Diabetes Mellitus

Author

Asst. Prof. Muhammet Sait TOPRAK

Asst. Prof. – Istanbul Kent University, Faculty of Pharmacy

"Diabetes is a major life-threatening disease worldwide."

Title: | What is Diabetes Mellitus? | Types of Diabetes | Diabetes Complications

What is Diabetes Mellitus?

Diabetes is a chronic metabolic disease that occurs due to insufficient secretion of the hormone insulin or insufficient use in the body even though it is secreted adequately. According to the data from the International Diabetes Federation, there were 285 million diabetics in the World in 2010 and 425 million in 2017, while the estimated expectation for 2045 is 629 million people. According to 2017 data, 4 million people die annually due to diabetes complications worldwide. The prevalence of diabetes is also increasing in the Turkish population. It is reported that there are approximately 9 million diabetic patients in Turkey and it is estimated to reach 13.4 million in 2045. Considering this number of patients, it is seen that Turkey is one of the countries with the highest prevalence of diabetes among European countries.

Types of Diabetes

There are 4 types of diabetes: "Type I Diabetes", "Type II Diabetes", "Gestational Diabetes" and "Other Types of Diabetes".

2.1.1 Type I Diabetes: It is a chronic disease that develops due to insulin deficiency. It is common in childhood and adolescence, and the most prevalent disease among individuals aged 0 and 18. Generally, it is seen in individuals under 35. The most common age range for onset is 10-15 years. Type I diabetes accounts for approximately 10% of all diabetic patients. In patients with Type I diabetes, uncontrolled hyperglycemia can lead to severe damage to many organs and systems, particularly to the liver and the brain. Symptoms include polydipsia (frequent thirst), polyphagia (frequent hunger), and polyuria (frequent urination). Patients may also have symptoms such as blurred vision, persistent infections, and unexplained weight loss. People with type I diabetes are generally thin and the risk increases if there is a family history of diabetes.

2.1.2 Type II Diabetes: It is also referred to by terms such as “adult-onset diabetes” and “non-insulin dependent diabetes”. It is a disease in which the body cannot respond fully to insulin and also includes insulin resistance. Since there are disruptions in the functioning of the insulin hormone, the level of glucose in the blood gradually increases. Type II diabetes typically occurs later in life. It constitutes approximately 90% of all diabetic patients. These patients are often overweight at diagnosis and often have a strong family history of the disease. Unlike type I diabetes, patients with type II diabetes usually do not show symptoms when diagnosed, and the doctor often makes the diagnosis while investigating another complaint. It is a major social problem affecting millions of individuals across the universe, and its prevalence is increasing faster than expected.

2.1.3 Gestational Diabetes: It is diagnosed in the second or third trimester of pregnancy. It is a disease in which high blood glucose (sugar) levels occur during pregnancy and cause complications for both the mother and the baby. It usually disappears after pregnancy, but affected women or children are at risk of developing type 2 diabetes later in life.

2.1.4 Other types of diabetes: these can result from factors such as infections, diabetes-related syndromes, medications, and chemical agents.

Diabetes Complications

As a result of complications caused by diabetes, the cost of treatment increases, and the quality of life of patients is negatively affected. Complications that can be seen in diabetic patients in the future are divided into two classes: acute and chronic.

3.1. Acute Complications

3.1.1. Hypoglycemia

Hypoglycemia is defined as a blood glucose level below 70 mg/dL. Conditions that cause hypoglycemia include mistakes in insulin dosage, the incorrect application time of insulin of the patient, using the wrong type of insulin, and skipped meals. Hypoglycemia is an emergency condition that increases the mortality rate. It requires urgent intervention and treatment. Hypoglycemia is very common in individuals with diabetes. Hypoglycemia causes symptoms such as irritability, palpitations, inattention, confusion, and seizures. If left untreated, it will result in loss of consciousness, coma, or death.

3.1.2. Diabetic ketoacidosis

Diabetic ketoacidosis is one of the serious complications of diabetes that requires prompt diagnosis and immediate treatment. It usually occurs in patients with Type I diabetes. In addition, it can also be seen in patients in cases of serious infection, trauma, cardiovascular condition, or other emergencies. As a result of hyperglycemia, blood flow to the kidneys decreases and urinary glucose excretion decreases. It is very important to diagnose early and start treatment immediately and start the treatment immediately. Early intervention reduces the mortality rate due to complications.

3.2. Chronic Complications

Chronic complications of diabetes can be classified into two different groups: microvascular and macrovascular.

3.2.1. Microvascular Complications

3.2.1.1. Diabetic Retinopathy: Diabetic retinopathy is a complication that causes visual impairment or blindness in most individuals with diabetes as a result of occlusion in the eye vessels and impaired vascular permeability. It is of great importance for these patients to have regular eye checks.

3.2.1.2. Diabetic Nephropathy: It is the loss of function in the kidneys as a result of the deterioration in the structure of the vessels that supply blood to the kidneys. This condition develops due to high blood glucose (sugar). In the United States and our country, approximately half of end-stage renal failure patients are individuals with diabetes. This shows that the most important cause of end-stage renal failure is diabetic nephropathy.

3.2.1.2. Diabetic Neuropathy: Diabetic neuropathy is damage to the nervous system as a result of years of exposure to diabetes. It is a common complication of diabetes that negatively affects the quality of life and creates an economic burden. The main cause of diabetic neuropathy is peripheral vascular disease, damage, and injury to the foot. The most commonly affected areas include the extremities, especially the feet. Nerve damage in these areas is called peripheral neuropathy and can cause conditions such as loss of sensation and widespread pain. It is more important as the loss of sensation can lead to infections and amputations (surgical excision of an organ).

3.2.2. Macrovascular Complications

3.2.2.1. Coronary Artery Disease: It is one of the leading diseases in individuals with diabetes. Cardiovascular diseases occur much more frequently in patients with diabetes. The risk of death in diabetic individuals with cardiovascular disease is higher than in other individuals. Cardiovascular diseases seriously reduce the quality of life in patients with diabetes, negatively affect their health, and pose a serious economic, psychological, and social burden to patients. For these reasons, it is very important for individuals with diabetes to control their blood glucose (sugar).

3.2.2.2. Cerebrovascular Disease: The risk of stroke is higher in individuals with diabetes compared to those without diabetes. Decreased insulin secretion in individuals with diabetes causes arteriosclerosis and problems in cerebral (brain) small vessels. Additionally, hyperglycemia may cause vascular damage by reducing cerebral (brain) blood flow.

3.2.2.3. Diabetic Foot: It is a result of neuropathy or peripheral artery disease. It is a leading complication of hospitalizations in individuals with diabetes. If diabetic foot and ulcers (tissue destruction, open wounds) are not treated and cared for properly, they may result in infection, gangrene, amputation, or even death. Diabetic patients; One should be careful against the use of inappropriate shoes and the development of calluses and wounds. In addition, diabetic patients must be educated about foot care and this education must be continued throughout life.

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