently, it is known that a lack of testosterone in the blood worsens the course of diabetes, because it reduces the sensitivity of cells to insulin. There is a vicious circle: diabetes reduces the concentration of testosterone in the blood, and the less testosterone, the harder the diabetes. In the end, the hormonal background in the blood of a man is very disturbed.
So, diabetes strikes male sexual function in three directions simultaneously:
- promotes clogging of vessels with atherosclerotic plaques,
- creates problems with testosterone in the blood,
- disrupts nerve conduction.
Therefore, it is not surprising that men with diabetes often experience failures in their personal lives. More than half of men who have had type 2 diabetes for 5 years or more complain of potency problems. All others experience the same problems, but are not recognized by doctors.
As for the treatment, the news is good and bad. The good news is if you diligently follow a type 1 diabetes treatment program or a type 2 diabetes treatment program, then over time, nerve conduction is fully restored. Normalizing the level of testosterone in the blood is also real. Use for this purpose the means prescribed by the doctor, but in no case “underground” goods from the sex shop. The bad news is if blood vessels are damaged due to atherosclerosis, then it is impossible to cure it today. This means that the potency may not be restored, despite all efforts.
Read the detailed article, “Diabetes and Impotence in Men.” In it you will learn:
- how to correctly use Viagra and its lesser-known “relatives”,
- what are the means to normalize the level of testosterone in the blood,
- penile prosthetics is a last resort if all else fails.
I urge you to take blood tests for testosterone, and then, if necessary, consult a doctor how to normalize its level. This is necessary not only to restore potency, but also to increase the sensitivity of cells to insulin and improve the course of diabetes.
Diabetes and memory impairment
Diabetes impairs memory and other brain functions. This problem occurs in adults and even in children with type 1 and type 2 diabetes. The main reason for memory loss in diabetes is poor blood sugar control. Moreover, normal brain function is disturbed not only by increased sugar, but also by frequent cases of hypoglycemia. If you are too lazy to treat your diabetes in good faith, then do not be surprised when it becomes difficult to remember old and remember new information.
The good news is that if you carefully follow a type 1 diabetes treatment program or type 2 diabetes treatment program, then short-term and long-term memory usually improves. This effect is felt even by older people. For more details, see the article “Objectives for the treatment of type 1 and type 2 diabetes. What to expect when your blood sugar returns to normal. ” If you feel that your memory has worsened, then first do a total blood sugar control for 3-7 days. This will help you find out where you made mistakes and why your diabetes got out of hand. At the same time, diabetics are aging, just like all people. And with age, memory tends to weaken even in people without diabetes.
Remedy can be caused by medication, whose side effect is lethargy, drowsiness. There are many such drugs, for example, painkillers, which are prescribed for diabetic neuropathy. If possible, lead a healthy lifestyle, try to take fewer “chemical” pills.To maintain normal memory over the years, pay attention to the inhibition of the development of atherosclerosis, as described in the article “Prevention of heart attack, stroke and heart failure in diabetes”. Atherosclerosis can cause a sudden brain stroke, and before that gradually weaken the memory.
Diabetic foot problems
Type 1 and type 2 diabetics often lose sensation in their legs due to diabetic neuropathy. If this complication is manifested, then the person with the skin of the foot can no longer feel cuts, rubbing, cold, burning, squeezing due to uncomfortable shoes and other problems. As a result of this, a diabetic can have wounds, ulcers, abrasions, burns or frostbite on his legs, which he will not suspect until gangrene begins. In the most severe cases, patients with diabetes do not even pay attention to broken bones of the foot.
In diabetes, infection often affects leg wounds that are not treated. Typically, patients have impaired nerve conduction and, at the same time, blood flow through the vessels that feed the lower limbs is difficult. Because of this, the immune system cannot resist germs and wounds heal poorly. Severe consequences occur when the infection spreads to deeper tissues, affects even bones and causes blood poisoning.
Blood poisoning is called sepsis, and bone infection is called osteomyelitis. With blood, microorganisms can spread throughout the body, infecting other tissues. This situation is very life threatening. Osteomyelitis is difficult to treat. Often the most powerful antibiotics do not help, even when they are administered intravenously. In this case, only the emergency amputation of the entire foot or leg can save the life of a diabetic.
Diabetic neuropathy can lead to a violation of the mechanics of the foot. This means that when walking, pressure will be exerted on areas that are not intended for this. As a result, the bones will begin to move, and the risk of fractures will increase even more. Also, due to uneven pressure, corns, ulcers and cracks appear on the skin of the legs. To avoid the need to amputate the foot or entire leg, you need to study the rules of foot care for diabetes and carefully follow them.
