Diabetic Vascular Disease state caused by the deficiency of a chemical in the body called insulin which is a hormone is called Diabetes. There are two forms of diabetes. In the type-one diabetes no insulin is formed and people require insulin injections for existence. This was once thought it would affect only children, but now it can occur at any age. The type2 diabetes is due to the resistance of the body towards the effects of insulin. This also includes insulin which is insufficient. But in this type there is some amount of insulin produced. In both the types the blood glucose levels is increased. When compared to people without diabetes, people with diabetes are prone to certain problems. These problems occur in the nerves (neuropathy), kidney (nephropathy) and eye (retinopathy). These people are prone to early heart attacks and stroked due to the hardening of the arteries (arteriosclerosis). With proper care and attention all these problems can be avoided. ("Diabetes Basics-About Diabetics")
Diabetic retinopathy, diabetic nephropathy are some of the vascular diabetic diseases. ("Diabetes & Vascular Disease Research"). Complications of diabetes mellitus (DM) at the later stage are the main causes for the adult blindness and end-stage renal disease in the western world, and a major source to cardiovascular, cerebrovascular and peripheral vascular disease. Several theories have been proposed to elucidate the mechanism involved in the etiology of the development of acute complications of DM and it is vague. In the recent years, interests have grown extremely in the role of genetic factors inclining individuals to the vascular complications of DM. There has been proof that haptoglobin phenotype may serve as an analyst for the relative risk of diabetes-related vascular disorders. ("Haptoglobin: A major susceptibility gene for diabetic vascular complications")
Patho-physiology of Diabetes:
Diabetes is an acute metabolic complaint which occurs due to the lack of, or unsuccessful use of the hormone insulin, the body cannot metabolize carbohydrates, fats and proteins. Diabetes is divided into three types, but they all share the indications of hyper glycemia (high blood pressure). Type I: was before called insulin dependent diabetes mellitus, IDDM, or juvenile onset diabetes. It causes genetic predisposition; environmental exposure as a result of virus, toxin, stress; autoimmune reaction which occurs because beta cells which produce insulin in the pancreas are being destroyed. Explicit symptoms occur when 80 to 90% of the beta cells are destroyed. Characteristics usually occur before 30 years of age, but it can also occur at any age; sudden onset of signs and symptoms of hyperglycemia which include increased thirst and hunger, repeated urination, loss of weight and tiredness. Treatment is made in the form of injection by insulin with the help of syringes or pumps. A proper diet, education, necessary exercise, and monitoring is also required as part of the treatment.
Type 2 was previously known as non-insulin dependent diabetes mellitus, NIDDM, or adult-onset diabetes. It causes insulin resistance which means the inability to make use of insulin which the body makes because of the cell-receptor defect. As a result glucose is unable to be engrossed into cells for fuel. There could also be decreased insulin secretion whereby pancreas does not secrete the necessary insulin which should be secreted in reaction to glucose levels. There could also be surplus production of glucose from the liver. ("Pathophysiology of Diabetes"). In this type 2, characteristics usually occur after a person attains 30 years of age. But nowadays it is now occurring frequently in children and young people. There could also be found increased occurrence of the disease in some ethnic groups. African-Americans, Hispanic/Latino, Native Americans, Asian-Americans and Pacific Islanders are some of the ethnic groups who are prone to this disease. Other characteristics include genetic tendencies usually in the form of obesity, numbness of hands and feet, blurred vision, symptoms of hyperglycemia, delay in healing and yeast infection which keeps occurring.
Gestational diabetes mellitus (GDM) on the other hand causes resistance to insulin as a result of pregnancy, tendencies to have genetic traits and diseases. ("Pathophysiology of Diabetes"). Treatment is by means of diet control, performing exercises, taking hypoglycemic or antiperglycemic agents orally, and taking sensitizers of insulin or taking insulin itself. Other forms of treatment include by means of education and monitoring diet. Diet should provide sufficient calories without hyperglycemia or ketonemia. Again exercise should not cause fetal distress or hypertensions. Blood glucose should be continuously monitored and test for ketones should be conducted as presence of ketones would show starvation. ("Pathophysiology of Diabetes").
