Chronic medical conditions and urology: Diabetes

Written by: Dr Kgomotso Mathabe (Part 2 of 4)

Introduction

Diabetes mellitus, more commonly known as diabetes, is one of the chronic medical conditions which are prevalent throughout the world, with 366 million people affected globally, of which 3,6 million are in South Africa. That accounts for about 6% of the population.

It is estimated that a further 5 million South Africans have pre‐diabetes in which the glucose levels in the body are high but not high enough to qualify as diabetes. It takes on average 7 years for a person who is diabetic to be diagnosed, because the initial symptoms are subtle and non‐specific.

Symptoms of diabetes

• Fatigue
• Excessive thirst (polidipsia)
• Excessive urination (poliuria)
• Excessive appetite (poliphagia)
• Unexplained weight gain or weight loss
• Slow healing wounds
• Recurrent thrush

Prevalence of diabetes by race in SA

• Indian 11‐13%
• Coloured 8‐10%
• Black 5‐8%
• White 4%

What is diabetes?

Diabetes is a condition in which the body is no longer able to process the glucose (sugar) from our diet. Insulin is a hormone produced by the pancreas which metabolises glucose and converts it into energy

There are three types of diabetes:

Type 1 diabetes – this is an autoimmune condition affecting the pancreas, where the body is then unable to produce insulin. This typically starts in childhood or young adulthood.

Type 2 diabetes – a condition which develops over time, typically due to an unhealthy lifestyle. This manifests in adults.

Gestational diabetes – some women develop symptoms and signs of diabetes during pregnancy.

Screening for and diagnosing diabetes

The symptoms of initial diabetes are so subtle that it isn’t advisable to depend on symptoms to make the diagnosis.

It is better to screen for the disease if one has any risk factors which include gestational diabetes, a family history of diabetes, history of excessive alcohol use. Screening is done on either a urine or a blood sample.

Tests to confirm diabetes

• Random blood glucose
• Fasting blood glucose
• Glycated Hb (HbA1C)
• Oral glucose tolerance test

Diabetes and the body

The effect of diabetes on the body can be divided into two main groups

Diabetes and the urological system

From the top down

Kidneys

• Pyelonephritis
• Xanthogranulomatous pyelonephritis
• Renal abscess
• Renal colic
• Renal failure
• Renal calculi
• Diabetic nephropathy/ Kimmelstiel Wilson kidney
• Fungal bezoar
• Haematuria

Ureters:

• Obstruction from papillary necrosis

Bladder

• Diabetic cystopathy, initially a sensory dysfunction with an overfilled bladder, later a motor dysfunction with inability to empty to completion, thus a high postvoid residual volume.
• Recurrent cystitis/ UTI

Prostate

• Prostatitis

Penis

• Balanophosthitis
• Erectile dysfunction

Epididymis and Testes

• Epididymorchitis
• Testicular abscess
• Fournier’s gangrene

Conclusion

Diabetes mellitus is a silent disease often until the process is far advanced. There are simple, inexpensive, non‐invasive test which can be done to screen for it. Its effect on the urological system can be devastating. However like many medical conditions if diagnosed early and managed appropriately the patient can enjoy a good quality of life and the complications averted.

Diabetes Tsunami hits South Africa