Diabetes mellitus

SHARED FROM:
Star2, Wednesday, 2 October 2013
Tell Me About … By Dr Y.L.M.
JUST TOO SWEET

Diabetes mellitus is actually a group of diseases that affect you for a long duration (chronic).  They are characterised by high sugar in your blood stream (hyperglycemia) and also sugar in your urine (glycosuria).  Hyperglycemia is extremely dangerous to the body’s tissues and organs in the long term because the high sugar will affect small and large blood vessels and lead to all sorts of complications.  The two diabetic complications are:

• Macrovascular – complications that involve the larger arteries such as the heart, the brain and the limbs.
• Microvascular – complications that involves the smaller blood vessels such as those of the eyes, nerves and kidneys.

When you have uncontrolled high blood sugar, the process called artherosclerosis is hastened.  This turns causes major blood vessel walls to be inflamed and thicken over time.  As a result, more muscle gets laid down in the arterial walls.  In the end, the opening of the vessel walls (called the lumen) becomes narrower.  This makes it very difficult for the blood to pass through the affected blood vessel.  There may be artherosclerotic lesions forms, and these appear like ‘caps’ on the vessel walls.  These are called artherosclerotic plaques.

If any of these plaques rapture, they can travel downstream and further lodge themselves in another part of a narrowed vessel.  This can lead to sudden blockage of blood flow.

Diabetes is a major risk factor for heart attack, coronary artery disease in general.  Coronary artery disease is the major cause of death in diabetic patients.  Diabetes also leads to strokes and peripheral vascular disease (blockage of the blood vessels that supply the limbs, especially the legs).

The most common diabetic microvascular complication is the diabetic eye disease.  The more uncontrolled your blood sugar, the more risk you get of developing this disease, which can lead to blindness.  There are several ways your eye can be affected in diabetes.  Diabetic retinopathy can cause small bleeding patches to appear on your retina, which can be seen as dots.  Protein exudates start to appear as well, resulting in swelling of the retina.  This can cause blurring of vision.  Proliferative retinopathy is caused when small new blood vessels start to form on your retina.  These vessels can tear and lead to bleeding.  If your retina tears due to pulling of these small vessels, blindness can occur.  Laser treatment can be used to keep this eye complication at bay.

Diabetic nephropathy (kidney disease) is unfortunately the leading cause of kidney failure.  Diabetic kidney disease can range from just having mild protein in your urine to end stage kidney failure needing lifelong dialysis or a kidney transplant.  Diabetic nephropathy affects your nerves. You start to lose sensation in your hands and feet, and get ulcers easily on your feet because you cannot feel the pain of injuries when you stub your toe or walk around barefoot.  Even your autonomic nerves, which control your digestion, bowel habits, sweating, urination and sexual performance can be affected.