**11. Can diabetic complications be prevented?**

This is an important and fascinating question strongly related with the patient prognosis. Hyperglycemia or other aspects of the abnormal metabolism of diabetes are responsible for the development of complications; additional factors, which maybe genetic, have also a pathogenic influence. The clinical practice shows the mistery; how diabetic patients suffering for decades from poor control are free of late complications; however typical complications can be found at the time of diabetes diagnosis, even in the absence of fasting hyperglycemia. Intensive therapy for all diabetic patients with strict dietary control is essential. The role of the family doctor, specialist and other professionals –nurses, nutritionists, auxiliary persons, etc-, are very important for these particular patients.

### **12. Miscellaneous findings on diabetes**

Because diabetes affects almost every body systems, the patients can develop several symp‐ toms and complications. The chapter of I*nfections* is large. In some cases this finding may not occur more frequently than in non diabetic population, but it seem to be more severe probably because in diabetic patients leukocyte function is impaired and subsequently accompanied by poor control. Also this population is particularly prone to four unusual infections with strong relationship with diabetes –focus on skin, urinary tract, lungs, and bloodstream. *Malignant external otitis*, usually due to *Pseudomonas aeruginosa* tends to appear in older population and is characterized by severe pain in the ear, fever, and leukocytosis. The facial nerve becomes paralyzed in 50% of the cases, but other crucial nerves can be involved. *Emphysematous cholecystitis* tends to affect diabetic men and diagnosis is established when gas is seen in the gallbladder wall or during non invasive imaging examination.

Hypertriglyceridemia is common in diabetics and is related to overproduction of VLDL (*Very Low Density Lipoprotein*) in the liver and to a defect of metabolization on the peripheral tissues. The latter is due to a deficiency of lipoprotein lipase, an insulin-dependent-enzyme. It is important to know that some patients have high level of lipids profile even when diabetic disease is controlled; probably these cases have a primary familial hyperlipoproteinemia, a circumstance independent of DM. Of course, these patients must be treated for lipids disorder –hypertriglyceridemia and lipids hypercholesterolemia with HMG-CoA reductase inhibitors such as lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin, as mode of action that reduces cholesterol synthesis and increases LDL receptors; ezetimibe reduces the absorption of lipids from diet at the intestinal level; and fibric acid derivatives –↓ LPD and tryglyceride, hydrolysis, VLDL synthesis, ↑ LDL catabolism. Patients can also suffer from a variety of skin lesions: necrobiosis lipoidica diabeticorum, candida albicans, vaginal monilia‐ sis, in women, hypertrophy of fat, bullosis diabeticorum, diabetic dermopathy, atrophy of adipose tissue, Dupuytren's contractures, and schleroderma. Additional illnesses such as the prevalence of eating disorders can be seen particularly in young women.
