Diabetes mellitus (type 1, type 2) & diabetic ketoacidosis (DKA)

Summary

La diabetes mellitus es una enfermedad donde el cuerpo tiene problemas para mover la glucosa de la sangre a las células, lo que resulta en altos niveles de glucosa en la sangre y falta de energía en las células. Hay dos tipos: la tipo 1, donde el sistema inmunológico destruye las células que producen insulina, y la tipo 2, donde las células se vuelven resistentes a la insulina. Los síntomas incluyen sed excesiva, fatiga y visión borrosa. El tratamiento incluye insulina, medicamentos y cambios en el estilo de vida. Es fundamental controlar la diabetes para evitar complicaciones como daños en los nervios y problemas circulatorios.

Takeaways

• 🩺 Aprender medicina puede ser difícil, pero plataformas como Osmosis facilitan el proceso con planes de estudio personalizados.
• 🍬 En la diabetes mellitus, el cuerpo tiene problemas para mover la glucosa de la sangre a las células, lo que lleva a niveles altos de glucosa en la sangre y células hambrientas de energía.
• 🏥 La insulina reduce los niveles de glucosa en la sangre, mientras que el glucagón los aumenta; ambos son producidos en el páncreas.
• 🧬 La diabetes tipo 1 es causada por una respuesta autoinmune donde las células T atacan las células beta del páncreas, reduciendo la producción de insulina.
• 🔬 La diabetes tipo 2 ocurre cuando el cuerpo produce insulina, pero las células no responden adecuadamente, lo que lleva a resistencia a la insulina.
• 👶 La diabetes gestacional afecta a mujeres embarazadas, y se cree que está relacionada con hormonas que interfieren con la acción de la insulina.
• 📉 La prueba de HbA1c mide los niveles promedio de glucosa en sangre durante 2-3 meses, siendo un indicador importante para diagnosticar diabetes.
• 💉 El tratamiento de la diabetes tipo 1 requiere insulina de por vida, mientras que la diabetes tipo 2 puede manejarse con cambios en el estilo de vida y medicamentos orales.
• ⚠️ La cetoacidosis diabética es una complicación grave de la diabetes tipo 1, mientras que el estado hiperosmolar hiperglucémico es más común en la diabetes tipo 2.
• 👁️‍🗨️ El control deficiente de la diabetes puede causar complicaciones graves, como daño a los vasos sanguíneos, neuropatía, retinopatía y enfermedades renales.

Q & A

¿Qué es la diabetes mellitus y cómo afecta al cuerpo?

La diabetes mellitus es una condición en la que el cuerpo tiene dificultades para mover la glucosa de la sangre a las células. Esto resulta en altos niveles de glucosa en la sangre y la falta de glucosa dentro de las células, lo que provoca que las células se queden sin energía.

¿Cuáles son los dos tipos principales de diabetes mellitus?

Existen dos tipos principales de diabetes mellitus: la diabetes tipo 1 y la diabetes tipo 2. La diabetes tipo 1 se caracteriza por la falta de producción de insulina, mientras que en la diabetes tipo 2 el cuerpo produce insulina pero las células no responden adecuadamente a ella.

¿Cómo regula el cuerpo los niveles de glucosa en la sangre?

El cuerpo regula los niveles de glucosa en la sangre mediante dos hormonas: la insulina, que reduce los niveles de glucosa, y el glucagón, que los aumenta. Ambas hormonas son producidas en el páncreas.

¿Qué causa la diabetes tipo 1?

La diabetes tipo 1 es causada por una respuesta inmune mediada por células, donde los propios linfocitos T del cuerpo atacan las células beta del páncreas, lo que resulta en una disminución de la producción de insulina.

¿Qué papel juega el sistema HLA en la diabetes tipo 1?

El sistema HLA (antígenos leucocitarios humanos) en el cromosoma 6 es importante en la regulación de la respuesta inmune. Las personas con diabetes tipo 1 a menudo comparten los genes HLA-DR3 y HLA-DR4, lo que sugiere un vínculo genético con la enfermedad.

