On World Diabetes Day, I shared some material created by the Indian Medical association about Diabetes. The focus was on preventing loss of vision due to Diabetes.

But today, I will talk about all the complications. It’s the series opener for complications of Diabetes and will include Eye, ENT, Kidney, heart, and quality of life issues with Diabetes. Something about Diabetes that people must know.The control is truly in your hands.

Genetics and epigenetics- It’s a polygenic disease. That makes it tricky. Luckily or unluckily, depending on how you look at it, type 2 has a strong lifestyle dependence. That’s where knowledge about epigenetics comes in. We talk about life living and in between. Diabetes is a chronic disease which just like Hypertension, leaves its footprint everywhere it goes.

The Numbers in India (source)

Diabetes in India:65·0 million in 2016. The order of prevalence in 2016 was highest in Tamil Nadu, Kerala and Delhi, Punjab, Goa, and Karnataka.

A critical risk factor for Diabetes in India – Being overweight.

Gestational Diabetes is another problem affecting between 5 and 8 million pregnant women in India every year. (source)

International Diabetes Federation found approximately 415 million people had Diabetes in 2015. Check out Diabetes numbers in your country here.

If you are what you eat, imagine the food label on a chips packet. That’s what you are made of if that makes up a lot of your snacking. Now before any more numbers, let’s see what this blood sugar does. There’s also Genetic susceptibility to microvascular complications.

Role of Advanced Glycation end products in Diabetes: source

Advanced glycosylation end products (AGES) are caused by increased intracellular glucose of the intra and extracellular proteins, creating glycation products that get deposited, causing damage. That’s behind the pathogenesis of diabetic complications like retinopathy, nephropathy, neuropathy, cardiomyopathy. Glycated proteins are also behind diseases such as rheumatoid arthritis, osteoporosis, and aging. You age faster with uncontrolled blood sugar. Recent studies suggest that AGEs interact with plasma membrane-localized receptors for AGEs (RAGE). This alters intracellular signaling, gene expression, the release of pro-inflammatory molecules and free radicals.

What are the Microvascular Complications of Diabetes Mellitus? source

• Retinopathy
• Neuropathy
• Nephropathy

What are the Macrovascular complications?

• Peripheral Arterial disease
• Coronary artery disease 2 to 4 times greater in type 2 DM
• Cerebrovascular disease

Diabetic Retinopathy :What you must know

Diabetes is the leading cause of loss of vision in age groups 29 to 74 years in the USA. People with Diabetes have twenty-five times more chance of becoming legally blind than those with no diabetes.

Two types of Diabetic Retinopathy

• Nonproliferative Diabetic Retinopathy
• Proliferative Diabetic retinopathy

Nonproliferative Diabetic retinopathy appears in the late first or second decades of living with Diabetes. Usually occurs with greater than 20 years of Diabetes. Duration of disease and degree of control determines the progression of complications. Usually 25 % in 5 years and 80 % incidence in 15 years.

What happens in Nonproliferative DR?

Retinal vascular microaneurysms, blot hemorrhages, cotton wool spots. This progresses to proliferative Diabetic retinopathy with time. More severe the nonproliferative Diabetic Retinopathy more chance of Proliferative retinopathy in five years

What happens with Proliferative Diabetic Retinopathy?

Appearance of neovascularization in response to retinal ischemia

Vessels appear near optic nerve macula->Ruptures-> vitreous hemorrhage-> fibrosis ->Retinal detachment.

How can you prevent Diabetic Retinopathy?

Prevention is still the most effective treatment for Diabetic Retinopathy

BLOOD sugar and blood pressure control intensively will slow progression and prevent loss of vision.

Regular eye examination by an ophthalmologist is crucial.

What is needed once Diabetic Retinopathy is diagnosed?

• Prophylactic photocoagulation may be indicated.
• Ophthalmologist review needed for optimal care
• Laser photocoagulation helps preserve vision.
• Proliferative Diabetic retinopathy needs Pan retinal laser photocoagulation.
• In the case of Macular edema, focal laser photocoagulation is needed.

Conclusion :

In Diabetes, the first rule is to get the Blood sugar normalized. Most often, two to three drugs are needed to get it in control. But a lot depends on what you eat when you eat and how active you stay.

Invest in a good Glucometer.

Invest in an excellent digital blood pressure machine.

Invest in your body and get a treadmill if possible. Walk and be as active as possible.

References:

The increasing burden of Diabetes and variations among the states of India: the Global Burden of Disease Study 1990–2016
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30387-5/fulltext
Diabetes mellitus and its complications in India
https://pubmed.ncbi.nlm.nih.gov/27080137/
Prevalence of Gestational Diabetes in India by Individual Socioeconomic, Demographic, and Clinical Factors
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772684
Complications of Diabetes 2017
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866895/