Definition

Diabetic encephalopathy is the most severe complication of diabetes, affecting the central nervous system in the brain. Encephalopathy is defined as damage or disease that affects brain function. This occurs when there are changes in the body or brain that disrupt the brain's function, resulting in neurological disorders, such as alterations in thinking processes and personality. Encephalopathy is a serious health condition, so if not promptly addressed, symptoms will worsen, causing temporary to permanent brain damage.

Diabetes mellitus itself has various complications, generally divided into two categories:

• Complications of large blood vessels, such as coronary heart disease, peripheral artery disease, and stroke.
• Complications of small blood vessels, such as diabetic nephropathy (kidney disorder), diabetic neuropathy (nerve disorder), and diabetic retinopathy (eye retina disorder).

According to the International Diabetes Federation (IDF), the number of people with diabetes mellitus has sharply increased in recent years, becoming one of the most prevalent diseases worldwide. Diabetes mellitus affects approximately 285 million people and is estimated to increase by 50% by 2030. This increase will also raise the incidence of diabetes mellitus complications, including diabetic encephalopathy.

Causes

Diabetes occurs when pancreatic beta cells fail to produce enough insulin hormone to regulate blood sugar levels or when insulin resistance occurs. Insulin resistance is a condition where cells in the body do not respond to insulin hormones. As a result, blood sugar cannot be absorbed and used by body cells, causing blood sugar levels to increase.

Diabetic encephalopathy is caused by several long-lasting mechanisms:

• High blood sugar levels
• High blood pressure
• High blood insulin levels
• Frequent and severe episodes of low blood sugar (hypoglycemia)
• Dyslipidemia (body fat disorder)

Risk factor

These factors increase an individual's risk of developing diabetes mellitus and its complications up to fivefold. These factors include:

• Obesity or increased waist circumference
• High cholesterol
• High blood pressure
• Smoking
• Excessive alcohol consumption

Symptoms

The severity of diabetic encephalopathy symptoms is related to the degree of brain damage. The experienced symptoms include:

• Confusion
• Memory impairment
• Personality changes
• Depression
• Impaired thinking or focusing ability
• Restlessness
• Speech difficulty
• Posture disturbances
• Body movement coordination disturbances
• Muscle weakness or uncontrolled twitching
• Uncontrolled eye movement
• Tremors
• Swallowing difficulties
• Drowsiness
• Irregular breathing patterns
• Seizures

Diagnosis

For the diagnosis of diabetic encephalopathy, the doctor will inquire about medical history and perform a physical examination to assess mental status, memory, and coordination. After that, the doctor will perform tests to determine the cause of encephalopathy. Further examinations may also be conducted to confirm the diagnosis and rule out other possible causes of encephalopathy. These examinations include:

• Complete blood count
• Blood pressure measurement
• Electrolyte, blood glucose, blood lactate, blood ammonia, blood oxygen, liver enzyme tests (to assess liver damage)
• Kidney function tests (creatinine)
• CT scan and MRI to detect brain swelling, structural abnormalities, or infections
• Electroencephalogram (EEG) to detect brain damage or abnormal brain wave patterns
• Autoantibody analysis. Some dementias are caused by antibodies that damage nerves (autoantibodies)

Management

Diabetic encephalopathy can be caused by excess glucose (hyperglycemia) or glucose deficiency (hypoglycemia). Both of these conditions often occur in diabetes patients and can cause encephalopathy. Therefore, the management of diabetic encephalopathy consists of:

• Administration of glucose if caused by hypoglycemia
• Insulin administration if caused by hyperglycemia
• After providing initial treatment, the doctor will prescribe other medications to control diabetes and prevent further brain damage. Several studies have shown that exercise has a positive impact on various aspects of brain function and has beneficial effects on overall brain health.

Complications

The impact of encephalopathy depends on the duration of treatment of the cause and the severity of your condition. Some people may experience total improvement, while others may experience slight improvement due to permanent brain damage. Late treatment can lead to depression, tremors, coma, and even death. Diabetic encephalopathy is also a risk factor for cognitive dysfunction and increased incidence of dementia, including Alzheimer's disease, Parkinson's disease, and Huntington's disease.

Prevention

In general, several things can be done to prevent diabetes complications, namely:

• Commit to managing your diabetes. Monitor your blood sugar levels and follow your doctor's instructions to manage your blood sugar levels. Take medication as directed by your doctor.
• Control blood pressure and cholesterol within normal limits.
• Regular exercise
• Quit smoking
• Schedule regular doctor's visits (about two to four times a year). During the examination, the doctor will ask about your nutrition and activities and look for diabetes complications to handle them early.
• Receive vaccinations as recommended by your doctor. Diabetes increases your risk of infection. Infections can disrupt diabetes control, including your blood sugar levels, making you more prone to complications.
• Manage stress. When you are stressed, you are prone to neglecting your diabetes routine. To manage stress, prioritize your work and learn relaxation techniques. Get enough rest and stay positive.

When to see a doctor?

If you or someone experiences symptoms of encephalopathy, immediate medical attention is necessary. Consult a doctor or visit the emergency room.

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