INTRODUCTION
Diabetes Mellitus is a collection of chronic metabolic diseases which occurs as a result of a sustained increase in blood glucose levels. The increased blood glucose levels result due to a lack of insulin secretion or resistance of the body to the insulin secreted. Insulin and glucagon are the principal hormones involved in the regulation of blood glucose levels.
They perform similar but opposite tasks. When insulin is trying to increase the take up of glucose as glycogen (storage form of glucose in muscles) by the body tissues, glucagon on the other hand is basically converting that glycogen to glucose to go back into blood. Does this occur at the same time ? No. How does insulin or glucagon know when it’s supposed to act ? Well, there are glucose sensors in a special organ called the pancreas which can detect the level of blood glucose and know if more or less glucose is needed in the blood.
This special organ produces both insulin and glucagon albeit in two different cells (beta cells produce insulin while alpha cells produce glucagon). When the blood glucose level is low, glucagon is produced abundantly by the pancreas and released into blood and thus causes the conversion of stored glucose (glycogen) into glucose for its easy escape into the blood raising the blood glucose level and when the blood glucose level is high, glucagon production is suppressed while insulin is produced in abundance and thus enhancing the take up of glucose by special tissues stabilizing the blood glucose level in the process.
It’s very interesting to note that, glucose is converted into glycogen in the muscles to prevent its easy escape into blood through its transporters that are always present (except in certain disease conditions) in the cells that it is stored in.
Diabetes mellitus just acts as a spoiler in that it causes the pancreas to secrete insulin just below the amounts required to normalize the blood glucose level or not even secrete insulin at all. This basically fucks up the coordinated but opposite regulation of blood glucose carried out by glucagon and insulin as one party is absent while the other just has to do its job anyway.
A metabolic disorder results and the body begins to experience certain trauma levels. This is basically what I want to highlight on this post but first of all, I’ll like us to see the classification, pathophysiology and cardinal symptoms of diabetes mellitus briefly.
CLASSIFICATION OF DIABETES MELLITUS (PATHOPHYSIOLOGY BRIEFLY HIGHLIGHTED)
- TYPE 1 DIABETES:
Also known as insulin-dependent diabetes mellitus (IDDM) or juvenile onset diabetes mellitus. This majorly occurs in infants and children and it is as result of an autoimmune disorder. Although Type 1 diabetes is idiopathic (exact cause of disease unknown) to an extent, it is well known that the beta cells of the pancreas is destroyed by the body’s own immune system.
One of the most striking features of the immune system is its ability to recognize self from non-self but in the case of type 1 DM, the immune system turns a blind eye to beta cells and destroys it anyway. This is what health workers term “autoimmunity”. [2].
- TYPE 2 DIABETES MELLITUS:
Also known as Non-insulin dependent diabetes mellitus (NIDDM) or adult onset diabetes mellitus. This form of diabetes is the most prevalent. It is found in 90% of people with diabetes mellitus. In this case, although sometimes, the pancreas are pretty much doing their job as they produce insulin at the normal levels but the body however can not make use of this insulin due to the fact that it has somehow grown resistant to it.
Can you imagine that ? Mehhh. Other times, the pancreas are producing just a minute amount of insulin which is practically not enough and although the body can utilize insulin, the insulin isn’t just enough to chase the glucose from the blood to the muscle cells where should be. Oh okay let me explain how the pancreas goes from producing enough insulin to producing just a minute amount. The pancreas has sensors, as I earlier stated, that detect blood glucose levels at all times.
When the blood glucose is below the normal range (70 - 100 mg/dL [fasting])[1], the pancreas begins to produce and release insulin. In a non-diabetic individual, this insulin will normalize the blood glucose levels and further insulin production will come to a halt.
In a type 2 diabetic Individual however, insulin production doesn’t stop cause the blood glucose level stay elevated and the pancreas has to do its job anyway. But just like every other organ, the pancreas can get tired. When it gets tired with no rest whatsoever, it begins to wear off. This wearing off leads to a decrease in its insulin producing capacity and insulin levels begin to lower due to a lower production rate by the pancreas. [2].
- GESTATIONAL DIABETES
This class of diabetes is a bit different in that it comes and goes on it’s own but strictly during pregnancy. Since the mother now has to provide for another individual besides herself, her body is likely to be met with excessive demands. The glucose demand is much more during pregnancy and thus, insulin is suppressed and blood glucose level is crazily elevated. This is done to supply glucose efficiently to both mother and child but uncontrollable results in diabetes at times. This diabetes however seizes to occur after pregnancy. [3]
SYMPTOMS OF DIABETES MELLITUS
During my days in the university, I knew a lecturer who always made it a point to humiliate students that rarely come to class by asking them a certain question:
what are the three P’s of diabetes mellitus ?
Well, easy as it may seem. Most people say the funniest things anyway. Pain, Penile dysfunction, Pooping (taking a dump) (yes, once someone said that). Back to business however,
The three cardinal symptoms of diabetes are:
- Polyphagia (Excessive hunger)
- Polyuria (Excessive urination)
- Polydipsia (Excessive thirst)
- Others include: blurred vision (diabetic cataract), weight loss, cuts and sores taking time to heal, lethargy. [3].
