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  What is Diabetes ?
Symptoms of Diabetes.
Why Diabetes Occurs? (Causes & Types)
Risk of Diabetes to Family Members
Treatment: Diet Therapy
Treatment: Exercise
Treatment: Medicines
Treatment: Insulin
What you should do when you are sick?
Precautions During Travel
Can Insulin be stopped?
Newer Treatments
Can Diabetes be cured? Yes in some
Prevention of Diabetes 
Diabetes during pregnancy
How to Monitor Diabetes Control
Complications of Diabetes
 Impotency in Diabetes
Preventions & Treatment of Complications



Complications of Diabetes

Diabetes patients may get following complications:

1) Immediate complications:

Infections: as fungus, bacterial infection, itching on genitals
- Recurrent boils/furuncles on body.
- Recurrent candidal balanophosthitis i.e. reddness, cracking, itching of glans pennis & foreskiin in man.
- In  women it leads to recurrent vulvo vaginitis i.e. Fungal infection of vulva & vagina leading to itching & whitish discharge from vagina.

High Cholesterol and Triglyceride: - It leads to hyper-triglyceridemia i.e. high total cholesterol, high tryglyceride, high LDL cholesterol, VLDL & sometimes low HDL cholesterol. This combination of fat abnormality is called Diabetic dyslipedemia. Its cause has to be determined by various blood tests then treatment need to be started soon. If it is not corrected, will lead to deposition of cholesterol in heart blood vessels leading to chest pain or heart attack.

Diabetic Ketoacidosis: high blood sugar with positive urine ketones

Diabetic Coma: Uncontrolled high blood sugar leading to coma.

           Low blood sugar (Hypoglycemia) due to drugs or insulin :Hypoglycemia is called when blood sugar becomes below normal. In hypoglycemia patient has recurrent symptom of weakness, anxiety, confusion, cold feeling, headache, vomiting.

          How to avoid Severe Hypoglycemia In Diabetes:
•           Don’t make changes in Diet, insulin dose, exercise yourself.
•           Don’t forget to take meal & snacks at proper time
•           Take extra snacks before doing unusual exercise.
•           Take glucose on slightest symptom.
•           If on insulin keep inj. Glucagon (s.c./IV) to treat hypoglycemia.
•           Avoid Night-time Hypoglycemia : Nightmares, excess sweating at night, early morning 
             headache, for confirmation  3 AM Blood sugar below 60.
•           Treatment of severe hypoglycemia : Inj. Glucagon s.c. or shift to hospital for intra venous Glucose.

2) Late Complications of Diabetes:

(1) Heart Complications
(2)   Vascular System Complications
(3)   Eye Complications
(4)   Nerves Complications
(5)   Kidneys Complications
(6)   Skiin Complications
(7)   Foot complications
(8)   G.I.T. System / Abdominal Complications
(9) Urinary System Complications
(10) Bone & Joint Complications
(11)  Tooth & Gum complications
(12)   Impotency in Diabetes

                           Heart Complications

The various complications affecting the heart are:

a)      Angina: decreased blood to heart leading to chest pain on exertion.
b)      Heart attack (Myocardial Infarctions): sudden stoppage of blood flow to certain part of heart leads to dysfunction of the certain part of heart.
c)      Unstable Angina
d)      Ischemic Heart Disease
e)      Left ventricular failure
f)        Heart Enlargement
g)      Dilated Cardiomyopathy
h)      Left ventricular enlargement

Symptoms suggestive of heart involvement are chest pain, breathlessness on walking, dyspnoea on climbing stairs, swelling over feet & face, weakness etc.

How to Prevent Heart Problem
(1)   Blood Sugar under control
(2)   Do Regular Exercise
(3)   Stop Smoking & Alcohol
(4)   Maintain Blood Pressure under control <130/85
(5)   Keep Cholesterol under control
(6)   Eat fat as little as possible
(7)   Check urinary Microalbuminuria yearly & get treated.
(8)   Use proper ratio of PUFA / MUFA & omega-3 fatty acid

                                Decreased Blood Supply to Legs 

Decreased Blood Supply to Legs: Due to uncontrolled blood sugar for longtime the blood flow to leg may decrease due to narrowing of the lumen of blood vessels.

Symptoms of diminished circulation of blood to lower limb are:

                                    : Pain in leg on walking (Claudication)
                                    : Nocturnal rest pain
                                    : Skiin of feet becomes thin & shiny
                                    : Feet remains cold
                                    : Delayed wound healing.
                                    : Gangrene of toe (blackening of toes)

Eye Complications of Diabetes

Eye Complications of Diabetes are:

(1)   Temporary diminution of Vision: due to swelling of the lens of eye due to high blood sugar. Thus the focal power of eye changes resulting in temporary diminution of vision. Normally vision returns to normal in four weeks once diabetes is controlled.

