Diabetes Complications
Diabetic complications have become a serious issue for public health. Multiple factors like hyperglycaemia, hyperlipidaemia, and inflammation all contribute pathogenic effects to various vascular complications in diabetes. Hyperglycaemia plays a critical role in the widespread cellular damage since endothelial cells poorly regulate intracellular glucose and are particularly vulnerable to hyperglycaemia-derived oxidative damage. Furthermore, these pathogens also inhibit antigenic pathways, leading to inadequate blood vessel growth and consequently delaying diabetic wound healing process. Cytokines, especially various growth factors, provide the cellular and molecular signals necessary for normal healing process, but are deficient in diabetic wounds.
The chronic complications, which cause considerable morbidity and mortality, are atherosclerosis, microangiopathy, retinopathy, nephropathy, neuropathy, and cataracts. The biochemical basis of these abnormalities may be attributed to increased tissue ambient glucose concentration and may involve the following mechanisms: non-enzymatic protein glycation increased production of sorbitol, and decreased levels of myo-inositol.
The chronic complications, which cause considerable morbidity and mortality, are atherosclerosis, microangiopathy, retinopathy, nephropathy, neuropathy, and cataracts. The biochemical basis of these abnormalities may be attributed to increased tissue ambient glucose concentration and may involve the following mechanisms: non-enzymatic protein glycation increased production of sorbitol, and decreased levels of myo-inositol.
Hypertension and Heart Disease: This extra fluid causes the pressure in the vessels to increase. Heightened blood pressure, in turn leads to a generalized weakening of the circulatory system. This can eventually lead to blood vessels bursting in some extreme cases (e.g., vascular stroke) or lead to the development of chronic blood flow problems in the limbs and other peripheral parts of the body. Chronically high insulin levels are also associated with early development of atherosclerotic plaques inside blood vessel walls, which lead to further risk of aneurysm, hypertension, stroke, and heart attack.
- Eye Disease: Untreated diabetes can lead to a variety of eye problems including blindness and reduced vision. People with diabetes experience damage to blood vessels and retina. This leads to Diabetic Retinopathy. Diabetes can also cause abnormal new growth of capillaries inside the retina that degrade blood flow and weaken vision. Once it occurs, damage to vision is permanent. People with diabetes can prevent eye problems by keeping their blood glucose under good control, lowering their blood pressure, and cholesterol levels.
- Diabetic Nephropathy. The kidneys main job is to filter blood. In those with diabetes, sugar that is filtered from the blood damages the blood vessels in the kidneys over time. In extreme cases diabetes can lead to kidney failure, necessitating frequent dialysis or kidney transplantation. Micro albuminuria is the earliest sign.
- Nerve Damage (Neuropathy). Sugar in the blood damages the peripheral nervous system Affected patients report pain, tingling or buzzing sense in their hands and/or feet. Complete numbness (loss of sensation) in the limbs is also common. Patients may also lose bladder control, or the ability to walk. Male loss of ability to function sexually (impotence or erectile dysfunction) may also occur.
- Joint and Foot Problems. Poor blood flow in the limbs combined with nerve damage and reduced or deadened sensation lead to a situation where the extremities become easily susceptible to damage and disease. Damage to joints and ulcers of the feet are common. Foot and limb problems related to diabetes can usually be helped with proper treatment. However, left untreated, damage can become infected and require amputation.
- Infections of the Skin. Diabetes can cause a number of skin conditions, including fungal and bacterial infections, diabetic dermopathy, and a variety of spots, rashes and bumpy or oddly textured skin patches. Most of these conditions are related to chronically raised blood sugar levels, and become less of a problem once blood sugar is brought under control.
- Cognitive Issues. As one of the organs most affected by blood sugar fluctuations, the brain is also impacted by diabetes. Chronic uncontrolled diabetes appears to be associated with memory problems and dementia in the elderly, and may increase risk of Alzheimer’s disease. In younger patients with Type 1 diabetes, elevated blood sugar levels were found to be associated with increased difficulty performing mental arithmetic and with decreased verbal fluency performance. This slowing of cognitive functions was reversible as sugar levels decreased.
Acute complications of diabetes mellitus include hypoglycaemia, diabetic ketoacidosis, and hyperglycaemic hyperosmolar nonketotic coma. Blood glucose levels below 50 mg per 100 ml (venous blood) usually indicate hypoglycaemia in adults, whereas blood glucose values less than 40 mg per 100 ml indicate hypoglycaemia in children. The estimated incidence of hypoglycaemia in diabetic patients is 9 to 120 episodes per 100 patient-years. Hyperglycaemia may also result diabetic coma, but this usually represents the end of a much longer process.