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.

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Diabetes:Complications

🩸 Diabetic Complications in Type 1 and Type 2 Diabetes