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Complications of Diabetes Mellitus: a Review R Review Article Complications of diabetes mellitus: A review R. Balaji1, Revathi Duraisamy1, M. P. Santhosh Kumar2* ABSTRACT Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia and complications that include microvascular disease of the eye and kidney and a variety of clinical neuropathies. DM, also known as simply diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. These high blood sugar levels produce the symptoms of repeated urination, increased hunger, and increased thirst. Untreated diabetes can cause many complications. Acute complications include diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar coma. Serious long- term complications include heart disease, stroke, kidney failure, foot ulcers, and damage to the eyes. Metabolic abnormalities in carbohydrates, lipids, and proteins result from the important role of insulin as an anabolic hormone. Low levels of insulin to achieve adequate response and/or insulin resistance of target tissues, mainly skeletal muscles, adipose tissue, and to a lesser extent, liver, at the level of insulin receptors, signal transduction system, and/or effector enzymes or genes are responsible for these metabolic abnormalities. The severity of symptoms is due to the type and duration of diabetes. Some of the diabetes patients are asymptomatic, especially those with type 2 diabetes during the early years of the disease. Others with marked hyperglycemia, especially in children with absolute insulin deficiency, may suffer from polyuria, polydipsia, polyphagia, weight loss, and blurred vision. Uncontrolled diabetes may lead to stupor, coma, and if not treated death, due to ketoacidosis or rarely from non-ketotic hyperosmolar syndrome. Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the beta-cells of the pancreas with consequent insulin deficiency to the abnormalities that end in resistance to insulin action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or more points in the complex pathways of the hormone action. Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality is the primary cause of hyperglycemia. KEY WORDS: Complications, Dentistry, Diabetes mellitus, Hyperglycemia, Hypoglycemia, Insulin INTRODUCTION the disease. Type 1 diabetes must be managed with insulin injections. Type 2 diabetes may be treated with A metabolic disorder of various etiology characterized medications with or without insulin. Insulin and some the by chronic hyperglycemia with interference of oral medications can cause low blood sugar. Weight carbohydrate, fat, and protein metabolism arising from loss surgery in those with obesity is an effective defects in insulin secretion, insulin action, or both is measure in those with type 2 DM. Gestational diabetes known as diabetic mellitus (DM). Diabetes is due to usually resolves after the birth of the baby. The effects either the pancreas not producing enough insulin or of diabetes mellitus (DM) include long-term damage, the cells of the body not responding properly to the dysfunction, and failure of various organs.[1,2] insulin produced. Prevention and treatment involves healthy diet, physical exercise, no tobacco use, and The two main types of diabetes are Type 1 diabetes having a normal body weight. Blood pressure control and Type 2 diabetes. Other categories of diabetes and proper foot care are also important for people with include gestational diabetes (a state of hyperglycemia which develops during pregnancy), and DM due to Access this article online rarer causes (genetic syndromes, acquired processes such as pancreatitis, and diseases such as the cystic Website: jprsolutions.info ISSN: 0975-7619 fibrosis, exposure to certain drugs, viruses, and 1Department of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India, 2Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India *Corresponding author: Dr. M. P. Santhosh Kumar, Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, Poonamalle High road, Velappanchavadi, Chennai - 600 077, Tamil Nadu, India. Phone: +91-9994892022. E-mail: [email protected] Received on: 19-08-2018; Revised on: 21-09-2018; Accepted on: 25-10-2018 98 Drug Invention Today | Vol 12 • Issue 1 • 2019 R. Balaji, et al. unknown causes). Furthermore, there are intermediate non-ketotic state (HNS), which is more common in type states of hyperglycemia (impaired fasting glucose or 2 diabetes and is mainly the result of dehydration.[9] impaired glucose tolerance), which are significant in that they can progress to diabetes, but with weight PATHOPHYSIOLOGY loss and lifestyle changes, this progression can be prevented or delayed.[3] The uptake of glucose from the blood into most cells of the body, especially liver, muscle, and adipose In the short term, hyperglycemia causes symptoms of tissue is regulated by the principal hormone, insulin. increased thirst, increased urination, increased hunger, Therefore, deficiency of insulin or the insensitivity and weight loss. However, in the long term, it causes of its receptors plays a central role in all forms of blindness, renal failure, impotence, foot disorders, and DM. Gluconeogenesis is the generation of glucose possibly amputation. As well, it also increases the risk from non-carbohydrate substrates in the body. The of heart disease, stroke, and insufficiency in blood intestinal absorption of food, breakdown of glycogen, flow to legs. Studies have shown that good metabolic and the storage form of glucose found in the liver are control prevents or delays these complications. the main three ways the body gets glucose. Insulin Thus, the primary aim of treatment is to bring the plays a critical role in balancing glucose levels in the elevated blood sugars down to a normal range, both to body. Insulin can inhibit the breakdown of glycogen improve symptoms of diabetes and to prevent or delay or the process of gluconeogenesis, it can stimulate diabetic complications. Achieving this goal requires the transport of glucose into fat and muscle cells, and a comprehensive, coordinated, patient-centered it can stimulate the storage of glucose in the form approach on the part of the health-care system.[4,5] of glycogen.[10] Insulin is released into the blood by β-cells, found in the islets of Langerhans in the SIGNS AND SYMPTOMS pancreas, in response to rising levels of blood glucose, typically after eating. The glucose is used as fuel, for Polyuria, polydipsia, and polyphagia are the conversion to other needed molecules, or for storage most common symptoms of untreated diabetes. when two-thirds of the body’s cells absorb it from the Symptoms may develop rapidly (weeks or months) blood with the help of insulin. Lower glucose levels in type 1 diabetes, while they usually develop much result in decreased insulin release from the β-cells more slowly and may be subtle or absent in type 2 and in the breakdown of glycogen to glucose. The diabetes. Others include blurry vision, headache, hormone glucagon mainly controls the process of fatigue, slow healing of cuts, and itchy skin. Glucose breakdown of glycogen to glucose, which acts in the absorption in the lens of the eye brings about opposite manner to insulin.[11] changes in its shape and results in vision changes that can be caused by prolonged high blood pressure The glucose will not be absorbed properly by the in diabetic patients. A number of skin rashes that body cells when the amount of insulin available is can occur in diabetes are collectively known as insufficient or if cells respond poorly to the effects diabetic dermadromes. Retinopathy with potential of insulin, and the glucose will also not be stored loss of vision; nephropathy leading to renal failure; appropriately in the liver and muscles. The net effect peripheral neuropathy with risk of the foot ulcers, is persistently high levels of blood glucose, poor amputations, and Charcot joints; and autonomic protein synthesis, and other metabolic derangements neuropathy causing gastrointestinal, genitourinary, such as acidosis. The kidneys will reach a threshold and cardiovascular symptoms and sexual dysfunction of reabsorption, and glucose will be excreted in the are some of the long-term complications of diabetes. urine which is known as glycosuria when the glucose Patients with diabetes have an increased incidence concentration in the blood remains high over time. of atherosclerotic cardiovascular, peripheral arterial, This increases the osmotic pressure of the urine and and also cerebrovascular disease. People with inhibits reabsorption of water by the kidney, resulting diabetes often show hypertension and abnormalities in increased urine production (polyuria) and increased of lipoprotein metabolism in their body.[6-8] fluid loss. Replacement of lost blood volume will occur osmotically from water held in body cells. Body DIABETIC EMERGENCIES parts will help in replacement
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