MISCELLANEOUS COMPLICATIONS
Arteriosclerosis.—When we pass the age of thirty-eight, we are enjoying life which was denied our grandparents. The expectancy of life for a newborn baby in 1860 was thirty-eight years. Now it is nearly sixty years. This accounts, in a large measure, for the specially rapid increase in the amount of diabetes among people more than forty-five, and for the larger incidence today of other diseases of a chronic type. Hardening of the arteries, or arteriosclerosis, is a complication with which older diabetic patients are frequently afflicted. As has been said, arteriosclerosis may be a cause of diabetes in a predisposed person, but be that as it may, diabetes, once established, unless controlled, aggravates and intensifiesdisease of the arteries. It is, therefore, important for the older diabetic patient to make a serious effort to avoid arteriosclerosis by keeping his diabetes checked. Most of the complications which harass and endanger the older patient are due to hardening of the arteries. In this disease, the elastic contracting tissue in the hollow muscular tubes that carry blood is replaced, bit by bit, with scar tissue.
Apoplexy, heart trouble, gangrene.—The walls of the tubes thicken, become brittle, and what results? A vessel in the brain breaks, and hemorrhage in the brain may cause apoplexy. A vessel may also break in the eye. The amount of blood that can pass through the narrowed tubes is too little to supply the beating heart, and pain results, called angina, or irregular heart action or even heart failure. The circulation in the legs is restricted, and pains result, and sometimes gangrene. Coma, it will be remembered, is the chief cause of death among younger diabetic patients. Coma can now be prevented and no one should die from coma. Gangrene is the chief cause of death among older patients. In gangrene, usually of the legs, the tissues lose their vitality because of lack of blood; infection follows and blood poisoning results.
Prevent gangrene.—We must prevent these deaths from gangrene. It can be done by watchfulness and attention. Keeping the urine sugar-free is the first requisite. Gangrenous ulcers of the feet can be made to heal by vigorous treatment with insulin, and diet. It is of great importance to encourage the circulation in the feet by massage and proper exercises. Finally, care in avoiding bruises and cuts of the skin of the feet will prevent much trouble. Every old diabetic patient should wash his feet daily, wear clean stockings, and very comfortable shoes. Watch and guard the feet. Achilles, the Greek hero, must have been a diabetic. The only vulnerable spot on his body was his heel. When before the walls of Troy the spear of Paris touched him on the heel, he died. Watch and guard the feet.