DIABETES MELLITUS: NATURAL HISTORY, FACTORS AND COMPLICATIONS - MEDICINE - 2025

The diabetes mellitus is the name for a number of metabolic disorders with high levels of blood sugar, which can have various causes. But, all of them include defects in the production or use of insulin. Depending on these factors, it can be type 1 or type 2.

There may be a defect in insulin production, due to the destruction or non-functioning of pancreatic beta cells. In the absence of insulin, the body cannot stimulate the use of glucose by the muscle, or suppress the hepatic production of glucose when there are already high levels in the bloodstream.

Various methods to measure and control insulin

In these cases, diabetes mellitus is called type 1.

Instead, pancreatic beta cells may be undamaged. Therefore, insulin production continues. If the blood glucose is still high, it means that there is a resistance to the action of that insulin.

So, it is a type 2 diabetes mellitus.

Prepatogenic period of diabetes mellitus

In the prepatogenic period of any pathology, it is important to clearly define the agent, the host and the environment that favor the onset of the disease. However, in this particular pathology, the three concepts are closely related.

Agent

The agent, in the case of diabetes, are the risk factors that predispose the host to suffer from the disease. In turn, these are defined by the environment in which the host develops.

In this way, the agent is insulin and its lack of action, either due to a deficit in its production or due to resistance to its action.

Guest

The host is the human being who has certain risk factors that can predispose the appearance of the disease.

Ambient

As for the environment, it influences the type of risk factors to which the host is exposed. Urbanism and industrialization, as well as daily stress, condition sedentary habits, malnutrition (diets rich in carbohydrates, low in proteins), smoking, among others.

Risk factor's

Family members with the disease

Having first-degree relatives who have presented the disease (genetic component) is a risk factor. An age greater than 45 years is also. However, in case of a deficit in insulin production, the pathology usually occurs in children or adolescents.

Sedentary lifestyle and obesity

As a risk factor, sedentary lifestyle and obesity with a muscle mass index greater than 27 are closely linked. In addition, nutritional habits affect and predispose the host to suffer from insulin resistance.

Hormonal and metabolic diseases add to the list. Among them, polycystic ovary syndrome and metabolic syndrome. Even pregnancy is potentially diabetic.

Primary prevention

Primary prevention is aimed at avoiding the establishment of the pathology.

It is important to recognize the population at risk and take immediate action. This includes education on the causes and consequences of diabetes mellitus.

Primary prevention against this pathology should be based on nutritional counseling, exercise routines, and education on smoking and diabetes drugs.

Pathogenic period

In the pathogenic period of diabetes, several defects come together that will ultimately determine the hyperglycemic pictures.

The first trigger is the destruction of the pancreatic cell, or its malfunction, by genetic factors or by infiltrates of immune cells in the body.

Initially, insulin resistance develops in two ways. The first is called peripheral. This is produced in skeletal muscle, reducing glucose uptake and metabolism. That is, the muscle resists the action of insulin.

The second, called central resistance, occurs in the liver, increasing glucose production. It ignores the insulin signal to stop production.

Feedback resistance stimulates the production of insulin in the pancreatic beta cells, but the amount becomes insufficient to counteract the resistance. Therefore, hyperglycemia is established.

Some literatures refer that this insufficiency is not a failure in itself, but a relative failure, since insulin is being secreted at corresponding levels. However, the body resists its action.

Normally, the evolution of diabetes is subclinical. This does not mean that it is not already established and is in the pathogenic period of the disease.

The four Ps

By the time it becomes clinical, the signs and symptoms are known as "the four Ps":

1. Polydipsia
2. Polyuria
3. Polyphagia
4. Weightloss

They are not the only symptoms, but they are the most noticeable. Itching, asthenia, eye irritation and muscle cramps are also attached.

If at this point in the pathology a timely diagnosis and treatment and a change in lifestyle are not established, it advances to the next stage of the pathogenic period. There are complications.