(2) Retinopathy: Prolong uncontrolled diabetes damages the retina of the eye resulting in blurring of vision & diminution of vision. Sometimes sudden loss of vision may occur due to bleeding in the eye, retinal detachment or due to maculopathy, or due to central retinal vein occlusion.

(3)   Cataract: develops early, progresses rapidly

(4)   Glaucoma: pressure in eye increases leading to eye pain due to increased eye pressure.

 Nerves Complications (Neuropathy)

Nerve complication i.e. Neuropathy :-

Diabetes affects the various nerves of the body if remains uncontrolled for long time.

The symptoms suggestive of nerve involvement i.e. neuropathies are:

Effects on nerves of leg& hand leads to burning pain, pins & needle feeling in leg, hand, feet may become numb, dry, excessive cold feeling in feet. Sometime this may cause excessive sweating of face & upper chest during eating or in hot weather. This problem can be treated with various neurotropic drugs & membrane stabilizers.

Involvement of motor nerves leads to difficulty in walking & standing from sitting posture & gradual thining of hand & feet..

  • Tingling, numbness, burning pain, heaviness, cold feeling in feet, hand, and patient feels as if he is walking on cotton or irregular surface or other parts of body as thigh.
  • Weakness of Leg, Thigh, eye muscles or other body parts.
  • Excess sweating in upper part of chest & face specially during eating or when patient is exposed to warm environment.
  • Dry cracked feet.
  • Less sweating in hand & feet.
  • Involvement of nerves of abdomen leads to either of constipation, fullness of abdomen after food, nausea, vomiting & sometimes recurrent diarrohea.

Involvement eye nerves as IIIrd Nerve (leads in difficulty in opening eye) & facial nerve palsy (bells palsy) is possible. These can be cured by treatment in 2 months time.

Involvement of nerves of stomach leads to nausea feeling, feeling of fullness in abdomen, recurrent vomiting. Involvement of nerves of intestine leads to chronic constipation & recurrent diarrohea. For diarrhea we do certain tests then it can be managed in three months time. In some cases patient loses control on defecation & he passes urine & stool anytime. Sometime involvement of nerves or upper hand can leads to carpal tunnel syndrome, symptoms of which are pain & burning pins & needle sensation in hand.

                               Kidney involvement (Nephropathy)

In long standing diabetes kidneys are involved. The first sign of kidney involvement are passing of very small amount of microalbumin in urine called positive microalubuminuria. When kidney damage further progresses the protein starts coming in large amount in urine and urine protein testing is trace or one plus positive. When excretion of protein in urine further increases then swelling over face & body starts occurring. Later blood urea & serum creatinine increases & urine excretion also decreases. Patient feels week, loss of appetite occurs. But in all case of swelling over body & protein passing in urine other causes of kidney involvement should be investigated & treated accordingly.

The symptoms of kidney involvement are swelling over feet, face, and decreased urine output, presence of microalumin & protein in urine, rise in blood pressure. In advanced cases of kidney involvement blood urea & serum Creatinine increases. This result in loss of appetite, nausea & vomiting, anemia, weakness, breathlessness. 

Treatment of Diabetic Kidney involvement

      •         Diet – Low proteins (milk, milk product, egg, non-vegetarian food.)
           Low sodium diet
           Low cholesterol diet
•         Control Blood Pressure – Frequent check-ups, Aim  keep below 120/80
•         Whenever develop any burning in urine (U.T.I.) – consult Doctor.
•         Avoid kidney toxic drug
•         Avoid dehydration.

                                           Skiin Complications

Skiin complication may be as follows:

  • Recurrent Skiin Infection :          - Bacterial        : Furuncle, Boils, Abscess, Carbuncle

                                                            - Fungal            : Tinea on Leg / body / between fingers
                                                                                    : Candidal infection on genitalia resulting in 
                                                                                      itching over glans pennis in men or around vulva in women

  • Dry Cracked Feet
  • Callus: hard skiin over pressure points.
  • Necrobiosis Lipoidica Diabeticorum: (reddish yellow lesion with central atrophic scar)
  • Diabetic dermopathy & bullae

                                 Foot Complications

The foot of diabetic patient is at risk of getting more frequent trauma due to involvement of foot nerves. The skiin of the foot may also be dry with decreased blood circulation. All this & below mentioned high risk factors make the feet more susceptible to infections. Once the foot infection occurs it is difficult to heal due to less blood supply. Thus sequence of events are like this

How Foot Ulcers & Infections occurs:

Feet of diabetics are more at risk of ulcer or infections because

                         (i)            Feet are numb.
(ii)            Blood Supply is decreased
(iii)            Injury due to vision & instability in working
(iv)           Cracked feet, poor hygiene & other below mentioned high risk foot factors

All above factors leads to ulcer or infection in feet. These do not heal easily & get infected.

