Diabetes refers to a high blood glucose level. Diabetes high blood sugar occurs when either our pancreas fails to produce enough insulin or when the body resists the action of insulin. Insulin is a hormone that decreases blood glucose. For a rough idea, in a healthy person, fasting blood glucose ranges from 70 to 100 mg/dL. If it’s more than 100, the condition is termed hyperglycemia. If these patients also fulfill the WHO criteria for diagnosis, they have diabetes. However, the good news is that diabetes can be prevented. That’s right! Even though diabetes is preventable to some extent, it can still progress to a more complicated stage if not controlled at the right time. We’d discuss the complications of diabetes in much more detail. Let’s first learn how complications develop in diabetic patients?
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How Do Complications of Diabetes Develop?
A Quick Review: The two major types of diabetes are Type 1 and Type 2 diabetes. Type 1 diabetes is more common in the younger population, whereas type 2 diabetes commonly occurs in the elderly. Type 2 diabetes affects approximately 90 to 95% of the population. Compared to 5 to 10% of the population who have type 1 diabetes.
Glucose is a source of energy regulating our normal body metabolism. High glucose in blood vessels affects the vascular anatomy making them more prone to damage. Since a higher amount of glucose remains in the vessels, our tissues do not receive enough glucose resulting in their gradual loss of function. In short, the pathogenesis of diabetes complications include:
- Oxidative stress due to Reactive Oxygen Species (ROS)
- Low levels or total lack of insulin or insulin resistance by the body tissues
Some women during pregnancy may also develop diabetes, termed Gestational diabetes. Prediabetes is a condition in which blood glucose is higher than normal values but not too high to categorize it as diabetes. However, it may progress to diabetes and later develop complications.
If not diagnosed and treated earlier, all these major types of diabetes may gradually engulf the whole body, destroying bodily cells and tissues. And this resulted in their death.
Complications of Diabetes
To easily grasp the idea, complications of diabetes have been divided into two categories.
- Acute, that is, occurs at any time of disease, and
- Chronic, in which complications build up after long-standing diabetes.
We’d first discuss chronic complications of diabetes as they are more common.
CVS Disorders
Macrovascular complications are more common in type 2 diabetes. Besides, if you smoke or have a positive family history of heart disease, you are already at risk of developing heart problems later in life.
Diabetes, as we know, affects our blood vessels, narrowing them, which may result in atherosclerosis (a condition that can progressively lead to cardiac arrest or stroke). Other than that, diabetics are at risk of developing Coronary Artery Disease, Angina, and diabetes high blood pressure.
Kidney Failure (Nephropathy)
Tiny vessels supplying kidneys and peripheral body parts are the first vessels to get affected by diabetes. Our kidneys are vital for filtering out the waste, damage to the vessels supplying this organ results in diabetes kidney failure, or in more critical cases, there can be an irreversible end-stage renal disease.
Note: Pathogenesis of diabetic nephropathy is not well understood, studies suggest that it probably occurs due to genetic modifications.
Diabetic Neuropathy
Tiny blood capillaries nourish our nerves. If these vessels get affected by diabetes, there may be a nervous loss, termed Diabetic Peripheral Neuropathy. The patient experiences tingling or burning sensations and diabetes numbness. It mostly starts from the toes or fingertips spreading centrally towards the heart. If it is left untreated for a long time, you may have to amputate the affected body part/parts.
Moreover, Diabetes may also involve the nerves of the digestive system causing Gastroparesis. In such cases, patients complain of nausea, vomiting, constipation, or diarrhea.
Diabetic Retinopathy
As the name suggests, it’s the pathology of vessels supplying the retina. Diabetes vision loss progresses through multiple stages eventually leading to blindness. Diabetic Retinopathy is very common among the diabetic population. It mostly occurs in patients who have had diabetes for at least 10 years. Moreover, the patients may also develop other eye problems like cataracts or glaucoma.
Note: It’s recommended to see an ophthalmologist if you are a known case of diabetes.