Secondary prevention

As for secondary prevention, it is based on the early diagnosis of the pathology. Also called screening. It is performed in population groups considered at high risk of suffering from the disease.

Tertiary prevention

Once diabetes mellitus has been diagnosed, prompt treatment together with taking general measures to avoid chronic hyperglycemic states are the fundamental pillar on which tertiary prevention is based.

Its objective is to prevent the complications of the pathology. Treatment must be adequate and timely, reducing the risks of complications and increasing the life expectancy of the patient.

Complications

Diabetic cetoacidosis

If the pathology evolves and the levels of hyperglycemia are not controlled, then there is a severe lack of control in the metabolism of lipids, carbohydrates and proteins.

The characteristic of this clinical picture is the alteration of the state of consciousness, even without reaching a coma, with blood glucose levels above 250 mg / dL.

Approximately 10-15% of diabetic ketoacidosis culminate in a hyperosmolar coma, with hyperglycemic levels above 600 mg / dL.

Hypoglycemia

At this point, the complication occurs from not treating it properly.

Diets that are excessively low in carbohydrates, excessive exercise to lower blood glucose levels, the use of insulin or oral hypoglycemic agents without adequate measure or control can lead to excessively low blood glucose.

This entity is even more dangerous than very high concentrations of glucose in the blood, since neurons need glucose as food for their proper functioning. In addition, the altered state of consciousness is much more noticeable.

Diabetic foot

It occurs as a consequence of peripheral arterial disease. This, in turn, is produced by plaques deposited in the arteries due to insulin resistance, an increase in the concentration of fats in the blood and an increase in blood pressure. Then, the occlusion of these arteries occurs.

Consequently, there is insufficient oxygen delivery through the affected arteries. When there is any injury, it heals very difficult, frequently generating an ulcer. If it is not cared for properly, it will culminate in necrosis that can spread to the entire limb.

Retinopathies

For the same reason as peripheral arterial disease, there is a deficit in the blood supply of the retina, which is the light-sensitive tissue. This causes him great damage,

Neuropathies

In the setting of lack of oxygenation secondary to peripheral arterial disease, there is peripheral nerve damage. This causes a tingling sensation, pain, and sometimes paraesthesia of the limbs, particularly the lower limbs.

Nephropathies

Lack of oxygenation of the afferent arteries of the kidneys causes kidney damage, mostly irreversible. Hyperglycemia functions as a hypertensive, secondarily affecting glomerular filtration.

Disability

If each of the complications evolves, it can generate a different type of disability. In the case of ketoacidosis, hyperosmolar state or hypoglycemia, the neurological complications could be irreversible, causing disability.

A poorly treated diabetic foot could lead to the amputation of some toes for support, or the foot as a whole. This causes mobility impairment and limitations in some physical activities.

Retinopathy can lead to blindness. And kidney disease can result in kidney failure that makes the patient dependent on dialysis.

Death

Mainly hypoglycemia, hyperosmolar coma and nephropathy have a high probability of culminating in death.

The main cause of death from diabetes mellitus is the complication of vascular disease, which can lead to an acute myocardial infarction.

References

1. Leonid Poretsky. Principles of Diabetes Mellitus. Editorial Springer. 2nd Edition. 2010. Recovered from books.google.pt
2. Powers, AC (2016). "Chapter 417: Diabetes Mellitus: Diagnosis, Classification, and Pathophysiology". In Kasper, Dennis; Fauci, Anthony; Hauser, Stephen; Longo, Dan; Jameson, J. Larry; Loscalzo, Joseph. Harrison. Principles of Internal Medicine, 19e (19th edition). McGRAW-hill Interamericana Editores, SA
3. Diagnosis and classification of Diabetes Mellitus. American Diabetes Association. (2010). US National Library of Medicine. National Institutes of health. Recovered from ncbi.nlm.nih.gov.
4. World Health Organization, Department of Noncommunicable Disease Surveillance. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: WHO 1999. Recovered from apps.who.int.
5. Mellitus diabetes. World Health Organization. Recovered from: who.int.