These ulcer & infection keep on increasing & spreading even it may lead to Gangrene of part of foot. Sometime amputation of finger or leg may also be needed.

High Risk Foot
(1)   Numbness, pins & needle, burning feet.
(2)   Decreased blood supply : Pain in calf on walking, Cold Feet.
(3)   Foot deformity.
(4)   Skiin thin, dry, fissures, crack feet
(5)   Poor hygiene of foot.
(6)   Severe visual impairment.
(7)   Callus (thickened hard skiin)
(8)   Ingrowing toe nail.
(9)   Fungal infection between toes.

Foot Care

Do following to keep your feet healthy: 

      •         Wash feet twice a day then dry feet especially between toes.
Dry skiin : apply moisturizers, but not between toes
•         Cut toe nail straight, file the corners.
•         Inspect feet daily if needed with help of mirror or others help.
•         Use cotton socks without tight elastic
•         Use well fitting canvas shoe or soft leather shoe with laces.
•         Purchase shoe in afternoon, should be well fitting at that time.
•         Use new shoe gradually, for short time initially.
•         Inspect shoe for things like stones, protruding nail ends or linings or rough areas specially if feet is insensitive.
•         If feet insensitive change shoe 2-3 time daily.

Don’t do following things :
    .   Never walk barefoot
        •         Wear pointed shoe, high heel sandals or open toe sandals.
        •         Use strong chemical as corn cap etc.
        •         Do self surgery for callus/corn.
        •         Sit cross leg if blood supply to leg is decreased.
        •         Don’t warm your feet with heater or hot water bottle, rather wear socks.
        •         Check warmth of water before bath by elbow or thermometer not finger.
        •         Do not use tobacco (Smoking/or chewing) 

                    G.I.T. System / Abdominal Complications

Complications involving nerves of stomach, intestines leads to either of constipation, fullness of abdomen after food, nausea, vomiting & sometimes recurrent diarrohea.

                                  Urinary System Complications

 Involvement of nerves of urinary system leads to increased frequency of urinations, burning in urine, recurrent  urinary tract infections. There remains excess of urine in urinary bladder even after passing urine.

                                   Bone & Joint Complications

Bone Complications

  • Osteoporosis (bone weakness): Symptoms includes Back pain & easy fracture

Joint Complications

  • Frozen Shoulder  : manifests as pain in shoulder

  • Knee / Hip Osteoarthritis : manifests as

    • Knee pain

    • Hip pain

Tooth & Gum Complications

  • Gum infection (Pyorrhoea): Symptoms are foul smell from mouth, bleeding from gums, pain in gums & tooth may fall at early age

Complications Treatment & Prevention

There are many drugs that have been developed which if started at right time more than 90% complications of diabetes can be prevented. For detail consult our doctors.

Foot Complication : Non healing ulcer in foot may occur due to nerve involvement & decreased blood 
  supply to foot so that leg ulcers do not heal. Also recurrent bullae, fungal infection. For healing of ulcer 
  complete rest, surgical cleaning, antibiotic & blood supply increasing medicines & growth factors are 

Kidney Involvement i.e. Diabetic nephropathy :
For prevention (avoiding) of kidney disease in diabetes patient they should do three thing (1) Keep diabetes well controlled, blood pressure below 130/80 & eat less protein as paneer, soybean, egg, dals etc Get following tests regularly i.e. urine for pus cells & urea, creatinine, urinary microalbuminuria sodium & potassium, never take kidney toxic drugs, ask your doctor before taking any drug i.e. it should not be nephrotoxic.

Eye Complication of diabetes is called retinopathy, symptoms of which are decreased vision & development of cataract at early age. For its diagnosis flourecin angiography done & treatment is some drugs & if required laser photocoagulation. By some latest drugs prevention of eye complications is now possible. By laser therapy further progression is stopped.

Decreased blood supply to leg leads to pain in leg on walking. Sometime pain is very severe at night due to this any wound in feet may not heal easily. 













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