¿Cuáles son los síntomas comunes de la diabetes no controlada?

Los síntomas comunes incluyen polifagia (hambre excesiva), glucosuria (presencia de glucosa en la orina), poliuria (orina frecuente) y polidipsia (sed excesiva).

¿Qué es la cetoacidosis diabética (DKA) y por qué ocurre?

La cetoacidosis diabética es una complicación grave de la diabetes tipo 1 en la que el cuerpo descompone las grasas para obtener energía, produciendo cuerpos cetónicos que acidifican la sangre. Ocurre debido a la falta de insulina que impide la entrada de glucosa en las células.

¿Cómo se desarrolla la resistencia a la insulina en la diabetes tipo 2?

En la diabetes tipo 2, las células no responden adecuadamente a la insulina, lo que se conoce como resistencia a la insulina. Se cree que factores como la obesidad, la falta de ejercicio y la inflamación causada por adipocinas juegan un papel clave.

¿Qué pruebas se utilizan para diagnosticar la diabetes?

Se utilizan varias pruebas, como la prueba de glucosa en ayunas, la prueba de tolerancia a la glucosa oral y el test de HbA1c (hemoglobina glucosilada) para evaluar los niveles de glucosa en sangre y diagnosticar la diabetes.

¿Cómo se trata la diabetes tipo 1 y la diabetes tipo 2?

La diabetes tipo 1 se trata con terapia de insulina de por vida, mientras que la diabetes tipo 2 se puede controlar con cambios en el estilo de vida, medicamentos orales como la metformina y, si es necesario, insulina.

Outlines

00:00

🔬 Introducción a la Diabetes Mellitus

La diabetes mellitus es una condición donde el cuerpo tiene problemas para mover la glucosa de la sangre a las células, lo que causa altos niveles de glucosa en sangre y células hambrientas de energía. El cuerpo regula la glucosa con insulina, que la reduce, y glucagón, que la aumenta. En la diabetes tipo 1, las células T atacan las células beta que producen insulina, mientras que en la diabetes tipo 2, las células no responden bien a la insulina.

05:03

🚰 Síntomas y complicaciones iniciales de la diabetes no controlada

La diabetes no controlada provoca síntomas como la pérdida de glucosa en la orina (glucosuria), aumento de la micción (poliuria) y sed excesiva (polidipsia). La falta de insulina en la diabetes tipo 1 lleva al uso de grasas y proteínas para energía, causando pérdida de peso y hambre extrema (polifagia). El tratamiento incluye insulina para regular los niveles de glucosa.

10:03

⚠️ Cetoacidosis diabética (DKA)

La DKA ocurre cuando el cuerpo usa grasas para energía, produciendo cuerpos cetónicos que acidifican la sangre. Esto provoca respiración profunda (respiración de Kussmaul), deshidratación y niveles peligrosos de potasio en sangre (hiperpotasemia). En casos graves, puede causar náuseas, vómitos, edema cerebral y cambios en el estado mental. El tratamiento incluye fluidos, insulina y reposición de electrolitos.

15:07

🏋️‍♀️ Diabetes Tipo 2: resistencia a la insulina

En la diabetes tipo 2, las células no responden bien a la insulina, lo que lleva a una producción excesiva de insulina por las células beta, que con el tiempo se agotan. Factores como la obesidad y la inflamación contribuyen a la resistencia a la insulina, aunque también hay componentes genéticos. Los pacientes pueden desarrollar hiperglucemia, pero no suelen tener cetoacidosis diabética como en la diabetes tipo 1.

Keywords

💡Diabetes mellitus

Es una enfermedad crónica en la que el cuerpo tiene problemas para mover la glucosa de la sangre a las células, lo que resulta en niveles altos de glucosa en la sangre y falta de energía en las células. Este es el tema principal del video y se presentan dos tipos de diabetes: tipo 1 y tipo 2.

💡Insulina

Es una hormona producida por las células beta del páncreas que ayuda a reducir los niveles de glucosa en la sangre al permitir que la glucosa entre en las células. En el video se describe cómo la insulina es crucial para evitar la hiperglucemia en la diabetes tipo 1 y tipo 2.

