07/03/2021 / Endocrinology & Diabetes
Diabetes mellitus is a group of diseases that affect your blood sugar levels. We shall discuss the basics of Diabetes and about its various dangerous complications
Diabetes mellitus is considered a ‘silent epidemic’ especially in developing countries . Its prevalence has increased in the recent decades because of an increase in the rates of fast food intake, sedentary lifestyle and obesity.
Diabetic patients, if undiagnosed or inadequately treated, can develop multiple life-threatening complications. These complications can be either acute or chronic complications.
Insulin is a hormone produced by the cells called Islets of Langerhans or Beta cells in our pancreas. The main role of this hormone is to maintain an appropriate amount of blood sugar in our body at all times and also help store the surplus amount of glucose in the cells for future use as a source of energy. So naturally whenever there is an issue with Insulin , the blood sugar levels get affected correspondingly thereby causing symptoms and complications.
Glucose is a sugar ( that is ,a carbohydrate structure ) that can be supplied to our body by eating food. It is the main source of energy in our body , especially for cells of your muscles , brain , heart and liver. To be useful as a source of energy,glucose has to enter into the cells . Glucose is helped by insulin to enter into these cells.
Glucose is mainly supplied to these cells via food. Liver, with the help of insulin, stores the glucose in the form of a structure called Glycogen. When you haven’t eaten for some time, the blood glucose levels start falling. Now , the liver breaks down the stored glycogen to form glucose thereby maintaining an appropriate blood sugar level.
In diabetes, due to various reasons, insulin is either not produced in the body or even if produced in adequate amounts, it is not able to function effectively. Because of this, glucose is not able to enter into the cells to act as an energy source and it stays in the blood itself. This is the reason behind an increased blood sugar level in diabetes mellitus.
In short , the body is unable to use the glucose given to it via food without the presence of insulin.
The presence of excess glucose in your blood starts causing symptoms and complications over a period of time.
In type 1 diabetes , the body’s own immune system mistakenly destroys the insulin-producing cells in the pancreas, thereby affecting Insulin production. Usually starts around adolescence.
It is a chronic type of diabetes where even though the production of insulin is fine, the body doesn’t utilize the available insulin properly , thereby leading to high blood sugar levels. This is the most common type in India. Usually seen in older adults.
This is a stage where the blood sugar levels are higher than normal , but not high enough to be diagnosed as type 2 diabetes mellitus.
This is a type of diabetes that develops exclusively during pregnancy, usually in the second trimester. This mainly happens because of hormones produced by the placenta. These hormones interfere with the proper functioning of insulin in the mother, leading to raised blood sugar in the mother’s blood.
This is a group of inherited conditions, where the genes involved in the production of insulin from the pancreas are defective. Based on the gene involved , there are multiple types of MODY.
This disease is commonly confused with type 1 diabetes mellitus because MODY also occurs at a younger age, typically before the age of 30.
Age > 40 years
Positive Family history diabetes
History of GDM during pregnancy
Racial factors like - Indian, African-American, Hispanics etc .,
Sedentary lifestyle/ very less physical activity
Frequent fast food & soft drinks intake
Raised blood lipid & cholesterol levels
Is currently in pre-diabetes stage
Smoking , alcohol intake
Persistently disturbed sleep
Mental health disorders like schizophrenia, bipolar disorder etc.
In addition to the above , there are some specific risk factors for gestational diabetes:
1. History of GDM during her previous pregnancy
2. Gave birth to a heavy baby in the previous pregnancy ( weighing > 4kg )
3. Is overweight or obese during pregnancy
Now that we are aware of the process that happens behind diabetes , a question may arise in your minds : ‘ What complications can diabetes cause ? ‘
There are several acute and chronic complications of diabetes mellitus . Most of these complications of diabetes mellitus occur because of a long-standing raised blood sugar level or if the patient is inadequately treated.
The chronic complications of diabetes mellitus are more common.
Let’s talk about some of these chronic complications of diabetes now :
Diabetic patients are twice as common than the normal population to develop cardiovascular diseases. It is one of the major health complications of diabetes.
Diabetes increases the prevalence of heart diseases like coronary artery disease ( CAD) , angina ( chest pain) , stroke , heart attack , atherosclerosis ( narrowed vessels ) etc.,
These diabetes mellitus complications happen because of the raised blood sugar level that damages the blood vessels.
Neuropathy is one of the chronic common complications of diabetes mellitus. Raised blood sugar damages the tiny vessels supplying the nerves , causing their damage. The patient presents with a tingling sensation, numbness or a burning sensation starting on their palms and soles that spreads with time. These problems with diabetes can worsen with time if left untreated . The patient could even completely lose all the sensations in their limbs.
As we already saw, neuropathy is one of the common complications of diabetes. Along with the nerves of the limbs , the nerves and blood vessels supplying the sexual organs also get affected , both in males and females. This manifests as erectile dysfunction or impotence in males and reduced sexual drive in females.
Another major sexual health complications of diabetes is genital infections, especially fungal infections like yeast and urinary tract infections.
This is another major complication of diabetes mellitus. In long-standing cases of raised blood sugar , the tiny blood vessels supplying the retina and the optic nerve get damaged thereby leading to nerve blindness if left unchecked. Diabetics also experience an increased incidence of cataracts and glaucoma.
