Diabetics Complications and Management

Diabetes mellitus is a disease state in which there is an increased level of glucose in the blood (greater than or equal to126mg/dl for fasting blood sugar and greater than or equal to 200mg/dl for random blood sugar or oral glucose tolerance test).

It is a leading endocrine disorder in the various groups of people around the world. Type 1 mostly affects the Caucasians but type 2 does not really have racial group predilection.

There are other classes of diabetes, including gestational diabetes mellitus and some other specific ones like LADA (latent autoimmune diabetes of adult), MODY (maturity-onset diabetes of the young), etc. It is of great importance to know about diabetes because of reasons like; every 6 seconds someone dies of diabetes-related complication, 5 million people die every year from diabetes every year, also WHO has declared it has one of the global health emergencies of the 21st century.
Complications of Diabetes can be grouped as

• Acute

Acute complications include diabetic ketoacidosis (DKA) and hyperosmotic hyperglycemic nonketotic state(HHNS).
Diabetic ketoacidosis is a complication of type 1 diabetes. It occurs when there is increased blood glucose level and the body is not able to utilize the glucose because the body is not producing insulin. When this happens, the body will have to derive its nutrients from the breakdown of fatty acids. The end product of fatty acids is called ketone bodies. These ketone bodies when present in the blood can cause a form of acidosis which is called metabolic acidosis. Presence of ketone bodies in the blood is called ketonemia, and presence of ketone bodies in the urine is called ketonuria. One of the problems that people with DKA usually have is dehydration. Dehydration is usually caused due to vomiting and a process called osmotic diuresis in the kidney. The vomiting is usually due to the effect of the metabolic acidosis. When we vomit, water is lost and this causes the level of water in the body to reduce (dehydration). Osmotic diuresis is a medical term in which there is the excessive passage of urine due to the increased level of glucose in the blood. This further decreases the level of water in the body. The dehydration can manifest in the form of dry skin. Other symptoms of DKA include extreme fatigue, fast rate of breathing, and feeling like vomiting, and sometimes abdominal pain that can seem intense. The smell that comes from the breath of people having DKA usually have a characteristic type of odor called “acetone” smell. DKA is a medical emergency situation and affected people will need to be hospitalized. It can cause death if not managed as it ought to be. Initially patient with DKA is conscious. But if not attended to early enough, such patient can become confused and become comatose.

    Hyperosmotic Hyperglycemic Non-ketosis State (HHNS)

This is a complication often associated with type 2 diabetes mellitus. It is due to increased level of glucose in the blood of type 2 DM patients. The blood glucose level is usually as high as 600mg/dL.  Like DKA, there is osmotic diuresis in the kidney, this causes the kidney to pass out so much urine, as high as 9L of urine in a day. There is an increase in the pH level unlike DKA, in which there is metabolic acidosis. There is a small level of ketones in the urine, while there us an absent-to-low level of ketone in the blood. One of the prominent features of patients having HHNS is dehydration. They can also present with loss of consciousness. Triggers of HHNS in diabetics are an infection (e.g. pneumonia), infarction, etc. HHNS can lead to diseases like a cerebrovascular accident (also known as stroke), the deficit in the blood supply to the lower parts of the body (the lower limbs).

     Chronic Complications of Diabetes Mellitus

These can be divided into two, based on the types of vessels that are affected. If it affects small-sized blood vessels, it is referred to as microvascular complication, and if it affects the larger sized blood vessels, it is referred to as macrovascular complications. Microvascular complications include diabetic neuropathy, diabetic nephropathy, diabetic retinopathy. Diabetic neuropathy occurs when there is reduced blood supply to the sheath covering the nerves. Affected people can have the followings in the area that the affected nerve is supplying: numbness, needle and pin sensation that is worse in the night (patient may complain that their “cover-cloth” is exerting pressure on them as they lie on their beds). Also, complain that patient with DM neuropathy usually has is a pain. Diabetic nephropathy occurs when a diabetic patient is not controlling his/her sugar level well enough. This will make the vessels that carry blood to some capillaries in the kidney (called glomerulus) to have their diameters become wider (dilated). while the blood vessels that carry blood from glomerular capillaries are not dilated. As a result of this, there will be what is called in a medical term (increased glomerular pressure). This then later leads to the damage of some of the parts of the glomerulus. This affects the kidney, and at a point, if the kidney is not properly managed, the patient will be passing frothy urine (urine that foams and the foams do not resolve early enough as it would have been when a passing is in a normal healthy state). DM nephropathy can lead to a good kidney become a bad one.   Another acute complication of diabetes is diabetic retinopathy. In people with this condition, the eyes are affected, such that there can be blurring of vision. If it is not properly managed, it can lead to loss of eyesight.
Chronic complications of DM that affects bigger vessels include stroke, coronary artery disease, and peripheral artery diseases.

Management of Diabetes

 It involves diet (and lifestyle) modification and medications. Diabetics should reduce the consumption of saturated fatty food. They should also reduce the intake of alcohol and should refrain from smoking. Type 2 DM patients should endeavor to exercise more, in order to prevent them from weight gain. Medications will not work for diabetics if they will not adapt to diet modification. Medications include insulin, sulfonylureas (e.g. tolbutamide), biguanides (e.g. metformin), incretin mimetics (e.g. liraglutide), etc. Some of the medications have an oral mode of administration, while some are given by injection.

       References

Anon, (2018). [online] Available at: http://://www.who.int/mediacentre/factsheets/fs138/en/ [Accessed 3 Feb. 2018]. [Accessed 5 Feb. 2018].

Kumar, P. and Clark, M. (n.d.). Kumar & Clark’s clinical medicine.

Management of diabetes at diabetes camps. American Diabetes Association. (1999). Diabetes Care, 22(1), pp.167-169.