Infections
As we know, diabetes reduces a person’s ability to fight infections by weakening the immune system. Therefore, Diabetics have a low wound healing capability which makes them more susceptible to infections. Bacteria and fungi love to infect an open wound. Infections mainly occur in the bladder, urethra, kidneys, gums, feet, skin, or vagina.
Note: Studies report that every third patient with diabetes has a skin-related condition or a cutaneous infection.
Remember that due to the sensory loss in diabetes, patients do not feel even the slightest of cuts. Until it visibly gets worse. Therefore, it’s easier for bacteria and fungus to invade the broken tissue. An infected wound is even harder to treat. Hence, the earlier you diagnose, the better the outcome would be.
Foot Problems
Why is diabetes amputation important?
Due to the Peripheral Vascular Disease, there is poor blood flow to the distal body parts (feet). This prolongs the healing time of a wound. As a result, the death of that body tissue (Gangrene) happens. And if left undiagnosed and untreated for a long time, may transform into an ulcer. This classically presents as a Diabetic Foot.
Gum Disorders
Diabetics have a higher risk of developing dental and oral health issues due to lower defense mechanisms. The high sugar level in saliva attracts bacterial growth which along with food particles. This results in the formation of a dental plaque. Hence, disorders like gingivitis, tooth decay, and periodontitis are common in these patients. They may complain of swollen, painful, or bleeding gums, watch out for these signs.
Sexual Dysfunction
In Women: Sexual disorders are more common in diabetic males than females. Women may only lose slight sensations due to decreased blood flow to the genital organs. Diabetic females are more likely to develop UTI or Vaginal thrush.
In Men: Men with diabetes may experience Erectile Dysfunction. It becomes impotent due to the loss of nerves supplying the genital area. However, the condition is reversible through medications, exercise, and lifestyle modifications.
Miscellaneous
Diabetes may also cause Hearing impairment, Alzheimer’s, and Depression. Moreover, diabetes can cause headaches due to high blood sugar.
Acute Complications
The Acute complications of diabetes that may arise at any time of disease include:
- Hyperglycaemia even after taking medications and controlled blood sugar levels.
- Hypoglycemic episodes
- Hyperosmolar Hyperglycaemic State (HHS), which more commonly occurs in Type 2 Diabetes. It arises when there is hyperglycemia for a prolonged period resulting in a high osmolality. The patients of HHS acutely present with increased thirst and urination, altered level of consciousness, vision problems, dehydration, generalized weakness, and leg cramps.
- Diabetic ketoacidosis (DKA) is a condition in which there are excessive ketone bodies that are formed due to the uncontrolled breakdown of fats and glucose. DKA is commonly seen in Type 1 Diabetes, due to the total lack of insulin in these patients.
How to Prevent the Diabetes Complications
Following are the precautionary measures that can help prevent diabetes before the complications develop:
- Eat healthily, and try to eat food that is low in calories and fats. Add fruits, vegetables, whole grains, and food rich in fibers to your diet.
- Exercise regularly and be physically fit
- Quit smoking
- Keep a regular check on sugar levels
- Religiously follow the medical advice of your doctor
A positive family history strongly points toward the development of diabetes in the later stage of life. However, it’s not always the case. Hence, you should always cut down on carbs. Also exercise regularly to prevent the occurrence of diabetes in the first place.
Sum Up
In short, diabetes is a complicated disease and if left untreated it may become deadly. However, it surely is preventable. The more you know about diabetes and its complications, the earlier you would be able to treat it. Even though tremendous information is available about diabetes, pathogenesis & the mechanism of diabetes are still not very well understood. So do its complications. Hence, more research is needed to conclude that for sure.
REFERENCES:
- https://www.who.int/news-room/fact-sheets/detail/diabetes
- https://www.cdc.gov/diabetes/basics/diabetes.html
- https://www.webmd.com/diabetes/diabetes-complications#091e9c5e800bacf6-1-2
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515299/
- https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
- https://www.diabetes.org.uk/guide-to-diabetes/complications
- https://www.webmd.com/diabetes/foot-problems
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