Why Diabetes is the worst human disease?
As per WHO, 1.5 million deaths are attributed directly to diabetes each year, and 9% of the adult world population has diabetes.
These statistics are sufficient enough to make you feel insecure, and take note of your health.
What is Diabetes?
Diabetes is a chronic disease, which is characterised by increased blood sugar levels, or hyperglycaemia. Blood sugar levels increase either when the pancreas doesn't produce enough insulin,
or when the body cannot effectively use the insulin it produces. Diabetes can be broadly classified into two types based on the underlying cause of increased glucose levels.
Type 1 diabetes, which was previously known as insulin-dependent diabetes or young onset disease, is characterised by a lack of insulin production by the pancreas.
Type 2 diabetes, previously called non-insulin-dependent or adult-onset diabetes, is caused by our bodys' inability to utilise insulin.
Gestational diabetes is an entity which causes hyperglycaemia during pregnancy.
What is the role of Insulin in our body?
Insulin is secreted by the Beta cells of pancreas. Glucose levels more than 70 mg/dl stimulate secretion of Insulin from the cells. Once insulin is secreted from the pancreas into the venous system, 50% is removed and degraded by the liver itself. Insulin acts on certain receptors in skeletal muscles and fat, a step which is crucial in glucose metabolism.
Glucose metabolism in our body is a delicate balance between it’s production by liver from various substrates in our diet, and utilisation by different organs like muscles. Insulin promotes storage of excess glucose.
What is the difference between two types of Diabetes?
Type 1 Diabetes is caused by destruction of cells that produce Insulin in our body. The destruction of such cells in the pancreas leads to partial or near complete lack of this crucial hormone in our body. The Beta cells of pancreas that produce Insulin can get destroyed by an autoimmune response(Immunity kills own body cells), leading to deficiency of Insulin. Type 1 Diabetes commonly develops before the age of 30, and only 5-10% of individuals who are diagnosed with diabetes after 30 years of age have Type 1 disease.
Type 2 Diabetes is a broad group of disorders which is characterised by increased blood sugar levels. However this is not because of reduced production of the hormone, but because of increased resistance of end organs to Insulin, impaired ability of Insulin secretion from the cells, or increased glucose production.
Distinct genetic and metabolic defects in insulin action with or without secretion abnormalities leads finally to a common outcome of increased blood sugars.
Although both Type 1 & Type 2 disease variant prevalence has increased worldwide, the prevalence of type 2 DM is rising much more rapidly, because of increasing obesity, reduced activity, and the ageing of population.
Why is hyperglycaemia dangerous?
Although glucose is paramount for our survival, excess of it is dangerous. It is not exactly known how long standing hyperglycaemia causes damage to different organs. Increased blood sugar levels lead to increased formation of certain harmful byproducts like AGEs(Advanced glycosylation end products), sorbitol, and diacylglycerol which damage the proteins by cross linking them, increasing rate of atherosclerosis, worsening renal functioning. Widespread organ dysfunction is a result of micro-angiopathic changes, or changes that affect small vessels of our organs. With time changes affect all our body organs.
Why you should get screened for Diabetes?
Early identification and treatment can lead to prevention of many disease related complications.
Screening for Type 1 disease is impractical because the hyperglycaemia becomes symptomatic quite early in the disease course.
However, a person may be having a very long asymptomatic period of increased glucose levels in Type 2 disease. Type 2 disease may be present upto a decade before the diagnosis is made, and some patients may come to clinic with a diabetes related complication. Current recommendation is therefore screening every 3 years after 45 years of age. Screening tests include Plasma fasting glucose levels, or Glycosylated haemoglobin(HbA1C) levels.
Certain factors increase risk for Type 2 diabetes. These include a family history of Diabetes, obesity (BMI>25), lack of physical activity, diabetes during pregnancy, and hypertension.
So, why is Diabetes the worst human disease?
Diabetes is a condition that affects every single organ of our body directly, or indirectly. Let us review some of the effect diabetes has on various organs.
