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IMAGE 1 Diabetes ComplicationsDiabetes mellitus is a non-communicable disease characterized by prolonged high blood sugar concentrations or hyperglycemia. This could be due to problems in: (1) insulin production - the hormone that is needed for the body to be able to use sugars for energy or (2) insulin resistance - where the body is less responsive to insulin even at high levels due to prolonged high blood sugar. Other risk factors include genetic and environmental factors, family history of diabetes, older age, physical inactivity, prior history of gestational diabetes, prediabetes, hypertension, or dyslipidemia (high LDL or Cholesterol), race and ethnicity.

During the early prediabetes phase, insulin resistance happens within the muscle, liver, and fat cells. The pancreas compensates by producing more insulin to keep the blood sugar levels normal. However, when prolonged, the pancreas starts to get damaged and fails in producing enough insulin and blood sugar continues to increase - leading to Diabetes. When left untreated or if a Diabetic person does not consistently drink his or her antidiabetic medications - high blood sugars start to stick to red blood cells which is measured by the HBa1c test. Continuously high blood sugars will also start to trigger the development of the following complications:

1. Dyslipidemia (High LDL or Cholesterol)

High blood LDL or Cholesterol levels is one of the common comorbidities for individuals with Diabetes. This excess cholesterol may deposit in large and small arteries which may contribute to the development of hypertension and increased risk for stroke and blood clots. Thus, it is also important to control your blood cholesterol through a diet rich in healthy fats from fish, nuts, and seeds and to regularly take your cholesterol lowering medications until you reach the healthy range.

2. Hypertension

Hypertension may develop when there are deposits along the blood vessel walls from high blood cholesterol levels or when there is too much sodium from the diet. Thus, having a low sodium diet or eating salty foods such as processed meats and salted snacks may help reduce blood pressure. Also, taking your antihypertensive medications regularly may help prevent long term complications of hypertension.

3. Diabetic Kidney Disease

When the kidneys are exposed to chronic high blood pressure and elevated blood sugar, it gets damaged over time and may lead to abnormalities excreting excess body fluids, electrolytes, and toxins. This can be seen as elevated creatinine levels and abnormal electrolyte levels. When left untreated, this may lead to kidney failure then dialysis. Thus, controlling your blood pressure and blood sugar may help prevent or delay this progression.

4. Retinopathy which may lead to blindness

Retinopathy is a damage to the small vessels of the eyes which may lead to blindness. This is a late complication of Diabetes which happens after 10 or more years of poor blood sugar control or inconsistent diet and medication intake.

5. Neuropathy or disease of the nerves leading to decreased sensation

Neuropathy manifests with tingling sensations or decreased sensations of the fingers and feet due to damage of the small nerves due to uncontrolled high blood pressure and blood sugar. This can also be a side effect of some antidiabetic medications such as Metformin but can be reversed through Vitamin B complex supplementation.

6. Diabetic foot or wounds that do not heal which may lead to gangrene or eventually leg amputation

Due to reduced sensation of the hands and feet, Diabetic individuals are prone to getting wounds in the feet without knowing because of reduced pain sensation. Poor blood flow to those areas also increases the chances of infection and gangrene or decay. When left untreated, this may lead to irreversible gangrene of the foot or leg which may lead to amputation.

Since Diabetes is a chronic non-communicable and lifestyle related disease, its symptoms, and complications creep in slowly or undetected until they become severe to treat. Early diagnosis, lifestyle change and compliance to maintenance antidiabetic medications can help prevent or delay these complications - thus letting you stay productive and healthy throughout your adult years. Regularly consult your doctor for blood sugar monitoring so your medications can be adjusted and consult a Registered Nutritionist-Dietitian for a personalized nutrition program that works for you!

/AET

References:

• Jameson, J. L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (2018). Harrison's principles of internal medicine, 20th ed. United States of America: McGraw-Hill Education.

• Jamorabo-Ruiz, A., Serraon-Claudio, V., Exevea-de Castro, E. (2011). Medical Nutrition Therapy for Filipinos, 6th ed. Manila: Merriam Webster Bookstore.

• Raymond, J. L., & Morrow, K. (2020). Krause and Mahan’s Food and the Nutrition Care Process E-Book. Elsevier Health Sciences.

• Nelms, L., Sucher, K.P., Lacey, K. (2016). Nutrition Therapy and Pathophysiology, 3rd ed. United States of America: Cengage Learning.

• Gropper, S.S., Smith, J.L., Carr, T.P. (2021). Advanced nutrition and human metabolism, 8th ed. Cengage Learning.