End-Stage Diabetes - An Overview

Introduction:

End-stage diabetes is a serious condition. Diabetes mellitus (rise in blood sugar levels) is not one single disease. It is a group of metabolic diseases put together through some commonalities, such as the common problem being hyperglycemia (high blood glucose) due to either deficiency of insulin or reduced action of insulin.

Normally, in a healthy person, blood glucose level is maintained by insulin. The normal range of blood glucose levels in the body is fasting blood sugar levels, which should not exceed 100 mg/dL (milligram per deciliter). Once the person takes a glucose-rich meal, the blood glucose levels rise. After two hours of eating, a person's glucose level regulatory mechanism should be strong, and the postprandial blood glucose levels should be less than 140 mg/dL. Once the person starts taking the food, the blood glucose levels go very high, and the insulin hormone regulates blood glucose levels.

Ideally, the fasting state blood glucose level should be between 60 to 100 mg/dL. The maximum glucose level a person is allowed to have is 200 mg/dL. If the blood glucose level shoots above 200 mg/dL, it is dangerous, and if it goes beyond 200 mg/dL, the blood becomes toxic and can lead to severe damage to the kidneys.

What Is the Significance of Normal Blood Glucose Levels?

• Glucose is the main energy source for most of the organs in the body. The central nervous system, neurons, and brain need a constant supply of glucose to keep their metabolism active. This is because these organs and the central nervous system cannot use fatty acids as their energy source.

• Additionally, free fatty acids attached to albumin cannot cross the blood-brain barrier to supply energy to the brain. Thus, the central nervous system also uses another source of energy called ketone bodies for an energy source. Therefore, the body should maintain normal glucose levels for optimal function in the brain, eyes, and retina.

• The retinal epithelium also solely depends on glucose for its energy. Germinal epithelium, present in the genitals (testes and ovaries), also mainly depends on glucose for energy. Therefore, a normal supply of glucose is essential to them.

• Another significance of blood glucose levels is that it becomes toxic to health if it rises beyond the normal range. Too much blood glucose in the body causes all extracellular fluids to become hyperosmotic (higher concentration of solute inside the semipermeable membrane than the outside environment). Further, this rise in the blood glucose levels causes the hyperosmotic fluid extracellularly sucks the fluid from the cells.

What Is the Relationship Between Diabetes and Insulin?

Diabetes (diabetes mellitus) is of various types, such as type I, type II, and gestational diabetes. Type I (juvenile diabetes) is insulin-dependent diabetes, type II (adult onset diabetes) is noninsulin-dependent diabetes, and gestational mainly occurs due to pregnancy only. In diabetes mellitus, the beta cells of the pancreas are destroyed by the body’s immune system, whereas, in type 2 diabetes, the main problem is resistance to the action of insulin. Here, the beta cells of the pancreas produce normal insulin levels, but the body cells do not respond to the insulin and become insensitive to the action of insulin. So type 1 and type 2 diabetes are two extreme cases. In type 2 diabetes, the tissues do not respond to the insulin. However, the insulin is produced in sufficient amounts during the initial stages of type 1 diabetes.

What Are the Stages of Diabetes Mellitus?

• Stage 1: In this stage, there is insulin resistance, where the fat, muscle, and liver become resistant to insulin and have trouble bringing glucose into the cell. The pancreas produces more insulin and maintains blood sugar levels.

• Stage 2: This stage is also known as prediabetes, where the cells become insulin-resistant. The extra insulin produced is not sufficient to lower blood glucose levels. In some cases, the beta cells of the pancreas do not function properly. The blood glucose levels are higher than normal. In this stage, the blood glucose level is not too high to be classified as diabetes.

• Stage 3: In this stage, blood glucose levels are abnormally high, leading to type 2 diabetes. The beta cells of the pancreas also no longer produce insulin and become more resistant. These elevated levels cause long-term damage to the body.

• Stage 4: In this stage, the complications are due to very high blood glucose levels that cause damage to the vascular system. The potential complications of this disease are chronic kidney disease (CKD), heart failure, and peripheral neuropathy (it is due to damage to the nerves located outside the brain and spinal cord, causing weakness, numbness, and pain, usually in the hands and feet), stroke (interruption in the blood supply to the brain causing damage), and coronary artery disease (damage in the blood vessels of the heart).

What Is End-Stage Diabetes?

End-stage diabetes leads to end-stage diabetic complications or advanced complications, such as end-stage renal (kidney) disease, after many years of diabetes. The end-stage diabetes is a serious complication that occurs in people who have diabetes for a long time. The complications include kidney problems, heart disease, and nerve damage. Older adults are likely to experience end-stage diabetes due to difficulty in managing diabetes. Thus, end-stage diabetes is the final stage of diabetes that occurs after years of diabetes, with blood vessel damage, blindness, and end-stage renal disease.

