Introduction In type 1 diabetes, insulin deficiency due

Introduction

            Diabetes also known as diabetes
mellitus is a disorder or chronic disease in which the insulin action and
secretion in the body are disturbed resulting to hyperglycemia. Hyperglycemia
is high blood glucose level in the body. Normal blood glucose level in our body
is 70-100mg/dL whereas the blood glucose level in patients who have diabetes
will be in 200mg/dL or more. There are mainly two types of diabetes which are
type 1 diabetes and type 2 diabetes. Type 1 disease is juvenile diabetes or
insulin-dependent diabetes whereas type 2 diabetes is non-insulin dependent or
maturity- onset diabetes. In type 1 diabetes, the pancreas does not secrete
enough insulin whereas type 2 diabetes insulin is produced but the secretion is
not effective.

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Complications
of diabetes

Short-term
complications of diabetes or acute metabolic complications

            In both types of
diabetes, the complications which are either short-term or long-term are depend
on the severity and duration of hyperglycemia.

In
type 1 diabetes, insulin deficiency due to the destruction of beta-cells of
islets of Langerhans prevents the tissue metabolism of glucose and liver
storage of glucose in the form of glycogen. This results in hyperglycemia which is the rapid
increase in the blood glucose level in the body. When the blood glucose is
above the renal threshold which is 180 mg/dL, the glucose will split into urine
which is a condition known as glucosuria.
At the same time, the glucose will carry water and electrolytes like sodium
ions, potassium ions, magnesium ions and also phosphate ions together. Due to
high glucose level in the urine, the osmotic pressure is increased which
results in the attraction of water from the surrounding cells and this causes
osmotic diuresis, a condition in which the urine output rises. Frequent
urination which known as polyuria occurs
and if the condition continues for a long time, it will lead to severe
dehydration and electrolyte imbalance. Due to loss of too much of water, the
body tends to uptake more water in which polydipsia
is necessary. Polydipsia will increase the water intake by the person.

            Due to the wastage of glucose, water
and electrolytes, there will be increased in appetite (polyphagia) in order to offset the some of the loss but if the
condition is too severe, there will be weight loss and also muscle weakness. In
the normal condition, our body tissues will burn glucose for fuel but in the
person who has diabetes, instead of the glucose, the fats and amino acids are
burn for fuel. The fats and also amino acids are transported to the liver and
converted into ketones. Ketones are small, acidic, glucose-sized molecules
which are burned for fuel. The accumulat-ion of ketones will lower blood pH and
causes acidosis. Acidosis will lead to a combination of metabolic disturbances produces
diabetic ketoacidosis. Diabetic
ketoacidosis will cause the dysfunction of the kidney, causing the glucose
is not absorbed from the renal tube and it presents in the urine. This will cause
glycosuria which will then leads to polyuria. Polyuria is then causing the
volume depletion leading to polydipsia and also loss of calorie leading to
polyphagia. Diabetic ketoacidosis will cause Kussmaul respiration in which rapid and deep breathing due to the
expelling of acid in the form of ketones by lungs. Diabetic acidosis is
typically accompanied by nausea and vomiting.

            Diabetic acidosis is accompanied by
nausea and vomiting and if the condition is severe, it may cause diabetic coma which is often associated
with type 1 diabetes in which the glucose metabolism is unstable. There is
second type of diabetic coma which is called hyperosmolar hyperglycemia nonketotic coma (HHS). This type of
diabetic coma is usually seen in patient with type 2 diabetes. It occurs when
the water loss in the body is severe and the blood glucose levels is extremely
high. With this type of the diabetic coma, the patient usually can’t medicate
themselves to drink enough water to replace those lost through hyperglycemia
and glucosuria. Hyperosmolar hyperglycaemia nonketonic coma usually won’t
associated with nausea and also vomiting.

 

Long-term complications
or late systemic complications

            High blood glucose level is the main
key that lead to all diabetic complications. Diabetic will lead to many
long-term complications which included artherosclerosis,
diabetic microangiopathy, gangrene, renal disease (retinopathy), myocardial
infarction, tuberculosis, diabetic nephropathy (kidney disease), peripheral
nerve disease and also infection.
Infections like infection of skin and urinary tract are more common in diabetic
patient if compared to the people who do not have diabetes. For example, gangrenous necrosis is more easily
occurs in the patient who has diabetes. Diabetes patients are more prone to any
infection.

Gangrenous
necrosis is an ischemic coagulation necrosis with superimposed infection
associated with liquefaction necrosis. When the bacterial infection is
superimposed, coagulative necrosis is modified by liquefactive action of
bacteria. If the condition is getting worse, it will finally lead to septic and
even death. Hyperglycemia will lead to a situation which called glycosylation which glucose is attached
to proteins. This will lead to the inherited metabolic disorders that impairs
the production of glycoprotein. Glycohemoglobin (glucose binds to haemoglobin)
and fructosamine (glucose binds to albumin) levels are the indicators used to
detect the degree of glycosylation. Glycosylation will lead to complications
that will mainly affect blood vessels and nerves.

