Diabetes is a chronic and progressive disease that has a
serious effect on the lifestyle of those suffering from it. According to
World Health Organization estimates, in 2016, 13.1 percent of the Jordanian
population had diabetes. Fortunately, medicine is constantly evolving and
controlling the disease has become much easier. Despite this, there are many
who do not control their diabetes, which results in serious complications and
even death.
اضافة اعلان
By the same WHO estimates, diabetes-related conditions are
the 6th most common cause of mortality in Jordan. Furthermore, even when well
controlled, diabetes may result in complications. In these instances, it is
important to understand the signs and symptoms of the disease as it progresses,
in order to manage or prevent severe complications.
What is diabetes?
Our body requires sugar in the form of glucose to provide
energy. The level of glucose in our blood at any given point must be strictly
regulated. If blood glucose levels are high, it is known as
hyperglycemia and
even acute events of hyperglycemia can be detrimental to health. For those with
diabetes, there is an inability to properly regulate blood glucose levels,
which largely revolves around the pancreas and a hormone called insulin.
Insulin, a hormone produced by the pancreas, is responsible for lowering the
levels of sugar in the blood. After a meal, the pancreas secretes insulin to
ensure we do not become hyperglycemic and can effectively store the sugar for
later use.
13.1% of the Jordanian population had diabetes by 2016, According to World Health Organization estimates.
There are a few types of diabetes, and classifications can
vary depending on the country. The two most common are type 1 diabetes mellitus
(T1DM) and type 2 diabetes mellitus (T2DM). Type 1DM is an autoimmune disease
in which the cells of the pancreas that produce insulin (known as-cells) are
destroyed or damaged. Over time, this results in the body not being able to
produce enough insulin and requiring the use of insulin medications. Type 2DM
is when the body no longer responds to insulin the way it should. The pancreas
may be releasing the appropriate amount of insulin, but the body is not able to
lower the sugar levels enough. In this case, the use of medication, such as
metformin, can help increase the body’s sensitivity to insulin.
Diabetic neuropathy
This is nerve damage that results from long-standing and
often uncontrolled diabetes. The most common form of diabetic neuropathy is
peripheral neuropathy, which is damage to the nerves in the hands and feet.
Our body constantly repairs damages that occur daily. In
diabetics, the rate of repair is unable to keep up with the rate of damage and
ultimately results in nerve damage. For those with T1DM, maintaining adequate
control of the blood glucose can greatly reduce or prevent the progression of
nerve damage. However, in T2DM, adequate control of blood sugar is not enough.
Factors such as obesity and metabolic syndrome significantly increase the risk
of peripheral neuropathy.
Metabolic syndrome is a group of conditions that include
high blood pressure, high blood sugar, excess body fat, and high cholesterol.
The
American Association of Clinical Endocrinologists recommend screening for
neuropathy when you are first diagnosed with T2DM or five years after a
diagnosis of T1DM. You should be rescreened every year and should come in
sooner if you experience any symptoms. Symptoms include pain, tingling, or
numbness in the hands or feet.
Diabetic retinopathy
Diabetic retinopathy is a complication that affects the
eyes. Over time, especially those who do not control their blood sugar levels,
the disease can damage the blood vessels of the eye. Initially, retinopathy can
have mild to no symptoms, but as the disease progresses, it may eventually lead
to blindness.
There are two forms of retinopathy: early diabetic
retinopathy and advanced diabetic retinopathy. Early diabetic
retinopathy, also
known as nonproliferative diabetic retinopathy, occurs when the smaller blood
vessels that supply the retina (tissue sensitive to light in the back of the
eye) develop bulges that leak fluid and blood. Larger vessels may also become
malformed and result in blockages that can result in tissue death, or the
buildup of fluid known as edema. If left untreated, it may result in permanent
vision loss.
In advanced diabetic retinopathy, also known as
proliferative diabetic retinopathy, blood vessels become blocked and new and
abnormal ones grow in their place. The new blood vessels are fragile and prone
to damage, which results in scar tissue forming and potentially detaching the
retina from the back of the eye. In some cases, increased fluids in the eye
result in increased pressure which can damage the optic nerve and ultimately
cause glaucoma.
Screening for retinopathy should occur and people should be
examined soon if symptoms occur. Symptoms include spots or dark strings
floating in your vision, blurry vision, and progressive vision loss.
Diabetic nephropathy
Diabetic nephropathy is a complication of diabetes that
affects the kidneys. The kidneys are responsible for filtering and removing
waste as well as excess fluids from the body. Over time, diabetes damages the
blood vessels that filters waste, which ultimately results in reduced kidney
function and even kidney failure.
Kidney failure, also known as end-stage renal disease
(ESRD), has a huge effect on the quality of life for those affected. More often
than not, those who reach ESRD have to have their blood filtered by a machine
in a process known as hemodialysis. ESRD is accompanied by further
complications, such as a buildup of fluids in the arms and legs (edema),
electrolyte imbalance (e.g., potassium, calcium, and phosphorus) which can
affect the bone density, and reduced red blood cells (anemia).
It is important to look out for the early signs of
nephropathy in order to avoid ESRD. Symptoms include worsening of blood
pressure control, swelling in the ankles, hands, feet, and eyes, persistent
itching, increased need to urinate, and reduced need for diabetic medications.
Other complications
The longer you have diabetes and the more uncontrolled it
is, the more likely you are to develop complications.
Diabetic neuropathy,
retinopathy, and nephropathy are severe complications and one should be
regularly screened for them, but there are other complications that can be just
as dangerous.
Diabetics are generally considered immunocompromised and
heal wounds poorly. This makes them susceptible to a common condition known as
diabetic foot. Nerve damage to the feet, combined with poor blood flow can
cause cuts and blisters that can become infected. If left untreated, that may
result in gangrene and possible amputation.
There is also research into a link between Alzheimer’s
disease and diabetes. One study even found that T1DM patients are 93 percent
more likely to develop dementia. In fact, the relationship between diabetes and
Alzheimer’s disease/dementia is high enough to have many propose the term type
3 diabetes, which would encompass all who have Alzheimer’s as well as type 2
diabetics who later develop
Alzheimer’s.
Although many complications of diabetes are inevitable, the
progression of complications can be greatly reduced or prevented altogether. It
is important to take medication as prescribed by the doctor, to follow diets
and to exercise.
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