💡Glucagón

Es una hormona producida por las células alfa del páncreas que aumenta los niveles de glucosa en la sangre al estimular la producción de nueva glucosa en el hígado. Es el opuesto de la insulina y se menciona en el video en el contexto de la regulación del equilibrio glucémico en el cuerpo.

💡Diabetes tipo 1

Es una forma de diabetes en la que el sistema inmune ataca y destruye las células beta del páncreas, lo que resulta en la incapacidad de producir insulina. Se menciona en el video como un trastorno autoinmune que requiere terapia de insulina de por vida.

💡Diabetes tipo 2

Es una forma de diabetes en la que el cuerpo produce insulina, pero las células no responden adecuadamente a ella, lo que lleva a la resistencia a la insulina. Se menciona que está más relacionada con factores de riesgo como la obesidad y el sedentarismo.

💡Cetoacidosis diabética

Es una complicación grave de la diabetes tipo 1, donde el cuerpo descompone grasas en lugar de glucosa, lo que genera cuerpos cetónicos que acidifican la sangre. Se menciona en el video como una emergencia médica que requiere tratamiento inmediato con insulina y líquidos.

💡Hiperglucemia

Se refiere a niveles altos de glucosa en la sangre. En el video se explica cómo la hiperglucemia es un signo clave de la diabetes y cómo afecta al cuerpo a largo plazo, incluyendo los síntomas como la polidipsia y la poliuria.

💡Insulinorresistencia

Es la incapacidad de las células para responder adecuadamente a la insulina, lo que es característico de la diabetes tipo 2. El video lo relaciona con factores como la obesidad y el sedentarismo, y explica cómo esto contribuye a la hiperglucemia.

💡Hipoglucemia

Se refiere a niveles bajos de glucosa en la sangre, un riesgo común en personas que reciben tratamiento con insulina. En el video, se describe cómo la hipoglucemia puede ser leve o grave, y cómo debe tratarse rápidamente para evitar complicaciones mayores.

💡Complicaciones de la diabetes

Incluyen daños en los vasos sanguíneos, nervios, ojos y riñones debido a los niveles altos de glucosa en sangre a largo plazo. El video menciona complicaciones como retinopatía, nefropatía y neuropatía, destacando la importancia de controlar la diabetes para prevenirlas.

Highlights

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In diabetes mellitus, the body has trouble moving glucose from the blood into the cells, leading to high blood glucose and starving cells of energy.

Insulin reduces blood glucose levels by helping glucose enter cells, while glucagon raises blood glucose by promoting glucose production in the liver.

Type 1 diabetes is caused by a cell-mediated immune response where T cells attack insulin-producing beta cells in the pancreas.

HLA genes like HLA-DR3 and HLA-DR4 are linked to Type 1 diabetes, but not everyone with these genes develops the condition.

The four main symptoms of uncontrolled diabetes are polyphagia (increased hunger), glycosuria (glucose in urine), polyuria (frequent urination), and polydipsia (excessive thirst).

In Type 1 diabetes, a lack of insulin leads to the buildup of glucose in the blood, which causes cells to break down fat and muscle for energy, resulting in weight loss.

Diabetic ketoacidosis (DKA) is a serious complication of Type 1 diabetes that involves the production of ketone bodies, making the blood acidic and causing severe symptoms.

Type 2 diabetes is characterized by insulin resistance, where the body makes insulin, but the cells don’t respond properly to it.

Risk factors for Type 2 diabetes include obesity, lack of exercise, and hypertension, with inflammation from adipose tissue contributing to insulin resistance.

In Type 2 diabetes, beta cells in the pancreas try to compensate by producing more insulin, but over time they become exhausted and die off, leading to hyperglycemia.

Gestational diabetes occurs in pregnant women, likely due to hormones that interfere with insulin’s action.

Diabetes can damage blood vessels, leading to serious complications like heart attacks, strokes, retinopathy, nephropathy, and nerve damage.

