Type 2 diabetes (MECHANISM) SYMPTOMS https://www.health.harvard.edu/a _to_z/type-2-diabetes-mellitus-ato-z ● Excessive urination, ● thirst and hunger ● Weight loss ● Atherosclerosis — Atherosclerosis is fat buildup in the artery walls. This can impair blood flow to the all the organs. The heart, brain and legs are most often affected. ● Retinopathy — Tiny blood vessels in the retina (the back of the eye that sees light) can become damaged by high blood sugar. The damage can block blood flow to the retina, and can lead to bleeding into the retina. Both damage the ability of the retina to see light. Caught early, retinopathy damage can be minimized by tightly controlling blood sugar and using laser therapy. Untreated retinopathy can lead to blindness. ● Neuropathy — This is nerve damage. The most common type is peripheral neuropathy. The nerves to the legs are damaged first, causing pain and numbness in the feet. This can advance to cause symptoms in the legs and hands. Damage to the nerves that control digestion, sexual function and urination can also occur. ● Foot problems — Sores and blisters on the feet occur for two reasons: ○ If peripheral neuropathy causes numbness, the person may not feel irritation in the foot. The skin can break down, form an ulcer, and the ulcer can get infected. ○ Blood circulation can be poor, leading to slow healing. Left untreated, a simple sore can become infected and very large. If medical treatment cannot heal the sore, an amputation may be required. ● Nephropathy — Damage to the kidneys. This is more likely if blood sugars remain elevated and high blood pressure is not treated aggressively. How insulin works ? Insulin is a hormone that comes from a gland behind and below the stomach (pancreas). ● The pancreas releases insulin into the bloodstream. ● The insulin circulates, letting sugar enter the cells. ● Insulin lowers the amount of sugar in the bloodstream. ● As the blood sugar level drops, so does the secretion of insulin from the pancreas. RISK FACTOR ● Weight. Being overweight or obese is a main risk. ● Fat distribution. Storing fat mainly in your abdomen — rather than your hips and thighs — indicates a greater risk. Your risk of type 2 diabetes rises if you're a man with a waist circumference above 40 inches (101.6 centimeters) or a woman with a measurement above 35 inches (88.9 centimeters). ● Inactivity. The less active you are, the greater your risk. Physical activity helps control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. ● Family history. The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes. ● Race and ethnicity. Although it's unclear why, people of certain races and ethnicities — including Black, Hispanic, Native American and Asian people, and Pacific Islanders — are more likely to develop type 2 diabetes than white people are. ● Blood lipid levels. An increased risk is associated with low levels of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — and high levels of triglycerides. ● Age. The risk of type 2 diabetes increases as you get older, especially after age 35. ● Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes. ● Pregnancy-related risks. Your risk of developing type 2 diabetes increases if you developed gestational diabetes when you were pregnant or if you gave birth to a baby weighing more than 9 pounds (4 kilograms). ● Polycystic ovary syndrome. Having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes ● Areas of darkened skin, usually in the armpits and neck. This condition often indicates insulin resistance. Complications Potential complications of diabetes and frequent comorbidities include: ● Heart and blood vessel disease. Diabetes is associated with an increased risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis). ● Nerve damage (neuropathy) in limbs. High blood sugar over time can damage or destroy nerves, resulting in tingling, numbness, burning, pain or eventual loss of feeling that usually begins at the tips of the toes or fingers and gradually spreads upward. ● Other nerve damage. Damage to nerves of the heart can contribute to irregular heart rhythms. Nerve damage in the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. For men, nerve damage may cause erectile dysfunction. ● Kidney disease. Diabetes may lead to chronic kidney disease or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant. ● Eye damage. Diabetes increases the risk of serious eye diseases, such as cataracts and glaucoma, and may damage the blood vessels of the retina, potentially leading to blindness. ● Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. ● Slow healing. