Diabetic Complications by Organ System
| Integumentary System | Acanthosis nigricans, diabetic dermopathy, Necrobiosis lipoidica diabeticorum, lipodystrophy. Skin infections are also common in DM pts |
| Musculoskeletal system | Non-traumatic lower limb amputations 2/2 to diabetic foot problems. Infections: Osteomyelitis of the foot. |
| Nervous system | Neuropathy: Peripheral, autonomic, and mononeuropathy. -1) Peripheral: Symmetric distal sensory loss in a stocking or gloves pattern, paresthesias, ± motor loss. -2) Autonomic: Gastroparesis, intestinal enteropathy, neurogenic bladder, erectile dysfunction, orthostasis. -3) Mononeuropathy: Sudden-onset peripheral or CN deficit e.g. footdrop, CN 3, 4, 6 deficits. Retinopathy: Blindness. Hyperosmolar Hyperglycemic State – associated with AMS. |
| Respiratory system | DKA with Kussmaul respirations. OSA is associated with diabetes. |
| Digestive System | Gastroparesis, GERD. Intestinal enteropathy (diabetic diarrhea, constipation, and fecal incontinence) 2/2 to autonomic neuropathy. Liver – NAFLD, NASH, Diabetic hepatopathy (which involves overloading of hepatocytes with glycogen in persons with poorly controlled type 1 diabetes.) Diabetes also may exacerbate hepatitis C and pancreatitis. |
| Endocrine system | DM is an endocrine disease. |
| Cardiovascular / Circulatory system | Accelerated atherosclerosis in the cerebral, coronary, and peripheral beds. Microvascular disease (retinopathy, neuropathy (peripheral and autonomic), nephropathy). Macrovascular disease (CAD, stroke, PVD) |
| Lymphatic system / Immune system | Immunodeficiency, impaired wound healing. |
| Renal system / Urinary system | Nephropathy. Diabetes is the #1 cause of ESRD in the U.S. Patients end up on dialysis. It is usually accompanied by retinopathy. Lack of retinopathy suggests another cause. Progression of disease: Microalbuminuria leads to proteinuria (with or without nephrotic syndrome) which leads to renal failure. You see diffuse glomerular basement membrane thickening / nodular pattern (Kimmelstiel-Wilson). Infections: UTIs are more common in diabetics. |
| Reproductive system | Pregnancy complications; Erectile dysfunction. Infection: Yeast or Candida Vulvovaginitis. |
NAFLD – Nonalcoholic fatty liver disease
DM causes microvascular disease (retinopathy,
Infections: UTI, osteomyelitis of foot, candidiasis, mucormycosis, necrotizing external otitis.
References
Am Fam Physician. 2016 Dec 15;94(12):980-986.
http://www.diabetes.org/living-with-diabetes/complications/ (Last accessed 4/25/2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3449487/
Mark S. Sabatine, Pocket Medicine, 5th Edition, The Massachusetts General Hospital Handbook of Internal Medicine.