Diabetes and its Complications

Endocrinology is one of the body’s two chief communication systems. A system in which a group of secretory cells secretes a potent chemical transmitter substance which is called as a hormone, into the blood. The transmitter is then carried by the blood to the target cells where a reaction is provoked. It differs from the other systems. The Endocrine system is essential for the maintenance of homeostasis.

Pathophysiologic variation is a change in the task as distinguished from a structural defect. Diabetes occurs when there is a dis-balance between the demand and manufacture of the hormone insulin. Pathophysiology of diabetes is that in this circumstance the immune system outbreaks and terminates the beta cells of the pancreas which produce insulin. There is a lack of beta-cell leading to complete insulin deficiency. However in type 2 diabetes, there is a comparatively slighter deficiency of insulin but not a whole deficiency. This means that the body is incapable to harvest appropriate insulin to overcome the demand. Gestational diabetes is the third type of diabetes. It is caused when there are excessive counter-insulin hormones of pregnancy. This paves the way to a state of insulin resistance and high blood sugar in the mother. There may be faulty insulin receptors.

The most common form of diabetes is type 1 diabetes, type 2 diabetes, pre-diabetes, gestational diabetes. Type 1 diabetes is also known as insulin-dependent diabetes, and type 1 diabetes is due to autoimmune b-cell destruction, typically leading to a lack of insulin. Whereas type 2 diabetes is non-insulin-dependent diabetes. Type 2 diabetes is due to a progressive loss of b-cell insulin secretion commonly on the background of insulin resistance. Gestational diabetes mellitus (GDM) is triggered by pregnancy and is often diagnosed in middle or late pregnancy. Specific types of diabetes due to other effects, e.g., monogenic diabetes syndromes which is a neonatal diabetes and maturity-onset diabetes of the young (MODY), diseases of the exocrine pancreas; such as cystic fibrosis and pancreatitis, and drug- or chemical-induced diabetes by using glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation.

Complications associated with diabetes are often acute or chronic. Acute complications, though short-termed, can often present immediate danger and thus needs to be treated at the earliest possible. These short-term complications are mainly characterized by the hypoglycemic or hyperglycemic state of the body in which it is unable to function properly. Acute complications chiefly consist of diabetic ketoacidosis, diabetic coma and so on. These complications if promptly treated, usually results in full recovery, however, might prove fatal in case of delayed treatment.

Diabetics are more prone to developing dental complications than those who have proper control over their blood glucose level. There are a host of dental and gum diseases associated with diabetes including gingivitis, periodontitis (mild and severe), fungal infections, dry mouth, loose teeth and so on. Prolonged levels of blood glucose can lead to developing or worsening of dental infections. Keeping a check on the blood glucose level, maintaining proper oral and dental hygiene can help mitigate such complications.

Also known as diabetic kidney disease (DKD), diabetic nephropathy is the chronic loss of kidney function primarily because of high blood glucose level. About 40% of the individuals affected with Diabetes Mellitus, eventually develop DKD. Diabetic Nephropathy is characterized by the loss of protein in the urine (proteinuria or albuminuria) and by a decline in the estimated Glomerular Filtration Rate of the kidneys. It is one of the most common causes of End-Stage Kidney Disease (ESKD) which can ultimately lead to kidney failure. A proper diet, healthy lifestyle, regular checking of blood glucose and lowering blood pressure can help prevent diabetic nephropathy and protect kidney function.

Diabetic neuropathy or nerve damage which is brought about by diabetes is a severe form of diabetic complications. High blood glucose levels often damage the small blood vessels which supply essential nutrients thereby causing neuropathy. Diabetic neuropathy mostly affects the nerves in the legs and feet. Apart from neuropathy, diabetes has also been linked to various other disorders of the brain including Alzheimer's disease, Memory loss, Gastric Problem, Mental Health, etc. Though a serious complication, the progress of diabetic neuropathy can be slowed down with tight blood sugar control and a healthy lifestyle.

Diabetes can also cause a group of eye conditions which are collectively called Diabetic eye disease. The most common form of the disease is diabetic retinopathy which is associated with damage to the tiny blood vessels in the retina. This condition can progress through four stages and eventually result in retinal detachment or permanent vision loss. Other forms of diabetic eye disease include Glaucoma, Cataracts, Blindness, etc. For early detection and treatment of such disease, it is necessary for affected individuals to undergo retinopathy screening and taking proper care of oneself.

Having diabetes greatly enhances the risk of developing heart disease and having a greater chance of a heart attack or a stroke. High blood pressure or high cholesterol which is often associated with diabetes is the main causative factors of cardiovascular diseases. Apart from these, several other serious vascular complications also arise because of diabetes viz. Angina, Deep vein thrombosis, endothelial dysfunction, Peripheral arterial disease, etc.  Identifying symptoms, maintaining a healthy weight, proper diet and medications and cutting down on smoking can help keep these otherwise serious complications under control

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Often, raised blood glucose can damage the sensation in the feet, affecting blood circulation to the area without which there usually tends to be delay in healing of the cuts and sores. When these symptoms are kept untreated, various complications are likely to arise like foot ulcers, foot infections and foot deformation and might also lead to amputation. Hence, it is extremely essential to take proper care of the foot, undergo regular foot checkups and keep diabetes under control.

