by dr y.l.m.
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| Blinding truth: Diabetes is a leading cause of blindness all over the world. – Reuters |
MY neighbour was admitted to hospital the other day. Apparently, he had to undergo treatment for his eye. He is diabetic, and his family was telling us that he has a lot of complications. His medical bills are piling up. I understand that diabetes is a disease that causes high sugar in your blood stream and urine, right?
You are right. 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).
This 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.
We can separate diabetic complications into:
·Macrovascular complications – complications that involve the larger arteries in the body, such as the heart, the brain and the limb vessels. The term literally means “big” (macro) “vessels” (vascular).
·Microvascular complications – These involve the smaller blood vessels, such as those of the eye, nerves and kidneys.
Tell me more about these macrovascular complications.
These can be very dangerous to the diabetic patient.
When you have uncontrolled high blood sugar, the process called artherosclerosis is hastened. This in turn 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 blood to pass through the affected blood vessel. There may be artherosclerotic lesions formed, and these appear like “caps” on the vessel walls. These are called artherosclerotic plaques.
If any of these plaques rupture, they can travel downstream and further lodge themselves in another part of a narrowed vessel. This can lead to sudden blockage of blood flow.
Imagine what happens when blood flow gets blocked to the heart or brain.
So diabetics are prone to getting heart attacks?
Yes. Diabetes is a very major risk factor for not only heart attacks, but coronary artery diseases in general. In fact, coronary artery disease is the major cause of death in diabetic patients.
Not only does uncontrolled diabetes lead to heart disease, but it also leads to strokes and peripheral vascular disease – which is blockage of the blood vessels that supply the limbs, especially the legs.
Diabetic patients have a 150-400% higher risk of stroke than a normal person.
What about eye disease then? I always hear that my diabetic neighbour needs eye laser treatment. Why?
The most common diabetic microvascular complication has got to be diabetic eye disease. The more uncontrolled your blood sugar, the more risk you get of developing this disease, which can lead to blindness. The disease process can even begin as early as seven years before you actually get diagnosed with diabetes.
There are several ways your eye can be affected in diabetes. Your retina is the most worrying part of the eye, because once your focal spot is obscured, it can mean blindness.
Diabetic retinopathy (retinal disease) is divided into either background or proliferative.
Background retinopathy can cause small bleeding patches to appear on your retina, which can be seen as “dots”. Later, protein exudates start to appear as well, resulting in swelling of your retina. All 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.
If your neighbour is going for “laser” treatment, he probably has the proliferative kind of retinopathy. Laser treatment can be used to keep this eye complication at bay.
What about the kidneys and the nerves?
Diabetic nephropathy (kidney disease) is unfortunately the leading cause of kidney failure in Malaysia. Many patients are on dialysis today because they have uncontrolled diabetes.
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 neuropathy 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.
http://www.thestar.com.my/Lifestyle/Viewpoints/Tell-Me-About/Profile/Articles/2013/10/09/High-sugar-and-diabetes.aspx