The HbA1c test measures the percentage of hemoglobin that has glucose attached, indicating blood glucose levels over the past 2-3 months.

Hypoglycemia, a risk of insulin therapy, can cause symptoms from weakness and hunger to seizures, and in severe cases requires intravenous glucose.

Although Type 1 diabetes can’t be prevented, Type 2 diabetes can often be managed or prevented through lifestyle changes like diet, exercise, and medication.

Transcripts

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In diabetes mellitus, your body has trouble moving glucose, which is a type of sugar,

from your blood into your cells.

This leads to high levels of glucose in your blood and not enough of it in your cells,

and remember that your cells need glucose as a source of energy, so not letting the

glucose enter means that the cells starve for energy despite having glucose right on

their doorstep.

In general, the body controls how much glucose is in the blood relative to how much gets

into the cells with two hormones: insulin and glucagon.

Insulin is used to reduce blood glucose levels, and glucagon is used to increase blood glucose

levels.

Both of these hormones are produced by clusters of cells in the pancreas called islets of

Langerhans.

Insulin is secreted by beta cells in the center of the islets, and glucagon is secreted by

alpha cells in the periphery of the islets.

Insulin reduces the amount of glucose in the blood by binding to insulin receptors embedded

in the cell membrane of various insulin-responsive tissues like muscle cells and adipose tissue.

When activated, the insulin receptors cause vesicles containing glucose transporter that

are inside the cell to fuse with the cell membrane, allowing glucose to be transported

into the cell.

Glucagon does exactly the opposite, it raises the blood glucose levels by getting the liver

to generate new molecules of glucose from other molecules and also break down glycogen

into glucose so that it can all get dumped into the blood.

Diabetes mellitus is diagnosed when the blood glucose levels get too high, and this is seen

among 10% of the world population.

There are two types of diabetes - Type 1 and Type 2, and the main difference between them

is the underlying mechanism that causes the blood glucose levels to rise.

About 10% of people with diabetes have Type 1, and the remaining 90% of people with diabetes

have Type 2.

Let’s start with Type 1 diabetes mellitus, sometimes just called type 1 diabetes.

In this situation, the body doesn’t make enough insulin.

The reason this happens is that in type 1 diabetes there is a type 4 hypersensitivity

response or a cell-mediated immune response where a person’s own T cells attack the

pancreas.

As a quick review, remember that the immune system has T cells that react to all sorts

of antigens, which are usually small peptides, polysaccharides, or lipids, and that some

of these antigens are part of our own body’s cells.

It doesn’t make sense to allow T cells that will attack our own cells to hang around,

and so there’s this process to eliminate them called “self-tolerance”.

In type 1 diabetes, there is a genetic abnormality causes a loss of self-tolerance among T cells

that specifically target the beta cell antigens.

Losing self-tolerance means that these T cells are allowed to recruit other immune cells

and coordinate an attack on these beta cells.

Losing beta cells means less insulin, and less insulin means that glucose piles up in

the blood, because it can’t enter the body’s cells.

One really important genes involved in regulation of the immune response is the human leukocyte

antigen system, or HLA system.

Although it’s called a system, it’s basically this group of genes on chromosome six that

encode the major histocompatibility complex, or MHC, which is a protein that’s extremely

important in helping the immune system recognize foreign molecules, as well as maintaining

self-tolerance.

MHC is like the serving platter that antigens are presented to the immune cells.

Interestingly, people with type 1 diabetes often have specific HLA genes in common with

each other, one called HLA-DR3 and another called HLA-DR4.

But this is just a genetic clue right?

Because not everyone with HLA-DR3 and HLA-DR4 develops diabetes.

In diabetes mellitus type 1, destruction of beta cells usually starts early in life, but

sometimes up to 90% of the beta cells are destroyed before symptoms crop up.

Four clinical symptoms of uncontrolled diabetes, that all sound similar, are polyphagia, glycosuria,

polyuria, and polydipsia.

Let’s go through them one by one.

