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Diabetes: It’s Complicated

While the prevention and basic manifestations of diabetes are important, so is the understanding of the complications that can arise as a result of Diabetes Mellitus. The potential for multi-organ damage is quite high by all accounts. Research points to varying degrees of prevalence for some complications depending on the type of diabetes, but overall it is safe to say that the majority of people who have been diagnosed with diabetes will develop complications within the first couple of years. Remember that diabetes is a condition that is characterized by insufficient/inadequate insulin levels and a raised blood glucose reading, during or after fasting. This unassuming metabolic glitch might not seem like a big deal, but it can create havoc in your organs and overall bio-systems.

Complications that come as a result of diabetes are devastating for quality of life and the costs associated with having to deal with those complications on top of the changes needed to keep your diabetes in check, well, you can imagine how fast the odds can become stacked against patients, both near and long term negative effects.

Before we dive in to look at some of the complications associated with Diabetes Mellitus, it is of paramount significance not to be discouraged if you find yourself afflicted with one (or several) of these conditions. There is an innumerable amount of research that goes into diabetes and its treatments/managements. While full blown diabetes cannot be reversed, it can certainly be appeased with good strategic adjustments to the lifestyle that lead to its presence.

Let’s dive in and took a look at the complications that may arise as a result of Diabetes Mellitus.

Acute vs Long Term Complications

Acute complications are of short duration but typically severe in magnitude and can be quite scary. They require urgent medical action to avoid fatal outcomes.

Diabetic Ketoacidosis – Most prominent in DM type 1, ketoacidosis describes a decrease in the body’s ph as a result of the breakdown of fatty tissue as the main source of energy. Because diabetes describes a state of low or nil insulin, our cells cannot use the primary source of energy which is sugar. Our metabolism then turns to metabolize adipose tissue for the required energy production. The fatty acids are taken to our liver where they are catalyzed into ketone bodies.

Ketones are the metabolized consequence of this but are considered toxic for the human body. Ketones are highly acidic in nature hence the name ketoacidosis. Symptoms include fatigue, stomach cramps, nausea, frequent voiding, thirst, coma and even death. Another signature of ketoacidosis is having a sweet breath, many report a smell of apples or nail polish due to acetone content being exhaled by the lungs.

Hyperglycemic Hyperosmolar State (HHS) — Dehydration is one of the hallmarks of diabetes. As our bodies starve for insulin, glucagon is activated to release more glucose into the bloodstream from the liver’s glucose reserves. But, since there is no insulin, the release of more sugar into the blood only compounds the problem even further by increasing sugar with no insulin around to transport it. Our metabolism then tries to get rid of all this sugar by frequent urination due to increased osmolarity (you will see high glucose levels in the urine at this point). The problem with this is that sugar tends to drag water and other electrolytes with it. Thus, the consequence is dehydration, little to no sugar intake by our cells, abnormally high frequency of urination, mental confusion and little or absence of ketone bodies.

Hypoglycemia – As the name indicates, this usually happens in diabetes type 2 patients who are currently taking medications for more and/or better insulin production, excessive exercising, alcoholism and not eating sufficient amounts.

Rarely, this combination of factors may cause an over efficiency of glucose absorption, leading to low blood glucose levels. Hypoglycemia is characterized by seizures, hunger with mood changes, rapid heart rate, a hazed mental state and black outs.

Long term complications (chronic) of Diabetes are obviously ominous as well. These complications must always be kept in check without fail as some chronic complications can lead to death if untreated.

Ischemic Heart Disease (same as Coronary Heart Disease) – Risk of Ischemia of the cardio-vasculature is increased in patients with diabetes. The following common patterns as it pertains to diabetes, all contribute to ischemic heart conditions:

*Obesity

*Sedentary lifestyle

*Abnormally high levels of triglycerides and cholesterol

*Hypertension

*Dyslipidemia

Atherothrombotic processes are well known and understood to be a build-up of triglycerides, cholesterol and plaque against the arterial walls. The coronary artery becomes progressively blocked and an insufficient amount of blood is passed through its lumen. This sanguineous irrigation insufficiency to the corresponding heart musculature is called coronary ischemia. If the blockage is left untreated, it can lead to failure of the cardiac muscle, in medical terms it is called a myocardial infarction due to ischemia.

Diabetic Retinopathy – It begins with micro aneurisms. The human eye is highly vascularized by very small caliber capillaries. Diabetic patients commonly suffer from hypertension; the increased pressure against the vascular walls by blood torrent turbulence can lead to micro bubble-like capillary formations called aneurisms. The danger of course, is the bursting of these anatomical malformations causing retina damage in the eye. With repeated occurrences, blindness is sure to follow.

Diabetic Nephropathy – In terms of damage of microvasculature, something similar occurs in the kidneys. Normally, the kidneys filter waste products that the passing blood torrent carries. Microvasculature damage also occurs in the glomeruli; the actual capillary filters and functional unit of the kidney. The glomeruli contain small openings that only allow water and waste products to pass through, we call this urine. However, in the presence of diabetes, microvasculature damage inhibits proper filtration of molecules that should not pass through but do. Hence, when performing a urine test we see in increase in albumin (Hyper-albuminuria); a large protein molecule that evaded filtration thanks to the scarred glomeruli. This type of nephropathy can lead to ESRD (End-Stage Renal Disease) and ultimately, death.

Peripheral Neuropathy – Peripheral neuropathy refers to nerve damage of motor, autonomic and sensory nerves and plexus not located in the central nervous system. Hence, damage to these different types of nerves affects the corresponding systems that they control such as the digestive system (diarrhea or constipation), the sensory perception of limbs (this is why those who suffer from peripheral neuropathy feel numbness or tingling in their feet and hands), cardiac rate regulatory nerves (hypertension) among others. The pathophysiological mechanism in which hyperglycemia affects nerves is not yet fully understood, but the microvasculature damage previously mentioned is certainly a factor.

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