Complications and symptoms of diabetes

Diabetes affects people more than twenty years and older. Long-term health complications of poorly controlled diabetes are heart diseases, stroke, kidney failure, retinopathy, and neuropathies. These complications can result in death and disability at a young age.

Insulin – dependent type of diabetes has an acute onset, onset at a young age, rapid weight loss, and ketonuria. Conversely, factors that favor non-insulin-dependent diabetes are the absence of symptoms, onset at an older age that is over 30 years, and the presence of obesity.

The significant signs and symptoms of diabetes are thirst, frequent urination, excess hunger, severe weight loss, and extreme fatigue. Patients with these symptoms or coma associated with glycosuria need a fasting hyperglycemia diagnosis. In addition, an oral glucose tolerance test may be required if the fasting blood glucose value is not in the normal range.

Indications of diabetes are diabetic symptoms along with plasma glucose of above 200 mg/dl. In addition, the blood glucose level of more than 126 mg/dl in the empty stomach and more than 200 mg/dl in 2 hours after 75g glucose load also indicate diabetes.

Impaired glucose tolerance due to decreased glucose response and decreased insulin secretion occurring after the meals cause postprandial hyperglycemia. Conversely, high blood glucose levels due to raised hepatic glucose production or reduced glucose uptake in the tissues lead to decreasing insulin secretion.

Impaired insulin secretion occurs before the onset of diabetes, and its progression involves glucose toxicity and lipotoxicity. A decrease in pancreatic beta cells may occur if impaired insulin secretion is not treated. Impaired pancreatic beta-cell function affects the long-term control of blood glucose.

Insulin resistance: It is when insulin does not have enough action equal to the blood glucose concentration. Impaired insulin action in the liver and muscles is the pathological feature of type 2 diabetes.

1) Insulin resistance progresses and develops before the onset of diabetes.

2) It is related to genetic factors and other factors like free fatty acids, inflammatory mechanisms, and hyperglycemia.

3) Genetic factors are the polymorphisms of the insulin receptor, insulin receptor substrate one gene, beta-adrenergic receptor genes, and uncoupling gene.

4) Inflammatory mediators and glucolipotoxicity also contribute to the mechanisms of impaired insulin secretion and insulin signaling.

Types of insulin preparation: Rapid-acting insulin analog has modified amino acid sequence, which changes the time-activity properties of insulin. The insulin analog Lispro reaches the blood by fifteen minutes after injection. The level reaches maximum peaks within thirty to ninety minutes after reaching the blood and lasts for four to five hours.

1) Short-acting or regular insulin reaches the blood in thirty minutes after injection. It goes maximum within two to four hours later and lasts for about four to eight hours.

2) Intermediate-acting insulin takes two to six hours to reach the blood. It peaks within four to fourteen hours and stays for fourteen to twenty hours.

3) Long-acting insulin takes six to fourteen hours to begin action, and it has no peak or minimal peak. It lasts for about twenty to twenty-four hours in the blood.

Insulin therapy
Insulin sensitivity is the correction factor that controls the extra insulin needed for high blood glucose. Lower insulin sensitivity increases the insulin amount or dose for correcting the blood glucose. Pre-meal insulin dose depends on the carbohydrate ratio and insulin sensitivity. The insulin carbohydrate ratio is the number of carbohydrates in grams per unit of insulin.

1) Insulin treatment at the beginning has no correct formulae for the initial dose. Usually, the preference is a minimum dose of intermediate-acting insulin in 8 to 12 units before breakfast.

2) Another type of initial therapy includes short-acting and intermediate-acting insulins combined in minimum doses.

3) To get glycemic control, multiple short-acting insulins before eating food and intermediate-acting insulin before sleep at night are essential.

4) Insulin administration is subcutaneous using single-use syringes with needles, insulin pumps or using multiple-use insulin pens with needles.

5) Insulin vials need a 4 degree to 80-degree celcius. Insulin administration storage temperature is usually done twenty to third minutes before breakfast.

6) Parts suitable for insulin injections are the lower abdomen, upper outer arms, upper outer thighs, and gluteal regions.

7) Emergency cases of diabetic ketoacidosis may need intravenous or intramuscular insulin injections.

Side effects of insulin: Hypoglycemia is a significant side effect that needs adjustments in small amounts of insulin. Allergy usually occurs with older insulin, beef insulin, and porcine insulin. Edema can occur due to the salt retaining properties of insulin, and it needs adjustments in the salt intake or diuretic doses. Localized fat loss can occur with older insulin usage, and localized increases in fat can occur with any insulin.