Eyes: Diabetes is the leading cause of blindness in developed nations.Individuals with diabetes are 25 times more likely to become blind as compared to normal individuals. Blindness in diabetes is primarily because of changes in blood vessels of the retina of eye. Duration of bidets and control of blood sugar levels affect the rate of development of eye changes.
Type 1 Diabetics, 25% within five years of disease, and 80% within 15 years of onset of disease develop retinopathy. Therefore, regular eye checkups is necessary after diagnosis of Type 1 disease has been made.
Because of the long asymptomatic hyperglycaemia period in Type 2 disease, retinal changes may have taken place by the time diagnosis is made, and it is imperative to undergo an ophthalmological evaluation at the time of diagnosis itself.
Kidneys: Diabetes causes kidney dysfunction in 25-45 % of patients diagnosed with the disease before 30 years. The blood vessels of the kidney and the glomerulus (filteration cell of the kidney) are the main areas affected. Diabetic kidney disease is characterised by the presence of a protein called albumin in the urine(if in small amounts, called microalbuminuria), hypertension (high blood pressure), edema (swelling), and progressive renal dysfunction. Diabetic kidney disease is the leading cause of renal failure in the developed countries.
Brain: Diabetes patients have 1.5-3 times risk of developing ischaemic stroke as compared to non-diabetics. Looking at another angle, roughly one in four cases of stroke can be attributed to diabetes alone or in combination with hypertension.
Heart and peripheral blood vessels: The risk is extremely high. Type 2 diabetic patients without a prior heart attack(Myocardial infarction) have a similar risk for heart attack as non-diabetic individuals who have had a heart attack previously. Worst still, diabetic patients may have “silent ischaemia”, that is the diabetic patients may not experience the typical chest pain normally associated with myocardial infarctions. The risk of ’sudden death’ increases five fold in diabetics. Associated hypertension, and deranged serum lipid profile further aggravate risks for cardiovascular disease.
Nerves: Diabetes mostly affects sensory nerves. When peripheral nerves are affected sensation of numbness, tingling, sharpness, or burning that begins in the feet and then progresses up. Pain from involvement of nerves typically starts in feet, is much worse at night, and is even present on rest. Pain is a sign of nerve damage. Once nerves gets permanently damaged, pain disappears but numbness in area supplied by that nerve persists. Diabetes may also affect the autonomic nerves, that regulate processes that are not under our voluntary control, like bowel movements. The involvement of these nerves may cause slowing of emptying of stomach after meals, and urinary bladder emptying difficulties. Loss of autonomic nerves of skin leads to decreased sweating, which in turn causes dryness of skin and increased vulnerability to injuries and poor healing.
Abdominal and urinary problems: Diabetes affects the motility of stomach, called gastroparesis, and may also alter small and large intestine, presenting as constipation or diarrhoea. Common manifestations include loss of appetite, nausea, vomiting, early satiety, and abdominal bloating.
Patients with long standing diabetes may also develop urinary voiding difficulties, erectile dysfunction, loss of libido and loss of control over urination.
Diabetic foot: Foot ulcerations and gangrene are leading cause of non-traumatic causes of amputation worldwide. Loss of sensations, and poor wound healing abilities leads to formation of non-healing wounds. Approximately 15% of type 2 diabetics will develop a foot ulcer, and many of them require amputations for the same.
Involvement of nerves leads to loss of sensations, which interferes with normal protective mechanisms and puts the individuals at risk of sustaining minor repetitive traumas. Besides loss of sensations, involvement of other nerves leads to imbalance between different muscle groups, altering the mechanics of our foot, increasing stress and injuries.
Infection: Diabetics are prone to develop infections because of decreased immunity. The infections may be more severe than in normal individuals. Common infections include pneumonia, urinary tract infections, nasal fungal infections(mucormycosis), skin infections and abscesses. Patients with diabetes have poor wound healing due to poor vascularity of tissues and reduced sensations. Poor immunity and delayed poses a serious risk of surgical site infections after major or minor procedures.
Diabetes spares no tissues in our body. It maims and kills slowly. This is what makes diabetes a silent killer and worst human disease.