Complications of Diabetes

Diabetic Neuropathies

Diabetic Kidney Disease

Diabetic Foot Ulcers

Referral

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Macrovascular complications

Diabetic patients with a history of myocardial infarction, vascular bypass, stroke or transient ischemic attack, peripheral vascular disease, claudication, or angina need secondary prevention with aspirin and a statin – see Ischaemic heart disease and atherosclerosis, prevention

Hypertension

See Hypertension.

Dyslipidaemia

See Dyslipidaemia.

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DIABETIC NEUROPATHIES

ICD-10 Code: E10.4 † / E11.4 † + (G63.2*/G99.0*/G59.0*)

DESCRIPTION

Neuropathies are a common complication of diabetes. They play an important role in the morbidity and mortality suffered by people with diabetes.

There are three major categories:

• peripheral neuropathy,
• autonomic neuropathy, and
• acute onset neuropathies.

MEDICINE TREATMENT

Ensure appropriate glycaemic control.
Exclude or treat other contributory factors e.g.:

• alcohol excess,
• vitamin B12 deficiency, if suspected,
• uraemia, and
• HIV infection.

Pain

• See Management of neuropathic pain.

Gastroparesis

• Metoclopramide, oral, 10 mg 8 hourly, 30 minutes before meals.

If ineffective consult a specialist.

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DIABETIC KIDNEY DISEASE 

ICD-10 Code: E10.0/E11.2/E12.2/E13.2/E14.2 + (N18.1-5/N18.9)

See Chronic Kidney Disease (CKD).

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DIABETIC FOOT ULCERS 

ICD-10 Code: L97/L08.8 + (E10.5/E11.5/E12.5/E13.5/E14.5)

GENERAL MEASURES

• Metabolic control.
• Treat underlying comorbidity (e.g.: corns, alcohol misuse, ingrown toenails).
• Relieve pressure: non-weight bearing is essential.
• Smoking cessation is essential.

Deep (limb-threatening) infection

• X-ray of affected limb.
• Surgical drainage as soon as possible with removal of necrotic or poorly vascularised tissue, including infected bone – refer urgently.
• Revascularisation, if necessary

Local wound care

• Frequent wound debridement with scalpel, e.g. once a week.
• Frequent wound inspection.
• Absorbent, non-adhesive, non-occlusive dressings.

Superficial ulcer with extensive infection

• Debridement with removal of all necrotic tissue

MEDICINE TREATMENT

Superficial ulcer with extensive infection

Antibiotic therapy

For polymicrobial infection:

Topical antibiotics are not indicated.

• Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 10 days.
  - Longer course of therapy may be necessary.

Severe infection

• Amoxicillin/clavulanic acid, IV, 1.2 g 8 hourly.

Severe penicillin allergy (Z88.0)

• Clindamycin, oral, 150-450 mg 8 hourly.

AND

• Gentamicin, IV, 6 mg/kg daily (See Prescribing Information for Specific Medicines for guidance on prescribing)

REFERRAL

• Arterial revascularisation procedures.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition