Under normal conditions, the pancreas, a vital organ—releases insulin, a hormone that regulates blood sugar levels. Insulin is produced by beta cells in the pancreas. In type 1 diabetes mellitus, these beta cells are damaged or destroyed, and insulin production ceases, leading to uncontrolled blood sugar. In contrast, type 2 diabetes mellitus occurs when the body becomes resistant to insulin. Although insulin is still produced, the body’s cells do not respond effectively, causing persistent hyperglycemia. Due to this insulin resistance, the liver continues to produce glucose, erroneously interpreting the situation as a state of low insulin.
Failure to manage blood sugar levels in diabetes can lead to both acute and chronic complications affecting multiple organs, including the eyes, heart, kidneys, nervous system, gastrointestinal tract, and more.
Acute Complications
The two main acute complications of uncontrolled diabetes are diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS).
Diabetic ketoacidosis primarily occurs in individuals with type 1 diabetes. It typically arises when blood glucose exceeds 250 mg/dL but remains below 600 mg/dL. Common symptoms include nausea, vomiting, frequent urination, extreme thirst, shortness of breath, lethargy, and in severe cases, coma.
Hyperglycemic hyperosmolar state, on the other hand, is more common in type 2 diabetes and presents with extremely high blood glucose levels, usually over 600 mg/dL. Symptoms include decreased oral intake, excessive urination, rapid heartbeat, dehydration, low blood pressure, confusion, and coma.
Prompt medical attention and regular blood glucose monitoring are essential to prevent these life-threatening conditions.
Chronic Complications
1. Eye Damage (Diabetic Retinopathy):
Chronic hyperglycemia can damage the retina and the blood vessels in the eyes, leading to diabetic retinopathy. Diabetes is the leading cause of blindness in adults aged 20–74 in the United States. Once retinal damage occurs, it is irreversible. Early detection through regular eye screenings is key to prevention and slowing disease progression.
2. Kidney Damage (Diabetic Nephropathy):
Diabetes is the leading cause of chronic kidney disease and end-stage renal disease requiring dialysis or transplantation. High blood glucose levels damage the kidney’s blood vessels and basement membranes, impairing their ability to filter waste. Protein loss in urine (especially albumin) and increased blood pressure are common consequences. Blood sugar and blood pressure control are essential to prevent diabetic nephropathy.
3. Nerve Damage (Diabetic Neuropathy):
Uncontrolled diabetes can lead to peripheral neuropathy, particularly in the feet and legs. Symptoms include numbness, tingling, burning pain, and sensory loss—often worsening at night. As the condition progresses, patients may lose protective sensation, increasing the risk of ulcers and infections that can lead to amputation.
4. Gastrointestinal and Genitourinary Dysfunction:
Poor glucose control may affect the autonomic nervous system, leading to gastrointestinal issues such as gastroparesis (delayed stomach emptying), presenting with nausea, vomiting, bloating, early satiety, and constipation or diarrhea. It can also cause cystopathy, resulting in difficulty sensing bladder fullness and incomplete urination. Sexual dysfunction is also common, including erectile dysfunction in men and reduced libido, vaginal dryness, or painful intercourse in women.
5. Cardiovascular Disease:
Diabetes significantly increases the risk of cardiovascular diseases such as coronary artery disease, myocardial infarction (heart attack), and heart failure. Notably, diabetic patients may not experience the classic chest pain of heart attacks, making diagnosis more challenging. Cardiovascular mortality is notably higher in individuals with diabetes.
Conclusion
Diabetes mellitus is a chronic condition that requires diligent blood sugar management. Poor glucose control can lead to irreversible complications including blindness, kidney failure, nerve damage, cardiovascular disease, and even limb amputation. Prevention and early detection are the best strategies to reduce the burden of diabetes-related complications. Regular medical checkups, blood glucose monitoring, and adherence to prescribed treatments are essential for a healthier, complication-free life with diabetes.
