DIABETES UPDATE |
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What is diabetes? Diabetes mellitus is a chronic health condition in which the body is unable to produce adequate insulin to properly break down sugar (glucose) in the blood. Symptoms include hunger, thirst, excessive urination, dehydration and weight loss. Over time, diabetes can lead to heart and blood vessel disease, blindness, kidney failure, and foot ulcers, among other conditions. Diabetes is a disease of the endocrine system, specifically, the pancreas, and of glucose metabolism. Insulin is normally produced in the pancreas in response to high blood glucose levels; for example, after a meal. The Islets of Langerhan are small areas of tissue within the pancreas that contain beta cells, which produce insulin. In Type 1 diabetes, the beta cells are destroyed, leading to an absolute lack of insulin. In Type 2 diabetes, there is resistance peripherally to the inherent insulin. This leads to a relative lack of insulin and therefore hyperglycemia. Type 1 diabetes occurs at a very early age, caused, as mentioned above, by a destruction of beta cells in the pancreas. People with Type 1 diabetes have little or no ability to produce insulin and are entirely dependent on injections of insulin for survival. The cause of Type 1 diabetes is unknown, although childhood infections and a genetic tendency are two possibilities. The pancreas undergoes a change, and cells that normally produce insulin are destroyed. This may be a result of the body's own immune system believing the pancreas to be a foreign organ. Patients with Type 1 diabetes tend to be very slim people. Type 2 diabetes tends to be of adult onset, although more and more young people are now being diagnosed with this insulin-resistance syndrome. In Type 2 diabetes , the pancreas retains its ability to produce insulin , but either the quantity is inadequate for the body's needs, or insulin cannot be used to its full extent by the tissues. Most people who have this condition suffer from being overweight, and require a strict weight-reducing diet and exercise program, as well as possible treatment with drugs, sometimes including insulin. Definition of diabetes • Random plasma glucose of >200mg/dL • Fasting plasma glucose =126mg/dL on 2 separate occasions • Fasting plasma glucose 110-125mg/dL is considered Impaired Glucose Tolerance • Fasting plasma glucose <110mg/dL is considered normal • HbA1c <6.5% indicates good glucose control
Signs/symptoms At onset, the two types of diabetes present with distinction: Type 1 - weight loss, polyuria, polydypsia Type 2 - polyuria, polydypsia, recurrent infections Prevalence of diabetes It is estimated that 20.8 million people in the United States --7 percent of the population-have diabetes, including 6.2 million who are undiagnosed. Ninety-five percent of people with diabetes have Type 2. Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002. Diabetes is also likely to be underreported as a cause of death. Overall, the risk of death among people with diabetes is about twice that of people without diabetes of similar age. Complications of diabetes
Heart and blood vessel disease Heart disease is the leading cause of death for people with diabetes. Heart disease and stroke account for about 65 percent of deaths in people with diabetes. People with diabetes are 2-4 times more likely to have heart disease than persons without diabetes. Even people with Type 2 diabetes who do not have heart disease have an increased risk of having a heart attack. People with diabetes also tend to have other risk factors for heart disease, including obesity, high blood pressure, and hardening of the arteries (atherosclerosis). High blood pressure About 73 percent of adults with diabetes have blood pressure greater than or equal to 130/80 mm Hg or use prescription medications for hypertension. Blindness Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.
Adults with diabetes should have yearly eye exams to ensure the health of their eyes and to protect their vision. Over time, high blood sugar levels can damage the blood vessels that feed the retina of the eye. In nonproliferative diabetic retinopathy (NPDR), an early stage of diabetic eye disease, the blood vessels may leak fluid. This may cause the retina to swell and vision to blur, a condition called diabetic macular edema. In advanced or proliferative diabetic retinopathy (PDR), abnormal new blood vessels grow on the surface of the retina. The abnormal blood vessels don't supply the retina with normal blood flow. In addition, they may eventually pull on the retina and cause it to detach. Some cases of diabetic retinopathy can be treated with laser surgery. In this procedure, doctors aim a strong beam of light onto the patient's retina to shrink or seal leaking or abnormal vessels. Laser surgery can't restore vision already lost, so early detection is important. In some advanced cases of PDR, a surgeon may remove the vitreous portion of the eye and replace it with a clear solution (called a vitrectomy).
Kidney disease Over time, high blood sugar levels can damage the kidneys. Even when drugs and diet are able to control diabetes, the disease can lead to kidney disease (diabetic nephropathy) and kidney failure. Healthy kidneys act like filters to clean the blood of waste products and extra fluid. Damaged kidneys do not clean the blood well. Instead, waste products and fluid build up in the blood. Diabetes is the leading cause of kidney failure. People with kidney failure must either have dialysis treatment (to substitute for some of the filtering functions of the kidneys) or receive a kidney transplant. Foot ulcers Adults with diabetes need to take special care of their feet. People with diabetes are at risk for foot injuries due to numbness caused by nerve damage (diabetic neuropathy) and low blood flow to the legs and feet. The most serious injury is a foot ulcer. Diabetic foot ulcers are at very high risk of becoming infected, and sometimes they cannot be healed. Non-healing foot ulcers are a frequent cause of amputation in people with diabetes. Patients with foot ulcers may use wound dressings, skin substitutes, or other treatments to protect and heal their skin. Wound dressings are medical devices that are used to protect ulcerated skin and assist in its healing. They can range from simple bandages that can be bought in the drug store to complex materials that contain antibacterial and antiviral substances. Skin substitutes are products that help in closing the wounds of slow healing ulcers in patients with diabetes. They are made from human cells known as fibroblasts that are placed on a dissolvable mesh material. When the mesh material is placed on the ulcer, it is gradually absorbed and the human cells grow and replace the damaged tissue in the ulcer. Nervous system disease About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems. Almost 30 percent of people with diabetes aged 40 years or older have impaired sensation in the feet. Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations. Amputations More than 60 percent of nontraumatic lower-limb amputations occur among people with diabetes. Dental disease Periodontal (gum) disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes. Almost one-third of people with diabetes have severe periodontal diseases with loss of attachment of the gums to the teeth measuring 5 millimeters or more. Complications of pregnancy Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5 to 10 percent of pregnancies and spontaneous abortions in 15 to 20 percent of pregnancies.
Impotence Impotence is a common problem for men and is more common in men with diabetes. The relationship between diabetes and impotence is not clear and the reasons why men with diabetes are more prone to problems with impotence are not fully understood. Some people with diabetes suffer from hardened arteries, which may contribute to impotence by restricting the flow of blood to the penis. Nerve damage, another problem for people with diabetes, may also contribute to impotence. If blood glucose levels are kept in the normal range, it will help reduce the chance of these problems occurring. Other complications Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma. People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes. |
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Diabetes is a systemic disease which can have devastating effects on the body as a whole. Diabetes has numerous serious complications. 
