Complications induced by diabetes

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Diabetes is a chronic and progressive disease that has a serious effect on the lifestyle of those suffering from it. According to World Health Organization estimates, in 2016, 13.1 percent of the Jordanian population had diabetes. Fortunately, medicine is constantly evolving and controlling the disease has become much easier. Despite this, there are many who do not control their diabetes, which results in serious complications and even death. اضافة اعلان

By the same WHO estimates, diabetes-related conditions are the 6th most common cause of mortality in Jordan. Furthermore, even when well controlled, diabetes may result in complications. In these instances, it is important to understand the signs and symptoms of the disease as it progresses, in order to manage or prevent severe complications.

What is diabetes?

Our body requires sugar in the form of glucose to provide energy. The level of glucose in our blood at any given point must be strictly regulated. If blood glucose levels are high, it is known as hyperglycemia and even acute events of hyperglycemia can be detrimental to health. For those with diabetes, there is an inability to properly regulate blood glucose levels, which largely revolves around the pancreas and a hormone called insulin. Insulin, a hormone produced by the pancreas, is responsible for lowering the levels of sugar in the blood. After a meal, the pancreas secretes insulin to ensure we do not become hyperglycemic and can effectively store the sugar for later use.
13.1% of the Jordanian population had diabetes by 2016, According to World Health Organization estimates.

There are a few types of diabetes, and classifications can vary depending on the country. The two most common are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Type 1DM is an autoimmune disease in which the cells of the pancreas that produce insulin (known as-cells) are destroyed or damaged. Over time, this results in the body not being able to produce enough insulin and requiring the use of insulin medications. Type 2DM is when the body no longer responds to insulin the way it should. The pancreas may be releasing the appropriate amount of insulin, but the body is not able to lower the sugar levels enough. In this case, the use of medication, such as metformin, can help increase the body’s sensitivity to insulin.

Diabetic neuropathy

This is nerve damage that results from long-standing and often uncontrolled diabetes. The most common form of diabetic neuropathy is peripheral neuropathy, which is damage to the nerves in the hands and feet.

Our body constantly repairs damages that occur daily. In diabetics, the rate of repair is unable to keep up with the rate of damage and ultimately results in nerve damage. For those with T1DM, maintaining adequate control of the blood glucose can greatly reduce or prevent the progression of nerve damage. However, in T2DM, adequate control of blood sugar is not enough. Factors such as obesity and metabolic syndrome significantly increase the risk of peripheral neuropathy.

Metabolic syndrome is a group of conditions that include high blood pressure, high blood sugar, excess body fat, and high cholesterol. The American Association of Clinical Endocrinologists recommend screening for neuropathy when you are first diagnosed with T2DM or five years after a diagnosis of T1DM. You should be rescreened every year and should come in sooner if you experience any symptoms. Symptoms include pain, tingling, or numbness in the hands or feet.

Diabetic retinopathy

Diabetic retinopathy is a complication that affects the eyes. Over time, especially those who do not control their blood sugar levels, the disease can damage the blood vessels of the eye. Initially, retinopathy can have mild to no symptoms, but as the disease progresses, it may eventually lead to blindness.

There are two forms of retinopathy: early diabetic retinopathy and advanced diabetic retinopathy. Early diabetic retinopathy, also known as nonproliferative diabetic retinopathy, occurs when the smaller blood vessels that supply the retina (tissue sensitive to light in the back of the eye) develop bulges that leak fluid and blood. Larger vessels may also become malformed and result in blockages that can result in tissue death, or the buildup of fluid known as edema. If left untreated, it may result in permanent vision loss.

In advanced diabetic retinopathy, also known as proliferative diabetic retinopathy, blood vessels become blocked and new and abnormal ones grow in their place. The new blood vessels are fragile and prone to damage, which results in scar tissue forming and potentially detaching the retina from the back of the eye. In some cases, increased fluids in the eye result in increased pressure which can damage the optic nerve and ultimately cause glaucoma.

Screening for retinopathy should occur and people should be examined soon if symptoms occur. Symptoms include spots or dark strings floating in your vision, blurry vision, and progressive vision loss.

Diabetic nephropathy

Diabetic nephropathy is a complication of diabetes that affects the kidneys. The kidneys are responsible for filtering and removing waste as well as excess fluids from the body. Over time, diabetes damages the blood vessels that filters waste, which ultimately results in reduced kidney function and even kidney failure.

Kidney failure, also known as end-stage renal disease (ESRD), has a huge effect on the quality of life for those affected. More often than not, those who reach ESRD have to have their blood filtered by a machine in a process known as hemodialysis. ESRD is accompanied by further complications, such as a buildup of fluids in the arms and legs (edema), electrolyte imbalance (e.g., potassium, calcium, and phosphorus) which can affect the bone density, and reduced red blood cells (anemia).

It is important to look out for the early signs of nephropathy in order to avoid ESRD. Symptoms include worsening of blood pressure control, swelling in the ankles, hands, feet, and eyes, persistent itching, increased need to urinate, and reduced need for diabetic medications.

Other complications

The longer you have diabetes and the more uncontrolled it is, the more likely you are to develop complications. Diabetic neuropathy, retinopathy, and nephropathy are severe complications and one should be regularly screened for them, but there are other complications that can be just as dangerous.

Diabetics are generally considered immunocompromised and heal wounds poorly. This makes them susceptible to a common condition known as diabetic foot. Nerve damage to the feet, combined with poor blood flow can cause cuts and blisters that can become infected. If left untreated, that may result in gangrene and possible amputation.

There is also research into a link between Alzheimer’s disease and diabetes. One study even found that T1DM patients are 93 percent more likely to develop dementia. In fact, the relationship between diabetes and Alzheimer’s disease/dementia is high enough to have many propose the term type 3 diabetes, which would encompass all who have Alzheimer’s as well as type 2 diabetics who later develop Alzheimer’s.

Although many complications of diabetes are inevitable, the progression of complications can be greatly reduced or prevented altogether. It is important to take medication as prescribed by the doctor, to follow diets and to exercise.

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