Pathophysiology of Diabetes Mellitus - Get to Know the Meaning

What is Diabetes Mellitus?

Diabetes mellitus is a chronic health situation in which the body stop working to generate adequate amount of insulin or react strangely to insulin.When we talk about the categorization of diabetes mellitus, it is of three natures, namely,

1. Diabetes
2. Diabetes and Gestational diabetes.
3. Hyperglycemia which is the ultimate outcome for all the three types of diabetes.

Pathophysiology of diabetes mellitus is complicated, as the disease is characterized by diverse etiologies but share some related signs,symptoms and complications.

Meaning of pathophysiology
Pathophysiology means the learning of alteration seen in natural mechanical, bodily, and biochemical functions that are maybe caused by a disease or as a  result of an irregular syndrome. The pathophysiology of any given ailment or syndrome give details to  its source,symptoms and effects

Diabetes Mellitus - A Cardiovascular Disease

"Life is not over because you have diabetes. Make the most of what you have, be grateful." Dale Evans Rogers (American Singer known as the "Queen of the West", )

Glucose, a form of sugar, is the body's main source of fuel. Glucose needs insulin to enter the cells to be used as energy. Insulin is produced by a large gland situated behind the stomach - the pancreas. In diabetes, either the pancreas does not produce enough insulin or the cells in the muscles, liver, and fat do not use insulin properly, or both. This allows sugar to accumulate in the blood while the cells are starved. These metabolic abnormalities lead to vascular inflammation. People with diabetes are at a much higher risk of developing cardiovascular diseases like heart attack, stroke, peripheral artery disease and heart failure.

The incidence of diabetes is reaching epidemic proportions. Worldwide, it is estimated that the prevalence of diabetes will rise from 2.8% (171 million people) in 2000 to 4.4% (366 million people) in 2030. Elevated blood glucose levels are responsible for 21% of deaths from coronary heart disease and 13% of deaths from stroke. This translates into 3.16 million deaths a year. Diabetes is also a major problem in the United States.

Many clinical trials have established that cardiovascular diseases are the most common and most serious complications in diabetics. Almost 65% patients with diabetes die of heart attack or a stroke. Dr. Garcia and his co researchers reported in Diabetes in 1974, using data from the Framingham Study, that patients with diabetes have a two-three-fold increased incidence of cardiovascular disease and those who present in the fourth and fifth decade of life have a two-fold increase in mortality. This cardiovascular risk develops even before diabetes becomes clinically apparent. Researchers from the Harvard School of Public Health in Boston found that women who eventually developed type 2 diabetes had a risk of heart attack almost 4 times higher than those who never developed the disease. This data from the Nurses Health Study, was published in the July 2002 issue of Diabetes Care.

The cause of the increased risk of macro-vascular cardiac disease is multi-factorial. Eighty percent of patients with type 2 diabetes are either obese or overweight. Diabetics also carry an abnormal lipid profile. Diabetics typically have elevated plasma triglycerides, normal or mildly elevated low-density lipoprotein cholesterol (LDL-C), and reduced plasma HDL-C concentrations. This encourages atherosclerosis. The combination of high blood sugar and high insulin levels are also toxic to the cardiovascular system. Further, more than two thirds of the adults with diabetes suffer from high blood pressure, another major risk factor for cardiovascular disease.

"What was so upsetting was I didn't really know anything about diabetes except that Ella Fitzgerald lost her legs and later died from it." Della Reese. Diabetics also causes many micro-vascular complications. These include diabetic retinopathy, diabetic nephropathy and diabetic neuropathy. Despite good long-term sugar and blood pressure control, diabetes remains a major cause of blindness, renal failure and amputations. Two landmark studies, the Diabetes Control and Complications Trial, published in the New England Journal of Medicine in 1993 and the United Kingdom Prospective Diabetes Study Group (UKPDS) study published in the British Medical Journal in 1998, have shown that intensive control of blood glucose levels and tight blood pressure control reduce the risk of these micro vascular complications in diabetics.

An earlier report from the UKPDS Study published in the British Medical Journal in 1996, showed that increasing age, poor sugar control, increased systolic blood pressure, raised bad LDL-cholesterol, reduced good HDL-cholesterol levels and smoking were significant risk factors for coronary heart disease in diabetics. Lifestyle interventions reduce the risk of cardiovascular diseases and include eating healthier, staying active, drinking alcohol in moderation , stopping the use of tobacco products and maintaining a healthy body weight. They have been shown to prevent the development of diabetes by almost 58%. In patients who have impaired glucose tolerance, they can delay diabetes by almost 11 years. These beneficial effects of lifestyle interventions were also proven in the Diabetes Prevention Program Research Group report published in the New England Journal of Medicine in 2002.