The
most affected system in the whole body system for diabetes is vascular disease
in which it will affect aorta, large and medium-sized arteries. Glycosylation
will cause vascular diseases which include large vessels and small vessels (microvascular disease). In large
vessels, if the development of artherosclerosis is accelerated, it will cause stroke, heart attack and gangrene.
Microvascular disease is characterised by microscopically distinctive changes
in small blood vessels which is known as hyaline
artherosclerosis. In small vessels, blood flow and diffusion of the
essential substances is slowed, which will lead to most of the kidney disease and eye disease.

In
kidney, glomeruli and glomerular arterioles are most affected. The changes are
referred to diabetic nephropathy.
Diabetic kidney disease (diabetic nephrosclerosis) is a disease in which the
kidney is shrunken and granular, and in some cases the glomeruli are severely
affected by nodular deposits of hyaline material (diabetic nodular glomerulosclerosis). Besides, the renal artery and
also the main branches are often severely arthereosclerotic. In eye disease,
diabetes is the main cause that lead to blindness
associated with cataract (opacification of the lens), glaucoma (increased intraocular pressure and optic nerve damage)
and diabetic retinopathy. Diabetic
retinopathy is a mixture of exudates, hemorrhages, edema, new blood vessels
(angioneogenesis), small aneurysms and scarring.

Moreover,
the brain and peripheral nerve disease are also affected by diabetes. The entire
peripheral nervous system included motor, sensory, and autoimmune nerves is
affected by the diabetes. Sensory function will be more affected. Initially,
the patients will suffer from nerve irritation, pain, and abnormal sensations
and later they will lose the sense of fine touch, pain and proprioception.
Impaired sensation from lower limb joints can lead to severe wear and tear arthritis (Charcot
joint). A common autoimmune dysfunction is postural hypotension
–light-headedness or fainting which is caused by lack of autonomically
controlled vascular tone in legs which causes pooling of blood in the feet upon
rising from a flat or sitting position. Furthermore, the accelerated
atherosclerosis associated with diabetes carotid and intracerebral arteries
which lead to vascular obstruction
and stroke. Our brain is totally
depend on the glucose and cannot burn fat for energy. Due to this reason,
cerebral cortex is rendered especially susceptible to necrosis in hypoglycemia.

 

 

Epidemiology
of Diabetes
            Diabetes is getting more common
nowadays and the age range of getting diabetes is getting younger. Based on the
statistics shown by International Diabetes Federation in 2013, among all the
countries throughout the world, China is the one which has the highest number
of people getting diabetes. The number of people who has diabetes is 98.4
million. The second highest is followed by India. Diabetes are now more common
in the Asian countries like Malaysia, China, Thailand and Singapore. This is
due to the higher rate of obesity among the people in these countries. A person
is more prone to diabetes if he or she is obesity. The world diabetes cases
expected to jump to 55 percent by 2035.

            Just using the statistics shown by
WHO, there are about 422 million of people who are suffering from diabetes in
2014 when compared to the amount in 1980 which was just 108 million. In just 34
years, the number of people who were suffering from diabetes already increase
almost four folds. Thus, it is undeniable that diabetes now is considered to be
debilitating and deadly disease that has now reached epidemic proportions and
the prevalence rates are expected to be higher in the future years. In 1995,
the number of people who had diabetes was135 million while in 2020, the number
estimated is 154 million of people. In the year 2025, the number is expected to
increase till almost two-fold which is 300 million.

            An estimated 30.3 million of people
in United States are getting diabetes and among these 30.3 million, more than
98% are at the age of 18 years old above. The prevalence of diabetes is getting
higher when the age range is increasing. Based on the National Health Interview
Survey that had been done from 2013-2015, it was estimated that among the
adults aged more than 18 years old in United States, 45-64 years old shows the
highest rate of getting diabetes. And, if compared men with women, women will
have higher risk in getting diabetes if compared to men.

            Prevalence of diabetes is varied
based on different factors. One of the factors is education level. Education
level is an indication of socioeconomic status. Around 12% of the adults with
less than high school education are having diabetes if compared to the adults
who have proper high school education that have a percentage around 9.5%.
Education makes people more exposed themselves to the knowledge regarding
diabetes, thus, they can learn the prevention and management of the diabetes.

            The above statistics are done based
on worldwide. In Malaysia, the prevalence rate of diabetes is about 11% in 2006.
In just 5 years, the prevalence rate of diabetes increases till 15.2% in 2011.
Based on the above statement, it can be said that about 2.6 million of the
adults above 18 years old are living with diabetes. In other words, it can be
said that 1 out of 5 of adults in Malaysia has diabetes. It is quite shock that
1 in 10 men and 1 in 8 women had high blood glucose. The amount of people who
has already been diagnosed to have diabetes is about 543,385. Whereas, the
number of people who are just newly diagnosed to have diabetes is around
781,798. Among the most three main races in Malaysia, Indians have the highest
rate of getting diabetes. The percentages are around 20.0%. It is followed by
Malays which has around 11.1%. Chinese has the least percentages among these
three races. It is 7% out of 100%.

 

Conclusion

            Diabetes mellitus is a common
disease that will cause different complications either short-term or long-term
complications. Long-term complications will cause more severe consequences to
the body as it will affect the organ like brain, heart and etc. It is now very
important for all of us to learn how to prevent diabetes as the prevalence rate
of diabetes is getting higher especially in Asian country.