The most important activity is to follow a type 1 diabetes treatment program or a type 2 diabetes treatment program to lower your blood sugar and keep it normal. As a result of this, nerve conduction and sensitivity in the legs will fully recover within a few weeks, months or years, depending on the severity of the complications that have already developed. After this, diabetic foot syndrome will no longer be threatened.
You can ask questions in the comments about the treatment of diabetes complications, the site administration is quick to respond.
Is tuberculosis dangerous in diabetes?
Any form of tuberculosis is extremely rare in diabetes. At the same time, this is quite possible, because the body of a diabetic is weakened and easily exposed to infections. Including respiratory, which is quite difficult to deal with. About what are the causes of the development of pathology, symptoms and treatment methods further.
About the causes of the ailment
In order for tuberculosis and diabetes to develop, several factors must coincide. In particular, virus infection of the disease represented. This can occur by airborne droplets, as well as after prolonged contact with an infected person.
Also, the body of a diabetic can simply be weakened by prolonged colds, low or high sugar levels. As a result of this, pneumonia forms, which smoothly flows not into the direct form of tuberculosis, but into the conjugate one. It is important to remember that in diabetes mellitus such forms of pathology as false ones are frequent, which are often formed in smokers.
In their initial symptoms, they are similar to tuberculosis, however, when diagnosing, differences in terms of damage to the pulmonary system are visible. This condition is easily treatable, unlike true tuberculosis.
Thus, the main reason for its development is infection or infection by bacteria, the reproduction of which in the human body is expressed in obvious symptoms.
About symptoms and diagnosis
With type 1 and type 2 diabetes, which is accompanied by tuberculosis, the following symptoms are formed:
- permanent cough, formed by seizures, both in the morning and in the evening,
- secretion of sputum, mucus and other consequences of infection. If the infection is dangerous, hemoptysis will form,
- the coughing of symptoms such as high fever, aggravation of general health.
A person begins to lose weight quickly, loses his appetite. In a diabetic, the structure of the chest changes - it becomes hollow. With severe infection, the infected person is constantly slouching. His gait changes, becoming slow and shuffling.
In addition, other specific symptoms appear, for example, lack of dynamism, poor mood or imbalance. In the absence of timely treatment and developing diabetes mellitus, complications, even death, occur very quickly. In order to avoid this, when the first symptoms appear, it is necessary to undergo a diagnosis.
The primary stages are fluorography and sputum delivery to identify germs and other irritants. This will help establish at what stage the main pathology is, as well as what measures of action should be applied.
About treatment methods
With tuberculosis and diabetes mellitus, recovery should be conservative, however, if the condition is not compensated, surgical intervention is acceptable. Drug treatment involves the use of mucolytics, as well as herbal components that optimize the respiratory system.
An obligatory stage of treatment is the implementation of respiratory gymnastics.
With diabetes, it should be even more active, because the body of a diabetic works several times slower than just with the presented disease. Respiratory gymnastics should be carried out daily, and its elements are selected individually by a pulmonologist and endocrinologist.
Continuous monitoring of tuberculosis and the degree of cure for it is shown. If for 1-2 months, depending on the age of the patient and other nuances, relief does not occur, you should think about the operation.
Another universal method of treatment is a spa. It has several advantages, in particular:
- high percentage: 75% of patients are completely cured of tuberculosis,
- the possibility of leading an active lifestyle,
- constant observance of the required diet, as well as medical supervision.
When the patient's condition begins to improve, you can take care of preventive measures.
About Prevention and Recovery
The ideal prevention of tuberculosis in diabetes mellitus will be continuous immunization, the exclusion of any contact with infected people, as well as maintaining a healthy lifestyle. This will help to strengthen the body as much as possible, accelerating the process of getting rid of tuberculosis.
It is also advisable to lead an active lifestyle, breathe fresh air. It is recommended to use a special inhaler that cleanses the lungs. Proper nutrition should not be neglected. It is advisable to exclude fatty, smoked, salted and pepper dishes, using vegetable components.
With this approach, it will be possible to say that tuberculosis with diabetes is not terrible. This will help to maintain 100% vital activity, high activity indicators. Most importantly, you need to remember that any disease is much easier to cure at the initial stage than at the subsequent ones.
As you know, treatment without adequate subsequent prevention never gives a 100% result, which is why it is extremely important. Thus, careful observance of all the rules of personal hygiene will make it possible to avoid infection with those infections that can be transmitted by the respiratory route. But frequent and no less thorough washing of hands will make it possible to prevent the development and aggravation of the common cold, not only with diabetes, but also without it.
It is important to remember that no vaccine against the common cold exists for the disease described. However, it is still recommended to discuss with a specialist the possibility of using influenza vaccines. This should be done, if only because they may well create some stress for the body and even complicate the maintenance of the optimal ratio of glucose in the blood.