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation. ● Hearing impairment. Hearing problems are more common in people with diabetes. ● Sleep apnea. Obstructive sleep apnea is common in people living with type 2 diabetes. Obesity may be the main contributing factor to both conditions. It's not clear whether treating sleep apnea improves blood sugar control. ● Dementia. Type 2 diabetes seems to increase the risk of Alzheimer's disease and other disorders that cause dementia. Poor control of blood sugar levels is linked to more-rapid decline in memory and other thinking skills. Blood and oxygen circulation in diabetes mellitus The underlying cause leading to the reversible functional changes in the microcirculation of insulin-dependent diabetic subjects early during the disease prior to any clinical signs of retinopathy and nephropathy (functional microangiopathy) is discussed. It is suggested that the initial microvascular dilation observed in diabetics is due to an autoregulatory response to relative tissue hypoxia providing an increased tissue perfusion in order to improve tissue oxygen delivery. Supporting evidence for this suggestion is derived from the findings that diabetics simultaneously may show increased tissue oxygen consumption and decreased ability of the circulating blood to release oxygen to the tissues. The latter defect is likely to be caused by two interrelated factors: 1. an increased proportion of haemoglobin A1c with high oxygen affinity, and 2. difficulties of maintaining a sufficiently high concentration of plasma inorganic phosphate in order to provide an optimal 2,3-diphosphoglycerate (2,3-DPG) content in the erythrocytes. The basal oxygen demand of diabetics may fluctuate even within a few hours dependent upon the state of metabolic control and is increased at times of poor regulation. Hence, diabetics may suffer from innumerable cellular hypoxic injuries, which during the first years of the disease are counteracted in the microcirculation by an autoregulatory response. These microvascular reactions associated with increased plasma permeation may over the years be of major importance for the development of the degenerative microangiopathy in diabetes. Diabetes and Nerve Damage High blood sugar can lead to nerve damage called diabetic neuropathy. You can prevent it or slow its progress by keeping your blood sugar as close to your target range as possible and maintaining a healthy lifestyle. Managing your blood sugar is an essential part of your diabetes care plan. Not only does it help you with day-to-day wellness, it can help prevent serious health problems down the road. Nerve damage is one possible complication from having high blood sugar levels for a long time. High blood sugar damages your nerves, and these nerves may stop sending messages to different parts of your body. Nerve damage can cause health problems ranging from mild numbness to pain that makes it hard to do normal activities. Half of all people with diabetes have nerve damage. The good news is that you can help prevent or delay it by keeping your blood sugar as close to your target levels as possible. When you do this, you’ll also have more energy, and you’ll feel better! Symptoms of nerve damage usually develop slowly, so it’s important to notice your symptoms early so you can take action to prevent it from getting more serious. Types of nerve damage https://www.cdc.gov/diabetes/libr ary/features/diabetes-nerve-dam age.html Peripheral nerve damage Have you felt “pins and needles” or tingling in your feet? Maybe you feel like you’re wearing socks or gloves when you aren’t. Your feet may be very sensitive to touch—even a bed sheet can hurt. These are all symptoms of peripheral nerve damage. Peripheral nerve damage affects your hands, feet, legs, and arms, and it’s the most common type of nerve damage for people with diabetes. It generally starts in the feet, usually in both feet at once. Other symptoms may include: ● Pain or increased sensitivity, especially at night. ● Numbness or weakness. ● Serious foot problems, such as ulcers, infections, and bone and joint pain. You may not notice pressure or injuries causing blisters or sores, which can lead to infections, sores that don’t heal, or ulcers. Sometimes amputation (removal by surgery) is necessary. Finding and treating foot problems early can lower your chances of developing a serious infection. Learn how to care for your feet, including how to check them yourself and what kind of shoes to wear. Diabetic bullae Diabetic bullae, also known as bullosis diabeticorum, are blister-like lesions that occur spontaneously on the feet and hands of diabetic patients. Although rare, diabetic bullae are a distinct marker for diabetes. ● Diabetic bullae are more common in men than women ● They are prevalent between the ages of 17 and 84 years. ● They are also more common in patients who have long-standing diabetes or multiple diabetic complications, particularly neuropathy. The blisters are painless and can be from 0.5–17 centimetres in size. They often have an irregular shape. Two types of diabetic bullae have been defined. ● Intraepidermal bullae — these are blisters filled with clear, sterile viscous fluid and normally heal spontaneously within 2–5 weeks without scarring and atrophy. ● Subepidermal bullae — these are less common and may be filled with blood. Healed blisters may show scarring and atrophy. In most cases, diabetic bullae heal spontaneously without treatment. Patients should make sure the blister remains unbroken to avoid secondary infection.
