Is Diabetes Debilitating ? The most important NCD in 21st century

The answer to where diabetes is a debilitating disease is yes, it is. Without a doubt every scientists and clinicians are agreed with this statement. But it doesn’t say that every person who has diabetes is debilitated. There are people who live happily without serious health problems. It all depends on how severe your diabetes is, which measures with complications associated with the disease. For sure there will be some limitations compared with your non diabetic period. But you also can live a normal life with proper control.

Diabetes is a non communicable disease which WHO has identified as the most important one in 21st century. Health sector specially concerns about the disease as it leads to several other health issues which can be fatal.

As we all know diabetes is increasing blood sugar levels in our body. It can happens in both failure of the pancreas which cause inappropriate production of insulin. And insulin resistance in body cells. By these two mechanisms diabetes is categorized in to two main types called type 1 and 2. Both types are causing serious medical problems which are identified as complications of diabetes.

What are the complications of diabetes ?

Complications of diabetes are categorized in to three main areas.

  • Emergency complications
  • Micro vascular complications
  • Macro vasculitis complications

There are 2 main identified emergencies which are diabetic ketoacidosis and hyperosmolar non ketotic state. Diabetic ketoacidosis is more common in type 1 diabetes and both conditions present with relatively high blood glucose value. Patients develop vomiting, confusion and breathing difficulties with these two stages.

Diabetic ketoacidosis have high amount of ketone bodies in their blood whereas hyperosmolar non ketotic state doesn’t have ketone bodies as refer as it’s name. Both these conditions are known to be fatal if not identified early and managed effectively. The main component of the management of these patients are giving lots of fluid. Thereby intravascular normal saline is used in hospitals with serial monitoring.

Micro vascular complications of the diabetes are mainly included retinopathy, neuropathy and nephropathy. All these complications occur due to tiny changes in vessel walls. The high blood sugar levels leading to molecular changes in proteins in blood vessels. And also formation of reactive oxygen species which cause inflammatory changes on blood vessels are contributing to these problems.

Retinopathy presents with blurring of vision, double vision or complete loss of vision. It’s so sad that some patients loss their sight permanently. Early identification of the retinopathy can reverse the disease. The proper blood sugar control has a great contribution on this also.

Neuropathy patients present with burning sensation over calves and thighs, nocturnal diarrhoea, numbness on specific body part. It can be identified early if we are more vigilant. The earliest presentation of neuropathy is numbness over feet or walking on a cotton wool type sensation. Some neurological issues diabetic amyotrophy ( wasting of muscles ) can be improves with good blood sugar control.

Nephropathy presents in most patients with diabetes by the diagnosis of the disease. Increased urine frequency, increased urine frequency in nights more than one time are the early features. With further progress of the disease patients can get lower urinary tract symptoms like poor stream, dribbling of urine and even urine retention also. There is a high chance of getting chronic kidney disease due to poor control of diabetes.

Diabetic foot complications are also very common in these people. Loss of sensation, foot ulcers and web space infections are common as foot complications. Most people do not concern about this condition. But there is a high possibility of lower limb amputations in people with long term foot complications.

The macro vascular complications of diabetes are mainly strokes and myocardial infarction ( heart attacks ). Because of the changes in large vessel walls, due to improper blood glucose control these people get these problems.

Diabetic foot complications
Diabetic Foot Complications

How to live safely with diabetes?

Because diabetes is a multi systemic disease, it’s advisable to all diabetic patients to engage in regular medical follow ups. Thereby doctors can identify complications early. It helps to treat patients and advice them about lifestyle modifications.

Good blood sugar control is the mainstay in managing diabetic patients. Maintaining fasting blood sugar less than 110 mg/dl and HbA1C level less than 6.5% is advisable.

The lifestyle changes on diabetic patients is very important. Reducing the sugar consumption and avoid junk foods have great contribution on this. With the same time it’s advisable to reduce self intake as high blood pressure is co existence with diabetes. Never underestimate the foot care, as it helps in maintaining quality of life of a person.

How long can you live with uncontrolled diabetes?

The life expectancy of a diabetic patient is not easy to predict. Because it all depends with the control of the disease in each individual. The United Kingdom performed an investigation on 2010 and results say that type 2 diabetes reduce life expectancy by 10 years whereas type 1 diabetes in 20 years.

A study performed on type 2 diabetes by European heart journal on 2008 says that 55 years old person can live another 13.2 to 21.1 years. And 75 years old patient can live another 4.3 to 9.6 years.

However all these numbers varies with the person’s lifestyle. And they specifically mentioned that smoking cause drastic reduction of life expectancy in diabetic patients.

But a German study performed on diabetic and non diabetic life expectancy showed that there is a 4 to 9 years of increased lifespan than normal. This results are somewhat controversial with others. But the study also indicates that eventhough diabetic patients can live more, frequency of their morbidity is more.

A Bulgarian study performed in 2020 showed that type 2 diabetic patients have more lifespan than type 1 patients. And also with the good lifestyle modifications type 2 patients have similar life expectancy as non diabetics.

What is the most severe diabetes?

Both types of diabetes are serious conditions. There are no way to compare these two by their severity. Both conditions have their own complications as well as similar health issues because of the metabolic derangements that occur with these.

Generally type 2 diabetes affects in later in life, therefore there are serious comorbidities co existence with that. It all depends with the individual health of a person. Type 1 diabetes is diagnosed in young ages so these patients are able to actively engage in physical activities and maintain their dietary habits compared with older people with lots of comorbidities.

Do diabetics get sick easier?

By the clinical practice every doctor knows that diabetic patients are more prone to get sick compared with people who don’t. Because of that as doctors we concern on managing a diabetic patient more seriously. As some medications react with glucose reducing drugs. It will worsen the condition.

The reason of diabetic patients get sick easily is because of the metabolic derangement in their body, their immunity become less strengthen than others. Because of that their ability fight against infections also reduced. Thereby diabetic patients are more susceptible in respiratory, urinary and gastrointestinal tract infections. And the worse part is these conditions can be easily worsen and ultimately lead to death also.

Therefore in hospital practice we tend to treat these patients with intravenous medications and also select specific antibiotics.

Diabetic sick day rules
Diabetic sick day rules

How do diabetics handle sick days?

Careful handling of sick days is very important in diabetic patients. Because when we get sick our body produces more stress hormones than usual. These stress hormones lead to break our glycogen stores in skeletal muscles and liver to produce glucose. Because our body thinks we need more glucose to produce energy to survive in sick days. This mechanism act harm on diabetic patients.

Therefore when a diabetic patient get sick it’s better to seek medical attention early. And follow these simple steps to avoid getting serious problems.

  • Never miss your diabetic medications even you have nausea or vomiting.
  • Take clear fluids as much as possible, and avoid sugary drinks.
  • Take a reasonable amount of food as you were advised by the doctors. Don’t eat too much or too less.
  • Always concern about your body temperature, breathing difficulties. If body temperature is high or difficulty in breathing occurs immediately seek medical attention.
  • Regularly check your blood glucose levels. If you have a home glucose measuring device at least check your blood glucose levels 4 hourly.
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Sapumal Edirisinghe
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