Of course, you should remember the level of physical activity, taking all the necessary and permitted medicines, as well as constant monitoring of sugar levels and an approved diet. Only in this case, you can count on the fact that a cold with diabetes will pass quickly enough and without serious complications.
Diabetes and leg complications. Diabetes hurts the legs - treatment
Diabetes often gives complications to the legs. Foot problems throughout life occur in 25-35% of all diabetics. And the older the patient, the greater the likelihood of their occurrence. Diseases of the legs with diabetes bring a lot of trouble to patients and doctors. Legs hurt with diabetes - unfortunately, a simple solution to this problem does not yet exist. Will have to do my best to be treated. Moreover, you need to be treated only by a professional doctor, and in no case by "folk remedies". In this article, you will learn what to do. Treatment goals:
- Relieve pain in the legs, and even better - completely get rid of them,
- Save the ability to move "on your own."
If you do not pay attention to the prevention and treatment of complications of diabetes on the legs, the patient may lose the entire toe or foot.
In diabetes mellitus, the legs hurt because atherosclerosis results in too narrow a lumen in the blood vessels. Leg tissues do not receive enough blood, “suffocate” and therefore send pain signals. An operation to restore blood flow in the arteries of the lower extremities can relieve pain and improve the quality of life of a diabetic.
There are two main scenarios for leg problems with diabetes:
- Chronically elevated blood sugar affects nerve fibers, and they cease to conduct impulses. This is called diabetic neuropathy, and because of it, the legs lose their sensitivity.
- The blood vessels that feed the legs become clogged due to atherosclerosis or the formation of a blood clot (blood clot). Ischemia develops - oxygen starvation of tissues. In this case, the legs usually hurt.
Diabetic foot syndrome
Nerve damage due to elevated blood glucose is called diabetic neuropathy. This complication of diabetes leads to the fact that the patient loses the ability to feel touching his legs, pain, pressure, heat and cold. Now if he injures his leg, he will not feel it. Most diabetics in this situation have ulcers on the legs and soles of the feet, which heal long and hard.
If the sensitivity of the legs is weakened, then wounds and ulcers do not cause pain. Even if there is a dislocation or fracture of the bones of the foot, then it will be almost painless. This is called diabetic foot syndrome. Since patients do not feel pain, many of them are too lazy to follow the doctor's recommendations. As a result, bacteria multiply in the wounds, and because of gangrene, the leg often has to be amputated.
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Peripheral artery disease in diabetes
If the patency of the blood vessels drops, then the tissues of the legs begin to “starve” and send pain signals. Pain can occur at rest or only when walking. In a sense, if your legs hurt with diabetes is even good. Because pain in the legs stimulates the diabetic to see a doctor and heal with all his might. In today's article, we will consider just such a situation.
Problems with the blood vessels that feed the legs are called “peripheral artery disease”. Peripheral - means far from the center. If the lumen in the vessels is narrowed, then most often with diabetes, intermittent claudication occurs. This means that due to severe pain in the legs, the patient has to walk slowly or stop.
If peripheral artery disease is accompanied by diabetic neuropathy, then the pain may be mild or even completely absent. The combination of vascular blockage and loss of pain sensitivity dramatically increases the likelihood that a diabetic will have to amputate one or both legs. Because the tissues of the legs continue to collapse due to “starvation,” even if the patient does not feel pain.
What tests do if your legs hurt with diabetes
It is necessary to carefully examine your legs and feet daily, especially in old age. If the blood flow through the vessels is disturbed, then you can notice the early external signs of this. Symptoms of an early stage of peripheral artery disease:
- the skin on the legs becomes dry
- perhaps it will begin to peel off, combined with an itch,
- pigmentation or depigmentation may appear on the skin,
- in men, the hair on the lower leg turns gray and falls out,
- the skin can become constantly pale and cold to the touch,
- or vice versa, it can become warm and acquire a cyanotic color.
An experienced doctor can check by touch what kind of pulse the patient has in the arteries that feed the tissues of the legs. This is considered the simplest and most affordable method for detecting peripheral circulatory disorders. At the same time, pulsation on the artery stops or significantly decreases only when its lumen is narrowed by 90% or more. It is too late to prevent tissue starvation.
Therefore, they use more sensitive research methods using modern medical equipment. The ratio of systolic (“upper”) pressure in the arteries of the lower leg and brachial artery is calculated. This is called the ankle-brachial index (LPI). If it is in the range of 0.9-1.2, then the blood flow in the legs is considered normal. Finger artery pressure is also measured.