Even though there’s a lot of glucose in the blood, it can’t get into cells, which

leaves cells starved for energy, so in response, adipose tissue starts breaking down fat, called

lipolysis, and muscle tissue starts breaking down proteins, both of which results in weight

loss for someone with uncontrolled diabetes.

This catabolic state leaves people feeling hungry, also known as polyphagia.

“Phagia” means eating, and “Poly” means a lot.

Now with high glucose levels, that means that when blood gets filtered through the kidneys,

some of it starts to spill into the urine, called glycosuria.

“Glycos” refers to glucose, “uria” the urine.

Since glucose is osmotically active, water tends to follow it, resulting in an increase

in urination, or polyuria.

“Poly” again refers to a lot, and “uria” again refers to urine again.

Finally, because there is so much urination, people with uncontrolled diabetes become dehydrated

and thirsty, or polydipsia.

“Poly” means a lot, and “dipsia” means thirst.

Even though people with diabetes aren’t able to produce their own insulin, they can

still respond to insulin, so treatment involves lifelong insulin therapy to regulate their

blood glucose levels and basically enable their cells to use glucose.

One really serious complication with type 1 diabetes is called diabetic ketoacidosis,

or DKA.

To understand it, let’s go back to the process of lipolysis, where fat is broken down into

free fatty acids.

After that happens, the liver turns the fatty acids into ketone bodies, like acetoacetic

acid and beta hydroxybutyric acid, acetoacetic acid is a ketoacid because it has a ketone

group and a carboxylic acid group.

Beta hydroxybutyric acid on the other hand, even though it’s still one of the ketone

bodies, isn’t technically a ketoacid since its ketone group has been reduced to a hydroxyl

group.

These ketone bodies are important because they can be used by cells for energy, but

they also increase the acidity of the blood, which is why it’s called keto-acid-osis.

If the blood becoming really acidic can have major effects throughout the body.

Patients can develop Kussmaul respiration, which is a deep and labored breathing as the

body tries to move carbon dioxide out of the blood, in an effort to reduce its acidity.

Cells also have a transporter that exchanges hydrogen ions (or protons—H+) for potassium.

When the blood gets acidic, it is by definition loaded with protons that get sent into cells

while potassium gets sent into the fluid outside cells.

Another thing to keep in mind is that in addition to helping glucose enter cells, insulin stimulates

the sodium-potassium ATPases which help potassium get into cells, and so without insulin, more

potassium stays in the fluid outside cells.

Both of these mechanisms lead to increased potassium in the fluid outside of cells which

quickly makes it into the blood and causes hyperkalemia.

The potassium is then excreted, so over time, even though the blood potassium levels remain

high, overall stores of potassium in the body—which includes potassium inside cells—starts to

run low.

Patients will also have a high anion gap, which reflects a large difference in the unmeasured

negative and positive ions in the serum, largely due to this build up of ketoacids.

Diabetic ketoacidosis can happen even in people who’ve already been diagnosed with diabetes

and currently have some sort of insulin therapy.

In states of stress, like an infection, the body releases epinephrine, which in turn stimulates

the release of glucagon.

Too much glucagon can tip the delicate hormonal balance of glucagon and insulin in favor of

elevating blood sugars and can lead to a cascade of events we just described—increased glucose

in the blood, loss of glucose in the urine, loss of water, dehydration, and in parallel

a need for alternative energy, generation of ketone bodies, and ketoacidosis.

Interestingly, both ketone bodies break down into acetone and escape as a gas by getting

breathed out the lungs which gives a sweet fruity smell to a person’s breath.

In general though, that’s the only sweet thing about this illness, which also causes

nausea, vomiting, and if severe, mental status changes and acute cerebral edema.

Treatment of a DKA episode involves giving plenty of fluids, which helps with dehydration,

insulin which helps lower blood glucose levels, and replacement of electrolytes, like potassium;

all of which help to reverse the acidosis.

Now, let’s switch gears and talk about Type 2 diabetes, which is where the body makes

insulin, but the tissues don’t respond as well to it.