Gestational diabetes, if not carefully managed, can bring about complications for both the baby and the mother. Such complications are associated with premature birth, respiratory distress syndrome, excessive birth weight, hypoglycemia, stillbirth, etc. Along with the baby, the mother is also at the risk of developing serious complications like preeclampsia, future diabetes, etc. Screening for gestational diabetes, losing extra weight before pregnancy, eating healthy foods, exercise, lifestyle changes are some of the preventive measures that can be adopted for diabetic complications during pregnancy.

Pediatric or juvenile diabetes is chronic type 1 diabetes which affects the young population, particularly children under the age of 15. Such diabetes brings about lifetime dependence on exogenous insulin. Signs and symptoms of pediatric diabetes are like other types of diabetes and children are more likely to develop the disease if there is a family history of diabetes. Complications of pediatric diabetes also generally include heart diseases, nerve damage, nerve, kidney and eye damage, skin conditions, osteoporosis, etc. Proper diagnosis, treatment, and management are possible remedies for this type of diabetes.

One of the best preventive measures one can adopt for diabetes is undertaking diabetic screening tests. Such screening is useful for detecting diabetes at an early stage and consequently taking appropriate measures to curb the further development of diabetes-related complications. Screening tests can be performed for the eyes (retinopathy screening), nerves, kidney, blood pressure, cholesterol, etc. A variety of tests are also available for diagnosing or distinguishing between certain types of diabetes including HbA1c test, C-peptide test, antibodies test, etc.

It is always desirable to take up preventive methods for such a disease which brings about so many serious complications. Some of the measures include undertaking a balanced diet, doing regular exercise, making lifestyle changes and cutting down on harmful habits such as smoking, alcohol consumption. Assuming preventive methods for Pre-diabetes, which is a precursor to type 2 diabetes, is also endorsed. Diabetic medications are also helpful for lowering the risk of diabetes in patients for whom lifestyle interventions might not be enough.

With the help of some medical tests and by using medical devices we can diagnose diabetes and pre-diabetes. The fasting plasma glucose test will measure your blood glucose levels after you have gone at least 8 hours without eating. Health care professionals used this testing to detect pre-diabetes or diabetes. An oral glucose tolerance process measures your blood sugar after you have gone at least 8 hrs without eating and 2 hrs after you drink a glucose-containing beverage. Diabetes can be diagnosis by Random plasma glucose test, in this method your doctor calculate your blood sugar without regard to when you ate your last meal. This test, along with an assessment of signs, is used to diagnose diabetes, but not pre-diabetes.

Treatment scheme of diabetes objectives to keeping blood glucose levels near to the normal range. This treatment should be specific to every distinct person depending on the type of diabetes one is having. While Type 1 diabetes is usually treated with insulin, Type 2 diabetes usually requires management with diet and exercise. A variety of anti-diabetic medication, insulin treatment, transplants, surgery, and herbal remedies are available which should be coupled with planned diet, physical exercise and blood glucose screening for effectively treating diabetes.

Nutrition forms a very important part of diabetes care. Balancing all the right nutrients in the right amount helps in maintaining a healthy diet. Often a diabetic diet is recommended to individuals with diabetes which is naturally rich in nutrients and low in fat and carbohydrates. The objective of such nutritional therapies is to attain and maintain optimal metabolic outcomes by keeping the blood glucose level as close to the normal range as possible. Dietary fibers also form a crucial part of the diabetic diet as these moderates how the body digests and helps control blood sugar levels.

Of the many risk factors of diabetes, genetics play a very strong role in the development of both types of diabetes. Individuals with a family history of diabetes are more likely to develop the condition than those without any diabetes in the family. Some types of diabetes like MODY is can be directly inherited. Studies have shown that Type 2 diabetes has a very strong genetic component and the likelihood of developing it if parents and/or siblings are already having the condition is far more as compared to Type 1 diabetes.

One of the most important features of diabetes management is the self-management of diabetes which can be successfully achieved, and complications prevented with the help and support of the nursing team. Diabetes specialist nurses play a crucial role in screening diabetic persons, detecting early onset of diabetes, assessing nutritional needs of the patient, promoting self-management, providing prevention advice, spreading awareness on diabetes and providing health coaching. In this context, it is extremely necessary for nurses to be well educated, trained and skilled adequately to be able to proficiently deliver care, support self-management and provide advice to diabetic persons.

Diabetes is a severe condition which still doesn't have a medication which makes new research, treatment, and management techniques a vital necessity. Over the past years, there have been considerable breakthroughs in understanding and preventing diabetic complications. While some research focuses on generating artificial pancreas or engineering insulin-producing beta cells, some other researches are directed towards finding newer and longer-lasting drug molecules, devising more efficient diets and developing intensive treatment programs. Developments and progress on diabetes research is the necessity of the hour for bringing about excellent management of this serious life-threatening disease.