Complications of Diabetes
The most important health impacts of diabetes are the long-term complications it can cause. Most of these long-term complications are related to the adverse effects diabetes has on arteries and nerves.
Complications related to artery damage
Diabetes causes damage to both large and small arteries. This artery damage results in medical problems that are both common and serious:
Cardiovascular disease. Diabetics have up to a 400% greater chance of heart attack or stroke. Heart disease and stroke cause about 65% of deaths among people with diabetes.These deaths could be reduced by 30% with improved care to control blood pressure and blood glucose and lipid levels.
Amputations. About 82,000 people have diabetes-related leg and foot amputations each year. Over 60% of non-traumatic lower limb amputations are diabetes related. Foot care programs that include regular examinations and patient education could prevent up to 85% of these amputations.
Kidney disease. About 38,000 people with diabetes develop kidney failure each year. Treatment to better control blood pressure and blood glucose levels could reduce diabetes-related kidney failure by about 50%.
Eye disease and blindness. Each year, 12,000-24,000 people become blind because of diabetic eye disease, including diabetic retinopathy. Diabetes is the leading cause of new cases of blindness among adults 20-74 years old. Screening and care could prevent up to 90% of diabetes-related blindness.
Sexual Dysfunction. Approximately 70% of all adult males with diabetes currently suffer or will experience sexual dysfunction or impotence.
Complications related to nerve damage
60 to 70% of people with diabetes have mild to severe forms of nervous system damage. This diabetic neuropathy may result in numbness, tingling, and paresthesias in the extremities and, less often, debilitating, severe, deep-seated pain and hyperesthesias. The following are examples of diabetic neuropathy
Peripheral neuropathy The feet and legs can develop tingling, pain, or a loss of feeling. This problem makes foot ulcers and foot infections more common, adding to the possibility that an amputation may be needed.
Stomach and bowel problems The nerves that trigger normal movements of the stomach and intestines can become less active or less predictable. This can result in nausea, constipation or diarrhea. A stomach that is slow to empty has a diabetes condition called gastroparesis.
Dizziness when standing Your circulation has to make some adjustments to move blood from your toes to your torso when you are standing up, since it is pumping against gravity. When your body is working correctly, this adjustment includes tightening of blood vessels to prevent pooling of blood in your lower body. The circulation relies on nerve signals to know when to make this adjustment. These signals can fail in diabetes, leaving you with low blood pressure and lightheadedness when you are standing.
Sexual-function problems Impotence is especially common in people with nerve damage from diabetes. Artery damage also contributes to impotence.
Localized nerve failures A nerve that controls a single muscle can lose its function. Examples of problems that might result are eye movement problems with double vision, or drooping of the cheek on one side of the head (commonly known as Bell's palsy).
Flu- and pneumonia-related deaths. Each year, 10,000-30,000 people with diabetes die of complications from flu or pneumonia. They are roughly three times more likely to die of these complications than people without diabetes.
Pregnancy complications. About 18,000 women with preexisting diabetes deliver babies each year, and an estimated 135,000 expectant mothers are diagnosed with gestational diabetes. These women and their babies have an increased risk for serious complications.
Many of these potential complications can significantly shorten the life of a person with diabetes, and all of them can diminish the quality of life.
Diabetes complications are primarily caused by 2 factors:
Excessive Glycosylation and Sorbitol Accumulation.
Glycosylation is the process by which the sugar molecule binds irreversibly to a protein molecule. This process takes place in all humans, but because diabetics have higher levels of glucose in their blood and for longer durations than non diabetics, they have a much higher degree of glycosylation ocurring.
Excessive glycosylation results in abnormal protein structures which lead to a host of cellular dysfunctions such as: inactivation of enzymes, inhibition of regulatory molecule binding, decreased susceptibility to proteolysis, abnormalities of nucleic acid function, altered macromolecular recognitions and increased immunogenicity.
In diabetics, glucose binds to proteins in the blood, nerves and the eyes. This pathological process causes much of the damage in the complications of diabetes.
Sorbitol is the byproduct of glucose metabolism and is produced through the action of the enzyme aldose reductase.
In non-diabetics, sorbitol is converted to fructose and is easily excreted from the cell, but inside the cells of diabetics, when glucose levels become elevated (even after glucose levels outside of the cell return to normal), sorbitol is produced faster than it can be broken down. Since it cannot cross the cell membrane, it builds up to a toxic level inside the cells, creating an imbalance and causing a loss of electrolytes and other minerals. This accumulated sorbitol draws water in to the cell, by the process known as osmosis, and ultimately leads to the collapse of its architecture and loss of its function.
Sorbitol-induced osmotic swelling is believed to be one of the main causes of tissue damage in diabetics. This condition seems to target organs and tissues that are not dependent on insulin for their absorption of glucose. Elevations of sorbitol levels are a major problem in peripheral nerves, blood vessels, the cells of the retinal blood vessels, the lens of the eye, the pancreas, kidneys and other organs due to their lack of insulin dependence.
How Is Diabetes Diagnosed ?
Diabetes is diagnosed by evaluating both symptoms and lab test results.
There are two common lab tests:
Fasting Plasma Glucose test (FPG): With the FPG test, your blood glucose level is measured after an 8 hour fast. If your glucose is higher than normal (100 mg/dl), you have what's called "Impaired Fasting Glucose" (IFG), which suggests pre-diabetes. A diagnosis of Diabetes is made when an FPG level of greater than 125 mg/dl is measured on two occasions.
Oral Glucose Tolerance Test (OGTT): An OGTT may be helpful in diagnosing type 2 Diabetes in patients whose FPG is between 115 and 125 mg/dl. During an OGTT test, your blood sugar is measured after a fast and then again 2 hours after drinking a beverage containing a large amount of glucose. Two hours after the drink, if your glucose is higher than normal (140 mg/dl), you have what's called "Impaired Glucose Tolerance" (IGF), which suggests pre-diabetes. A diagnosis of Diabetes is made when an OGTT level is greater than 200 mg/dl.
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