The exact reason why cells don’t “respond” isn’t fully understood, essentially the

body’s providing the normal amount of insulin, but the cells don’t move their glucose transporters

to their membrane in response, which remember is needed for glucose to get into the cell,

these cells therefore they have insulin resistance.

Some risk factors for insulin resistance are obesity, lack of exercise, and hypertension,

and the exact mechanisms are still being explored.

For example, an excess of adipose tissue—or fat—is thought to cause the release of free

fatty acids and so-called “adipokines”, which are signaling molecules that can cause

inflammation, which seems related to insulin resistance.

However, many people that are obese are not diabetic, so genetic factors probably play

a major role as well.

We see this when we look at twin studies as well, where having a twin with type 2 diabetes

increases the risk of developing type 2 diabetes, completely independent of other environmental

risk factors.

In Type 2 diabetes, since tissues don’t respond as well to normal levels of insulin,

the body ends up producing more insulin in order to get the same effect and move glucose

out of the blood.

They do this through beta cell hyperplasia, an increased number of beta cells, and beta

cell hypertrophy, where they actually grow in size, all in this attempt to pump out more

insulin.

This works for a while, and by keeping insulin levels higher than normal, blood glucose levels

can be kept normal, called normoglycemia.

Now, along with insulin, beta cells also secrete islet amyloid polypeptide, or amylin, so while

beta cells are cranking out insulin they also secrete an increased amount of amylin.

Over time, amylin builds up and aggregates in the islets.

This beta cell compensation, though, isn’t sustainable, and over time those maxed out

beta cells get exhausted, and they become dysfunctional, and undergo hypotrophy and

get smaller, as well as hypoplasia and die off.

As beta cells are lost and insulin levels decrease, glucose levels in the blood start

to increase, and patients develop hyperglycemia, which leads to similar clinical signs that

I mentioned before, like polyphagia, glycosuria, polyuria, and polydipsia.

But unlike type 1 diabetes, there is generally some circulating insulin in type 2 diabetes

from the beta cells that are trying to compensate for the insulin resistance.

This means that the insulin/glucagon balance is such that diabetic ketoacidosis doesn’t

usually develop.

Having said that, a complication called hyperosmolar hyperglycemic state (or HHS) is much more

common in type 2 diabetes than type 1 diabetes - and it causes increased plasma osmolarity

due to extreme dehydration and concentration of the blood.

To help understand this, remember that glucose is a polar molecule that cannot passively

diffuse across cell membranes, which means that it acts as a solute.

So when levels of glucose are super high in the blood (meaning it’s a hyperosmolar state),

water begins to leave the body’s cells and enter the blood vessels, leaving the cells

relatively dry and shriveled rather than plump and juicy.

Blood vessels that are full of water lead to increased urination and total body dehydration.

And this is a very serious situation because the dehydration of the body’s cells and

in particular the brain can cause a number of symptoms including mental status changes.

In HHS, you can sometimes see mild ketonemia and acidosis, but not to the extent that it’s

seen in DKA, and in DKA you can see some hyperosmolarity, so there is definitely overlap between these

two syndromes.

Besides type 1 and type 2 diabetes, there are also a couple other subtypes of diabetes

mellitus.

Gestational diabetes is when pregnant women have increased blood glucose which is particularly

during the third trimester.

Although ultimately unknown, the cause is thought to be related to pregnancy hormones

that interfere with insulin’s action on insulin receptors.

Also, sometimes people can develop drug-induced diabetes, which is where medications have

side effects that tend to increase blood glucose levels.

The mechanism for both of these is thought to be related to insulin resistance (like

type 2 diabetes), rather than an autoimmune destruction process (like in type 1 diabetes).

Diagnosing type 1 or type 2 diabetes is done by getting a sense for how much glucose is

floating around in the blood and has specific standards that the World Health Organization

uses.

Very commonly, a fasting glucose test is taken where the person doesn’t eat or drink (except

water, that’s okay) for 8 hours and has their blood tested for glucose levels.