The Diabetic Foot and Peripheral vascular disease:
An open wound or sore on the foot of a person having diabetes is called diabetic foot ulcer. It is not usually painful, due to loss of pain sensation. A person with diabetes would have reduced circulation in the legs and also in the feet. Because of this slow circulation damages caused to the feet would have a slow process of healing. If the damage is untreated it can develop into a diabetic foot ulcer. The open wound can become infectious and also produce swelling. The blood sugar levels would also be at a higher rate. Proper foot care should be taken by wearing of shoes which would fir one correctly. If it is not treated properly, it may lead to amputation of the leg or even to death. In the U.S., people having diabetes have accounted for 50% of non-traumatic amputations. These amputations are usually below the knee. Diabetic foot ulcers are not contagious. (Diabetic foot ulcer)
In diabetic patients amputation is 40 times more common in persons above 65 years of age when compared to non-diabetic persons. In diabetes, due to neuropathy and arteriopathy, the feet are greatly prone to ulceration. This is due to glycaemic control, smoking, dyslipidaemis and hypertension. In places like Leicester, where the diabetic foot service is frequent, the rate of amputation is 1.42 cases per 1000 diabetic patients annually. In UK the rate is 10.1 per 1000 diabetic patients annually. In Asian patients it is four times lower when compared to the white Caucasian people. It is necessary that an early identification of the risk of the foot and yearly screening of the foot, awareness of the patient and care in hospitals is being provided. ("The Diabetic Foot and Peripheral vascular disease") Regular exercises can also prove to be effective. ("Exercise Helps Control Diabetic Vascular Disease")
Diabetic Eye Diseases:
Many people suffer eye complication from diabetes, including severe loss of vision. Many will probably do so in spite of all we know about prevention and effective treatment. The prevalence of serious visual impairment is expected to rise dramatically. Hopefully, cures for diseases like diabetes are just around the bend. Some familiarity with low vision services might best be viewed as an insurance policy and this information is nice to have. ("Diabetic Eye Disease: Low Vision Basics")
Vascular Disease markers in Diabetes:
In type1 diabetes inflammatory activity is increased and would get predisposed to vascular disease. The origin of this is very unclear. Thus the inflammation in type1 diabetes was investigated. A case study was done on 543 European people having type 1 diabetes (278 men) diagnosed at 36 years of age, from the EURODIAB Prospective Complications Study. The measures of inflammation were connected with sex, BMI, HDL cholesterol, glycemic control, duration of diabetes, advanced glycation end product pentosidine, and systolic blood pressure along with the general inflammatory markers. ("Vascular risk factors and markers of endothelial function as determinants of inflammatory markers in type 1 diabetes: the EURODIAB Prospective Complications Study Pathophysiology/Complications")
Atherothrombosis is held now as an inflammatory disease which is chronic. The plasma markers of inflammation, which includes interleukin-6 (IL-6) and C - reactive protein (CRP), are connected with having vascular disease in non-diabetic persons. In persons having type2 diabetes, inflammatory activity is being expanded. It is connected with the risk of atherothrombosis. Inflammatory activity is also increased in individuals with type 1 diabetes. This elevation of inflammatory markers is due to hyperglycemia and due to the formation of glycation end products which are advanced. ("Vascular risk factors and markers of endothelial function as determinants of inflammatory markers in type 1 diabetes: the EURODIAB Prospective Complications Study Pathophysiology/Complications")
Monitoring and interventions person having diabetes should follow proper guidelines relating to foot care and should check their levels of blood sugar continuously. The health care provider does the foot inspection and checks diabetes as well as high blood pressure of high cholesterol. ("Diabetic foot ulcer") For many companies, the diabetes checking and therapeutics to control the disease and its complications continues to be an appealing market. The factors which influence diabetes markets which include demographics relating to population and the policies of healthcare policy makers and clinicians can change for every country. ("Diabetes in France")
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