Diabetic nephropathy is a life-threatening chronic complication of diabetes mellitus . Kidneys are highly vascular organs, meaning they have millions of blood vessels. This vessel clumps in kidneys (called glomerulus) help in filtering the impurities in our blood. Long-standing diabetes can damage these essential blood vessels thereby leading to kidney failure. Such patients with end -stage kidney disease may need regular dialysis or even a kidney transplant.
As already seen, nerve and vessel damage in the feet reduce sensation in the soles because of which the patient may even be unaware of any cuts or wounds on the feet. When left untreated, these wounds can develop into severe infections. Since chronic diabetes also impairs wound healing , these wounds can worsen over time, increasing the risk for amputation of the toe, foot or even the whole limb.
This is one of the most common complications of diabetes mellitus. Diabetes impacts the person’s immunity thereby leading to increased risk of infections,especially fungal and bacterial infections. These infections could be of the skin and skinfolds, intimate areas and in severe cases, even of the internal organs.
Gums and Teeth are prone to get damaged when a person is facing Diabetes. In several cases, diabetic persons have also faced tooth loss, gum infection, etc.
Hearing impairments are more common in the diabetic population because of the damage caused to the minute nerves and vessels of the inner ear mechanism by raised blood sugar level.
This is a rare complication of diabetes mellitus. Compared to the general population, the diabetic people are more prone to develop dementia and Alzheimer’s disease later in life . Though the actual reason is not known, several have proved this relationship between diabetes and Alzheimer’s.
This is a commonly overlooked complication of diabetes called ‘ diabetes distress’ .Mental health illnesses like depression , anxiety are 2-3 times more common in diabetic individuals. Such patients have trouble following their treatment regimen for diabetes, thereby worsening the diabetes and this becomes a vicious cycle.
Acute complications of diabetes develop rapidly and are rare, but if not treated immediately, can be life-threatening.
The most common acute complications of diabetes mellitus are the following:
This is a dangerous complication of diabetes mellitus and is more common in type 1 diabetes. This happens mainly because of very high blood sugar levels and very low insulin levels . In such a situation, the liver is forced to convert all the stored fat into a substance called ketone bodies, which alter the complete metabolic profile of the patient causing serious complications.
The patient usually is very dehydrated, has breathing difficulty, may have a fruity smell in their breath and severe abdominal pain. If not immediately admitted to a hospital and treated with an insulin drip, the patient may become unconscious, followed by coma and death.
This is another life -threatening acute complication of diabetes mellitus. Hypoglycemia refers to abnormally low blood sugar levels. This usually happens when the patient has taken their diabetic medications or insulin injections but has forgotten to take adequate food . If the blood sugar levels become low, the patient may become weak, sweaty and anxious . Further , they can experience seizures, unconsciousness, coma and death if not immediately corrected.
Repeated episodes of hypoglycemia can cause permanent damage to the brain. So it’s important to treat it as soon as possible.
If you are a diabetic patient and feeling anxious and lightheaded, this could be because of hypoglycaemia mostly. Take 2 tablespoons of glucose powder or sugar mixed in water or a chocolate and once you feel even slightly better, immediately rush to the hospital to get your blood sugar levels tested.
If the patient is already unconscious, do not try to feed anything to them . Check their airway, breathing and pulse and rush them to a hospital immediately via an ambulance.
The major issue with the complications of diabetes is that they can start even before the person actually is diagnosed to have diabetes. So it’s important to constantly monitor the patient right from the time of diagnosis to avoid further worsening.
1. Follow a healthy lifestyle - healthy low-carb diet and plenty of exercise.
2. Maintain an ideal BMI.
3. Quit smoking and alcohol.
4. Adhere to the treatment plan sincerely.
5. Eat at regular intervals. Never miss a meal !
6. Get your blood sugar blood pressure levels , heart status and kidney functions checked frequently.
7. Consult your physician immediately in case you notice any long-standing wounds, reduced sensations on palms and soles or any sexual dysfunctions.
Acute complications develop so rapidly that it may be difficult to predict and prevent them . However a few steps can be followed:
Eat at regular intervals , never skip a meal.
If you are using Insulin injections, regularly visit your physician to check if you are taking the proper dosage.
Educate your family members, housemates and work colleagues about how to give you first aid in case any of these complications arise. This may save valuable minutes.
Ans- Cardiovascular complications of diabetes cause the most deaths.
Ans-Type 1 is worse because in most of the cases, type 2 is milder.
Ans- In type 1 diabetes, acute complications are more common , hence the patient can suddenly worsen compared to type 2 which has a slower progression.
Ans- One of the most common and earliest complications of diabetes is hypoglycemia, which is mainly caused by imbalance between insulin therapy and food intake.
Ans- Yes, this is possible in mild cases of diabetes.
Ans- If your blood sugar levels are usually within control and you are strictly adhering to the prescribed treatment plan, you can get your blood sugar levels tested every 6 months.
Ans- In type 1 diabetes, vision problems take some time to develop. So you could start getting regular annual eye checkups about 2-3 years after diagnosis. But In type 2 diabetes, you should start getting regular annual eye check-ups right from the time of diagnosis.
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