The ankle-brachial index gives false information if the vessels are affected by Menkeberg's atherosclerosis, that is, they are covered with calcareous “scale” from the inside. In elderly patients, this happens very often. Therefore, methods are needed that give more accurate and stable results. This is especially important when resolving the issue of surgery to restore vascular patency so that the legs no longer hurt.
- Type 1 diabetes treatment program for adults and children
- The technique of painless insulin injections
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Transcutaneous oximetry is a painless method that allows you to evaluate how well oxygenated tissues are. Transcutaneous means “through the skin.” A special sensor is applied to the skin surface, which makes a measurement.
The accuracy of the test depends on many factors:
- the condition of the pulmonary system of the patient,
- blood hemoglobin level and cardiac output,
- oxygen concentration in the air,
- the thickness of the skin to which the sensor is applied,
- inflammation or swelling in the measurement area.
If the obtained value is below 30 mm RT.Art., then critical ischemia (oxygen starvation) of the legs is diagnosed. The accuracy of the method of transcutaneous oximetry is not high. But it is still used, because it is considered quite informative and does not create problems for patients.
Ultrasound of the arteries supplying blood to the legs
Duplex scanning (ultrasound) of the arteries of the lower extremities - used to assess the state of blood flow before and after performed surgical operations on the vessels. This method increases the chances that it will be possible in time to detect an obstruction of the artery by a thrombus or repeated narrowing of the lumen in the vessels after surgery (restenosis).
Ultrasound of blood vessels allows you to study problem areas, that is, segments that are turned off from the bloodstream as a result of the development of the disease. Using this method, you can well consider the condition of the vessels and plan ahead the course of the operation to restore their patency.
X-ray contrast angiography
X-ray contrast angiography is an examination method in which a contrast agent is injected into the bloodstream, and then the vessels are "translucent" with x-rays. Angiography means “vascular examination”. This is the most informative method. But it is unpleasant for the patient, and most importantly - the contrast agent can damage the kidneys. Therefore, it is recommended to use it only when the question of conducting a surgical operation to restore vascular patency is being decided.
Stages of diabetes complications on the legs
There are 3 degrees of peripheral blood flow disturbance in patients with diabetes mellitus.
1st degree - there are no symptoms and signs of blood vessel disease in the legs:
- arterial pulsation is felt
- ankle-brachial index of 0.9-1.2,
- finger-shoulder index> 0.6,
- transcutaneous oximetry rate> 60 mmHg. Art.
2nd degree - there are symptoms or signs, but there is still no critical oxygen starvation of tissues:
- intermittent claudication (sore legs)
- ankle-brachial index of 30 mm RT. Art.,
- transcutaneous oximetry 30-60 mm RT. Art.
3rd degree - critical oxygen starvation of tissues (ischemia):
- systolic pressure in the arteries of the lower leg What is the treatment if the legs hurt with diabetes
If your legs hurt with diabetes, then treatment is carried out in 3 directions:
- impact on factors that stimulate the development of atherosclerosis, including in the arteries of the legs,
- careful implementation of recommendations for the prevention and treatment of leg problems, which are discussed in detail in the article “Diabetic foot syndrome”,
- solution of the issue of surgical operations to restore blood flow in the vessels
Until recently, at the stage of intermittent claudication, patients were prescribed the medicine pentoxifylline. But studies have shown that there is no real benefit for patients with diabetes with peripheral artery disease.
With complications of diabetes on the legs, surgery to restore blood flow in the vessels can be of great benefit. Doctors decide the question of its conduct with each patient, taking into account his individual risk indicators for surgical intervention.
Patients with leg pain in diabetes, as a rule, have pronounced disorders of carbohydrate metabolism (blood sugar is very high), diabetic foot syndrome, as well as manifestations of other complications of diabetes. To really help them, you need to involve a team of medical specialists in the treatment.
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Diabetic foot syndrome is treated by a special podiatrist (not to be confused with a pediatrician). First, surgical treatment of wounds on the foot may be necessary to prevent gangrene, and only then - restoration of the patency of blood vessels.
Diabetes and Leg Complications: Findings
We hope this article explained to you in detail what to do if your legs hurt with diabetes. You need to switch to a healthy lifestyle in order to normalize blood sugar and stop the development of atherosclerosis. With a doctor, you will be able to decide on a surgical operation that will restore patency of the vessels of the legs. You also need to be examined for other complications of diabetes and treat them.
Please do not try to “muffle” pain from peripheral lameness with the help of some pills. Their side effects can significantly worsen your condition and life expectancy. Consult a qualified doctor. In diabetes, it is important to carefully maintain foot hygiene in order to maintain the ability to move “on your own.”
- How to lower blood sugar and keep it normal,
- Type 2 diabetes treatment is the most effective
- How to make insulin injections painlessly.