Chronic Complications of Diabetes in Surgery Nii Armah Adu-Aryee

Prevalence of 6.3% in 2001 Amoah,Owusu et al High energy drinks causing diabetes? Ofei 2009 5-8% with coronary artery disease,50% with cardiomyopathy, 15% of stroke patients,PVD 4-8% Kengne and Amoah et al 2007

Introduction Adequate glucose control and blood pressure control Lipid control Recommended Blood pressure levels of 140/80 mm Hg or below  Fasting blood glucose levels of 4 - 7 mmol/litre  HbA1c levels of 7.0% or below *Self monitored blood glucose levels before meals between 4 and 7 mmol/ 

Neuropathy Autonomic Somatic Motor Sensory Vasculopathy Macro Micro

Gastro intestinal Urologic Peripheral Lower limb problems Global Vascular Neuropathic

Gastrointestinal Esophageal Gastric Intestinal

Esophagus Manifestations of neuropathy leading to heartburn and dysphagia Abnormal peristalsis Spontaneous contractions Impaired sphincter tone Symptoms occur in minority of patients Link to hyper glycemia not well established More related to association with obesity and reduced bicarbonate from parotids Treat with glucose control and prokinetics

Gastro paresis 5-12 % of diabetic patients More common on women Presents with Early satiety, nausea, vomiting, bloating, post prandial fullness or upper abdominal pain

Pathophysiology Impaired vagal control Impairment of inhibitory nitric-oxide containing nerves Damage to interstitial cells of Cajal Smooth muscle dysfunction

Confirmation Upper GI endoscopy Gastric Emptying Scintigraphy Other tests Antroduodenal Manometry Breath tests Electrogastrography MRI

Intestinal Enteropathy Diarrhea, constipation, fecal incontinence Prevalence ofdiarrhea between 4 and22 % Diarrhea Impaired motility leading to stasis and overgrowth Hypermotility from reduced sympathetic inhibition Pancreatic insufficiency Neuropathy of internal and external sphincter Drugs like metformin

Treatment Empiric and directed toward symptomatic relief Use antidiarrheals but with caution so as to avoid toxic megacolon Broad spectrum anti biotics

Constipation May alternate with diarrhea mimicking colonic cancer Fairly common Due to neuronal dysfunction and failure of gastrocolic reflex Rule out hypothyroidism or cancer Treat with good hydration, regular exercises and increase fibre in diet

NAFLD/NASH Non alcoholic fatty liver disease/ hepatitis NAFLD resembles alcohol induced liver injury without alcohol history. May progress to NASH with inflammation and fibrosis and in rare cases may become cirrhotic Interest is because of remote risk of malignant change

Urologic complications Bladder dysfunction in men Bladder dysfunction in women Erectile dysfunction Female sexual dysfuntion

CardioVascular Peripheral vascular disease Cardiac disease Cerebral vascular disoders

Neuropathy Cardiac Intestinal Peripheral Sensory Motor Autonomic

Nepropathy not surgical disease Cause of death in surgical patients preventable

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