The following diseases occur in end-stage diabetes:

• Atherosclerosis: It is a build-up of fat and plaque that accumulates in the blood vessels, and eventually, the blood vessel wall gets hardened and blocks the blood flow. When the blood vessels are blocked, it leads to a heart attack or stroke.

• Diabetic Nephropathy: High blood glucose levels damage the kidneys' filtering capacity. Therefore, in diabetes, the kidneys cannot properly remove waste, leading to kidney failure. Dialysis is a procedure that manually removes waste from the kidney.

• Diabetic Retinopathy: Due to high blood glucose levels, the blood vessels in the eye become swollen, which causes retinal detachment, vision loss, cataracts (clouding of the eye lens), and glaucoma (a group of diseases that cause blindness).

Can Type 2 Diabetes Be Reversed and Avoid Drugs With Lifestyle Changes?

Drugs and treatment help control diabetes. However, the chances of it recurring are high as it stays in remission only for some time without drugs. So, people must continue the treatment to ensure the condition is controlled. Blood glucose levels can easily rise if a proper diet is not followed. If they rise again, they may need to increase the dose of the drugs. An appropriate diet and exercise plan accompanied by lifestyle changes can help reverse the condition.

Low Glycemic Food Intake:

Food with a high glycemic index (GI) should be avoided. High glycemic foods increase blood glucose levels spontaneously. Foods with high glycemic indexes are processed foods high in sugars, carbohydrates, and animal fat. Carbohydrates are broken down quickly by the body. Carbohydrates cause a rapid spike in blood glucose and have a high glycemic index. The glycemic index is useful for type 2 diabetes. The glycemic index is a value that measures how much specific foods increase blood glucose levels. Foods are classified as low, medium, and high glycemic foods on a scale of zero to 100. Eating foods with low glycemic index helps control blood glucose.

However, other factors must also be considered because the number of carbohydrates significantly influences blood glucose levels after meals. It is very crucial to choose foods low in carbohydrates. Some high-GI foods are:

• Deserts.

• Sugary soft drinks.

• White bread.

• Potatoes.

• White rice.

• Chips.

• Pastries.

• Pasta.

• Honey.

• Yogurt.

• Juices.

A whole grain diet with low fat and calories can reverse type 2 diabetes. Incorporate low-calorie diets like:

• Whole grains like millet, barley, red rice, and brown rice.

• Healthy fats like fish and avocado.

• Vegetables.

• Lean meat.

• Fruits with complex carbohydrates like apples, cherries, grapes, blueberries, oranges, peaches, and plums.

How Do Physical Exercises Help Prevent Type 2 Diabetes?

A more active person has more sensitivity to insulin. The potential benefits of exercise are:

• Helps maintain a healthy weight.

• Aids to lose weight.

• Proper sleep.

• Helps control LDL (bad cholesterol) and raises HDL (good cholesterol).

Some examples of physical activity are:

• Aerobic Dance: It combines dance and aerobic exercises.

• Team Sports: Recreational sports like basketball, soccer, tennis, and softball.

• Swimming: Water aerobics and aqua jogging help improve circulation and reduce the joints' stress.

• Cycling: Diabetic neuropathy damages the nerves that cause joint pain in people with type 2 diabetes. Cycling helps meet fitness goals and minimizes joint strain.

• Walking: Walking helps lower blood pressure, body mass index, and HbA1c.

• Exercising With Resistance Bands: Exercising with resistance bands provides many benefits to control blood sugar.

• Pilates: It is a popular fitness program that improves core strength and high glucose condition.

• Yoga: Yoga helps manage cholesterol, weight, and blood sugar.

How Can Quitting Smoking Reverse Type 2 Diabetes?

The nicotine present in tobacco desensitizes insulin receptors to insulin. The chemicals in the cigarette harm the body and cause inflammation, rendering the cells unable to respond to insulin. Smokers have high belly fat, which increases the risk of type 2 diabetes.

Nicotine replacement products can be used to replace nicotine. These include gums and lozenges. The following changes can be seen immediately after quitting smoking:

• The heart rate and blood pressure go down.

• The carbon monoxide in the blood drops to normal.

• The circulation and lung functions improve.

Conclusion:

Diabetes is a condition characterized by high blood glucose levels. Various other means of controlling the condition are available, including conventional medications. A balanced diet, exercise, and lifestyle modifications can control elevated blood sugar. Therefore, before starting any new treatment, one should consult a diabetologist or general physician, who can help develop the best plan to address an individual's needs.