"Diabetes is like being expected to play the piano with one hand while juggling items with another hand, all while balancing with deftness and dexterity on a tightrope" - Marlene Less, Scott's Diabetes Journal. Treating diabetes and controlling your sugar may be difficult. This is because blood sugar levels ideally should be continuously maintained within a small normal range. This may require frequent medications or injections and careful monitoring of the sugar levels. Recent data suggests that the traditionally used blood sugar lowering medications may also have a dark side. In 2002, Duke researchers presented data at the 51st Annual Scientific Sessions of the American Heart Association which showed that there was a 2.6-fold increased risk of death for patients taking injected insulin and sulfonylurea drugs, compared with insulin-sensitizing therapies, such as metformin. They also found that at 90 days into the trials, 12% of diabetic patients on insulin-providing therapy had a major adverse event, compared with 5% of diabetic patients on insulin-sensitizing therapy. Treating diabetes is therefore just not limited to reducing blood glucose levels. Several metabolic abnormalities including elevated insulin levels, inflammation and lipids have to be taken into account. Most diabetics are now also placed on a class of high blood pressure pills called ace inhibitors and angiotensin receptor blockers, cholesterol lowering statins and the household aspirin. Recent trials (especially the ASCOTT-LLA study, published in Lancet in 2003) have shown that even in the absence of a history of coronary heart disease or high cholesterol, statin therapy is beneficial in diabetes. The American Diabetic Association advocates the use of aspirin in diabetics with an additional risk factor. Diabetics share a common vascular inflammation seen in patients with cardiovascular disease and aspirin appears to be beneficial in decreasing cardiovascular mortality. Ace inhibitors or angiotensin receptor blockers appear to have a better cardiovascular protection effect in diabetics that goes beyond the benefit achieved by their reduction in blood pressure. The blood pressures goals are lower in diabetics and you are better protected if the blood pressure is reduced to 120/80 mm/Hg or less.

"I lay in the bed at the hospital and said, 'let's see what I have left.' And I could see, I could speak, I could think, I could read. I simply tabulated my blessings, and that gave me a start." Dale Evans Rogers, American Singer. Many diabetics may feel this way, but recent understanding of the disease and the cardiovascular connection has made complications easier to delay or avoid. And lifestyle changes can even prevent or delay the development of diabetes. Jill Johnson said, ""Living a healthy lifestyle will only deprive you of poor health, lethargy, and fat." And I may add, diabetes and heart disease.

Dr. Shashi K. Agarwal is a Board Certified Internist and Cardiologist with a private practice in New York City and New Jersey. He is also a Diplomate of the American Board of Holistic Medicine and the American Academy of Anti-Aging Medicine.

Severe Diabetic Complications of Diabetes Mellitus to Know the Facts About

The five main diabetic complications!

As with any other disease, you may want as much as possible to learn about diabetes and the complications of diabetes. The more knowledge you have, the easier it will be overcome and manage diabetes.

Acquiring the Knowledge of diabetes is also useful for those do not suffer from diabetes because this knowledge could be used to prevent the onset of adult diabetes and hopefully avoid this chronic disease altogether.

In addition to knowledge of diabetes such as the diabetes symptoms, diagnosis of diabetes, causes and treatment of diabetes, it is also important to know about all the related diabetic complications. All this knowledge will help you prepare - emotionally and physically - with the possibilities of coping with having not only with your diabetes, but also with other complications that are related to it as well and the lifestyle changes that is necessary to deal with it effectively.

Some factors such as heredity, age and ethnicity can have an influence on people who are prone to diabetes. But regardless of the risk factors associated with diabetes the complications of diabetes will be the same. Below are some of the diabetic complications that people need to be aware susceptible to diabetes are:

DIABETIC NEUROPATHY - If you suffer from diabetes then there is an increased risk of suffering from severe diabetic complications of the nerves. Damage of the nerves in the body will cause poor circulation in the body especially the extremities like the hands and legs, and fingers and toes. Smoking or drinking alcohol only exuberate the problem so limiting these would be a good idea.

HEART DISEASE and STROKE - According to experts, people with diabetes have a much greater risk of developing coronary heart disease, and angina compared to those without diabetes. In fact, these complications are the leading cause of death in diabetics around the world.

Diabetics are prone to heart diseases and stroke because of deposits of fat deposits in the arteries and hardness of the arteries caused by the extra glucose in the blood. This will cause high blood pressure or hypertension to develop.

DIABETIC EYE DISEASE - people who suffer from diabetes have a higher instance of suffering from diabetic eye problems as a result their diabetes. These problems of the diabetic eye may lead to diabetic retinopathy, cataract, glaucoma, and optic nerve damage. If not treated immediately they could lead to irreversible damage of the eyes or even blindness.

DIABETIC KIDNEY DISEASE - Kidney disease is also a very common complication of diabetes, because the parts of the kidneys that filter the blood damage because of high glucose levels. The kidneys will eventually be damaged as a result of being over worked and will be unable get rid of toxic by-product from the blood
This diabetic kidney disease can be avoided by keeping blood sugar levels under control by following your diabetic diets closely and do regular physical activity to keep the blood sugar in check. Other useful things that you could do include: stop smoking and drinking alcohol.

GASTROPARESIS - This is somewhat related to diabetic nerve damage. The nerves in the stomach help the stomach to contract and relax thus allowing the food to pass down into the intestine. When these nerves are damage the food remains in the stomach for long periods causing bacteria to develop. The improper functioning of the stomach also cause the diabetic to struggle in controlling his or her blood glucose level because the organ that convert the food we eat into carbs cannot be predicted. Approximately 20-30 percent of diabetics with type 1 diabetes are vulnerable to suffer gastroparesis because the vagus nerve, which keeps the food moving through the digestive tract are damaged. While people can get type 2 diabetes only suffer from gastroparesis less frequently and only in the advance stages of diabetes.

Visit first signs of diabetes symptoms website for more information on diabetes and diabetic complications and for more info on REVERSING DIABETES read the diabetes reversal page. Here you can find more info about the complications of diabetes