1. Chronic Complications of Diabetes in Surgery
Nii Armah Adu-Aryee

2. 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

3. 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 mmol/litre
 HbA1c levels of 7.0% or below
*Self monitored blood glucose levels before meals between 4 and 7 mmol/ 

4. Neuropathy
Autonomic
Somatic
Motor
Sensory
Vasculopathy
Macro
Micro

5. Gastro intestinal Urologic Peripheral Lower limb problems
Global Vascular
Neuropathic

6. Gastrointestinal
Esophageal
Gastric
Intestinal

7. 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

8. 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

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

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

14. 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

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

16. 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

17. 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

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

19. CardioVascular Peripheral vascular disease Cardiac disease
Cerebral vascular disoders

20. Neuropathy
Cardiac
Intestinal
Peripheral
Sensory
Motor
Autonomic

21. Nepropathy not surgical disease Cause of death in surgical patients
preventable

22. We sink or swim together
Thank you