WHY I CONSIDER DIABETES MELLITUS A MONSTER LIKE NO OTHER
At this point you are probably thinking that, well, Diabetes Mellitus has nothing on HIV/AIDS when it comes to destroying the body system but I’m not saying diabetes is the most lethal disease one could have, I’m saying there is none like it.
There is no other disease that can destroy the heart, kidney (diabetic nephropathy), the eyes (diabetic retinopathy), the nervous system (diabetic neuropathy), the heart (atherosclerosis and cardiovascular disease) as well as causing disruption of the digestive system via vomiting and pains in the abdominal region [the list is endless] just by raising the blood level of a single harmless molecule (glucose) while having a global prevalence of 8.5 [4]. How is that not badass enough ?
- DIABETES AND THE KIDNEY (DIABETIC NEPHROPATHY)
The kidney is a very vital organ for excretion of waste products of the body. In diabetic patients, just like the pancreas are stressed out, the kidney also get stressed out.
The high levels of glucose in blood means that the osmotic concentration of the blood has to be on the rise. The body tries to normalize this by constantly absorbing water into blood and this means that the kidney has to do more filtering that it usually does.
The kidneys get stressed out and eventually it’s blood vessels which are essential for its filtering functions get ruptured and certain useful compounds like proteins (albumin) escape into the bladder and are seen in urine. This is bad for the body as functional proteins are lost even complicating everything. [5]
- DIABETES AND THE NERVOUS SYSTEM (DIABETIC NEUROPATHY)
Just like every component of the body system, the nerves need a constant supply of blood to stay functioning. There are blood vessels designated to supply blood to the nerves. In diabetes, these blood vessels can get badly damaged due to the accumulation of glucose in blood leading to shortage in the supply of blood to the nerves. The overall effect of this is numbness as certain tissues now lack nervous control. [6]
- DIABETES AND THE EYES (DIABETIC RETINOPATHY)
Just like the two above, diabetes also affects the eye by destroying certain blood vessels present in the eye. Destruction of these blood vessels could result in formation of pouches in the eye, leakage of fluid into the retina or closing off of the blood vessels that supply the eye as a result of excess destruction. The ultimate result is a certain loss of vision. [7]
- DIABETES AND THE TESTES (ERECTILE DYSFUNCTION)
Erectile dysfunction is one of the major consequences of diabetes mellitus as procreation is very essential for the continuance of the human race. [8]Studies have shown that diabetes causes male infertility through an unknown mechanism that involves insulin.
The testes and sperm cells are insulin producing cells and thus the levels of insulin in the testes can be affected by diabetes. There is also speculation that infertility may occur as a result of the hormonal disturbance of The hypothalamic-pituitary-gonadal axis. Which of the two mechanisms is responsible for the infertility seen in diabetic males still remains unclear.
- DIABETES AND THE BRAIN (DIABETIC ENCEPHALOPATHY)
Although it’s a relatively unknown complication, they’ve been speculations however as to how it occurs. One of those is that, the body’s inability to utilize insulin could possibly lead to the brain’s inability to break down amyloid, a protein responsible for blocking cell to cell signaling at nerve cell synapses by forming plaques.
Another speculation states that oxidative stress caused by excessive generation of free radicals (molecules that carry charges) due to increased lipid peroxidation could lead to diabetic encephalopathy since the body’s antioxidant system is being incapacitated.
It has also been speculated that destruction of blood vessels present in the brain which could affect the flow of blood coupled with insulin in excess can lead to this condition since the brain cannot process proteins effectively. [9]
- DIABETES AND THE HEART (DIABETIC CARDIOMYOPATHY)
Diabetes also affects the heart. Diabetes can affect the effective flow of blood around the body causing a heart failure. Fluid can be seen accumulating in the legs and hands too.
The heart cells are known to lose function due to a lot of factors including but not limited to, increased production of free radicals due to excess lipid peroxidation and an increase in oxidation of fatty acids. The heart tends to lose its nervous supply as a result of a destruction of the blood vessels which supply glucose to these nerves and this also complicates diabetic cardiomyopathy [10].
MANAGEMENT AND CONTROL OF DIABETES MELLITUS
I had to add little notes leaving links for those who are interested in this aspect of this write up because I believe it will benefit the overall community. Diabetes can be managed as highlighted below:
- INSULIN INJECTIONS
People with type 1 diabetes can receive insulin injections from time to keep their blood glucose levels at normal. [11].
- DIET
Diet also plays a huge role in the management of diabetes. Maintaining a low carbohydrate diet is very essential in the management of Type 2 DM especially. People with Type 1 DM will need insulin injections all their lives. Some Type 2 DM patients however can manage their diabetes condition by just maintaining a low carb diet [11].
- DRUGS
Antidiabetic meds can also help manage diabetes effectively. Metformin is a frontline treatment drug for diabetes and it has just a few side effects. Glibenclamide is also an alternative antidiabetic drug. [11]
- EXERCISE:
During exercise, cells which are controlled by insulin tend to take up glucose much more than they do normally. Exercise decreases the demand for insulin as it can promote the uptake of glucose by cells thus a lesser amount of insulin would be required to normalize blood glucose level. [11]
THANKS FOR READING !!
REFERENCES
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IMAGE SOURCES
All images used here are from free sources and eligible for commercial use