Levels of 100 110 milligrams per deciliter to 125 milligrams per deciliter indicates

prediabetes and 126 milligrams per deciliter or higher indicates diabetes.

A non-fasting or random glucose test can be done at any time, with 200 milligrams per

deciliter or higher being a red flag for diabetes.

Another test is called an oral glucose tolerance test, where a person is given glucose, and

then a blood samples are taken at time intervals to figure out how well it’s being cleared

from the blood, the most important interval being 2 hours later.

Levels of 140 milligrams per deciliter to 199 milligrams per deciliter indicate prediabetes

and 200 or above indicates diabetes.

Another thing to know is that when blood glucose levels get high, the glucose can also stick

to proteins that are floating around in the blood or in cells.

So that brings us to another type of test that can be done which is the HbA1c test,

which tests for the proportion of hemoglobin in red blood cells that has glucose stuck

to it - called glycated hemoglobin.

HbA1c levels of 5.7% to 6.4% indicates prediabetes, and 6.5% or higher indicates diabetes.

This proportion of glycated hemoglobin doesn’t change day to day, so it gives a sense for

whether the blood glucose levels have been high over the past 2 to 3 months.

Finally, we have the C-peptide test, which tests for this byproduct of insulin production.

If the level of C-peptide is low or absent, it means the pancreas is no longer producing

enough insulin, and the glucose can’t enter the cells.

For type I diabetes, insulin is the only treatment option.

For type II diabetes, on the other hand, lifestyle changes, like weight loss and exercise, along

with a healthy diet and oral antidiabetic medications, like metformin and several other

classes, can sometimes be enough to reverse some of that insulin resistance and keep blood

sugar levels in check.

However, if oral antidiabetic medications fail, type II diabetes can also be treated

with insulin.

Something to bear in mind is that insulin treatment comes with a risk of hypoglycemia,

especially if insulin is taken without a meal.

Symptoms of hypoglycemia can be mild, like weakness, hunger, shaking, but they can progress

to loss of consciousness and seizures in severe cases.

In mild cases, drinking juices, or eating candy, or sugar, may be enough to bring blood

sugar up.

But in severe cases, intravenous glucose should be given as soon as possible.

The FDA has also recently approved intranasal glucagon as a treatment for severe hypoglycemia.

Ok, now, over time, high glucose levels can cause damage to tiny blood vessels, called

the microvasculature.

In arterioles, a process called hyaline arteriolosclerosis where the walls of arterioles where they develop

hyaline deposits, these deposits of proteins, and these make them hard and inflexible.

In capillaries, the basement membrane can thicken and make it hard for oxygen to easily

move from the capillary to the tissues, causing hypoxia.

One of the most significant effects is that diabetes increases the risk of medium and

large arterial wall damage and subsequent atherosclerosis, which can lead to heart attacks

and strokes, major causes of morbidity and mortality for patients with diabetes.

In the eyes, diabetes can lead to retinopathy and evidence of that can be seen on a fundoscopic

exam that shows cotton wool spots or flare hemorrhages - and can eventually cause blindness.

In the kidneys, the afferent and efferent arterioles, as well as the glomerulus itself

can get damaged which can lead to a nephrotic syndrome that slowly diminishes the kidney’s

ability to filter blood over time - and can ultimately lead to dialysis.

Diabetes can also affect the function of nerves, causing symptoms like a decrease in sensation

in the toes and fingers, sometimes called a stocking-glove distribution, as well as

causing the autonomic nervous system to malfunction, and that system controls a number of body

functions - everything from sweating to passing gas.

Finally, both the poor blood supply and nerve damage, can lead to ulcers (typically on the

feet) that don’t heal quickly and can get pretty severe, and need to be amputated.

These are some of the complications of uncontrolled diabetes, which is why it’s so important

to, diagnose and control diabetes through a healthy lifestyle, medications to reduce

insulin resistance and even insulin therapy if beta cells have been exhausted.

While type 1 diabetes can not be prevented, type 2 diabetes can.

In fact, many people with diabetes can control their blood sugar levels really effectively

and live a full and active life without any of

the complications.