Renal Microvascular Complications Of Type 2 Diabetes Essay

Diabetes is a disease where the body is unable to produce or use insulin effectively. Insulin is needed for proper storage and use of carbohydrates. Without it, blood sugar levels can become too high or too low, resulting in a diabetic emergency. It affects about 7.8% of the population. The incidence of diabetes is known to increase with age. It’s the leading cause of end-stage renal disease in the US, and is the primary cause of blindness and foot and leg amputation. It is known to cause neuropathy in up to 70% of diabetic patients. Individuals with diabetes are twice as likely to develop cardiovascular disease. There are two types of diabetes: Type 1 and Type 2.

Type 2 Diabetes is a disease that is found in a variety of age groups around the world. This disease is growing at a rapid rate and it is impacting the health of this generation and future generations to come. Diabetes is a disease that impairs the body’s ability to produce or respond to the insulin hormone produced by the pancreas. The insulin allows for the glucose to be effectively used as energy throughout the body. Diabetes causes carbohydrates to be abnormally digested, which can raise blood glucose levels. This means that the glucose is not being taken up by the cells that need it. The cells cannot take up the excess glucose that has accumulated in the blood, so it is excreted through the urine. This can lead to problems with the kidneys, central nervous system, heart, and eyes because high blood glucose can damage the blood vessels of these organs. This diseased is managed by adopting a diet low in fat and high in fiber, increasing physical activity, losing excess weight, and not smoking. If this

Superoxide dismutase (SOD) is a free radical scavenging enzyme that catalyses the dismutation of highly reactive superoxide anion O2 to molecular (O2) and to the less reactive species hydrogen peroxide. It has been proposed that poor glycemic control in diabetes is associated with depletion of antioxidant enzymes including SOD.

This particular research was driven by the demand of the regulatory guidelines that deals with reduction of risks. The cases of cardiovascular risks among patients are have been reported to increase in the recent days. The regulatory guidance require being presented for the cardiovascular outcomes that can be used in the therapies of type 2 diabetes treatment. However, the

Diabetes Mellitus (DM) or Type 2 Diabetes is seen as a metabolic disease that is categorized by abnormally high blood glucose or hyperglycemia. Diabetes Mellitus is also formerly known as noninsulin-dependent diabetes mellitus and is the most common form of diabetes that is seen. Insulin is a hormone that is supplied to the body that allows us to efficiently use glucose as fuel. When carbohydrates are broken down into sugars in the stomach glucose enters the blood circulation simulating the pancreas to release insulin in an appropriate amount to become used for energy. With diabetes mellitus the body does not properly make use of the insulin supplied for the body. This causes the pancreas to produced an extra amount if insulin which the body cannot keep up with, causing an imbalance to the blood glucose levels (American Diabetes Association, 2015). In the united states diabetes affects almost 29.1 million people, while the another 86 million people have pre-diabetes but do not know. It is also known as the 7th leading cause of death in the country in the recent years (MedicineNet.com, 2016). For a patient suffering from a chronic form of diabetes mellitus understanding how these mechanisms lead to the condition can be used as preventative measures. Potential consequences as well as the causes and clinical manifestations will ensure a better knowledge on the issue to monitor the condition.

This article goes in detail about the complications of Type 2 Diabetes, on how hyperglycemia damages the vascular system leading to microvascular disease and macrovascular disease. The complications of microvascular disease are diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. On the other hand, with macrovascular disease includes Cardio Vascular Disease (CVD), such as Atherosclerosis. Furthermore, the article gives recommendations of treating Type 2 Diabetes and the prevention of its health related complications with medication, screening, diet, and exercise.

According to the CDC, type 2 diabetes is responsible for 95% of all diabetic cases in the US. Although it is the most common, it is also the least understood as far as cause or how it 's inherited. The pathophysiology behind it is, unlike people with type 1 diabetes, the bodies of people with type 2 diabetes are able to make insulin. But either their pancreas does not make enough insulin or the body cannot use the insulin well enough. When there isn 't enough insulin or the insulin is not used properly, glucose can 't get into the body 's cells. When glucose builds up in the blood instead of going into cells, the body 's cells are not able to function as they should. Though signs and symptoms sometimes differ from patient to patient, common problems associated with the buildup of glucose in the blood include hypertension, dyslipidemia, inflammation, hypercoagulation, and endothelial- cell dysfunction. Some of the life threatening disorders include, but are not limited to the following:

Diabetes is associated with an increased risk of developing primarily vascular complications that contribute to morbidity and mortality of diabetic patients. Poor glycaemic control leads to vascular complications that affect large (macrovascular), small (microvascular) vessels or both. Macrovascular complications include coronary heart disease, peripheral vascular disease and stroke. Microvascular complications contribute to diabetic neuropathy (nerve damage), nephropathy (kidney disease) and retinopathy (eye disease).

Patients with type 2 diabetes are at risk of macrovascular and microvascular complications. Evidence has shown that an improvement in blood glucose control, as shown by a reduction in HbA1c levels, is associated with a reduction in microvascular complications (2,3,4).

According to Dugan (2009), “patients with stress hyperglycemia are at higher risk of adverse consequences than are those with pre-existing diabetes” (p. 1798). Acute glucose fluctuations induce more ischemic injury, inflammation, cellular apoptosis, endothelial dysfunction, and oxidative stress responses (Dugan, 2009, p. 1802). One

Diabetes mellitus, commonly referred to as diabetes, is caused by a lack of absolute or relative insulin, in which there is a defect in insulin secretion and/or its action. The hormone insulin is produced by the pancreas and is responsible for regulating blood glucose levels. The pancreas normalizes elevations in blood glucose by lowering its levels by releasing insulin (1). In diabetic persons, the inadequate production of and/or reaction to insulin results in manifestations of hyperglycemia, other metabolic derangements, and long-term damage to blood vessels, eyes, nerves, kidneys, and the heart (2). Consequently, diabetes is a leading cause of cardiac death, nonfatal myocardial infarction, heart failure, and stroke (3). These conditions experienced by diabetic persons are the result of damage to small vessels, as diabetes increases conditions of hardening and narrowing within the arteries.

Diabetic nephropathy (DN) is one of the leading causes of chronic kidney diseases worldwide and most of the affected patients have T2DM. A considerable number of patients newly diagnosed with T2DM may already have developed nephropathy due to a preceding period of undiagnosed diabetes and impaired glucose tolerance [11]. According to the classification of American Diabetes Association, DN is divided into three stages, incipient nephropathy (micro-albuminuria), clinical diabetic nephropathy (macro-albuminuria) and ESRD. To diagnose those DN patients in its early stage can effectively prevent or delay the progression to ESRD [12]. Renal biopsy is a useful way to diagnose DN but is an invasive method so we are in need to simple, accurate and non-invasive test for early diagnosis and/or monitoring DN progression [13]. Several mechanisms, including hyperglycemia, advanced glycation end products (AGEs), oxidative stress, and inflammation are the main contributors to DN pathogenesis through activation of nuclear factor κB (NF-κB) signaling which is the key regulator of inflammation and apoptosis [14].

Kidney disease and diabetes tend to go hand in hand as the kidneys of diabetics slowly thicken and become progressively scarred over time. The nephrons, which are the basic functional and structural units of the kidneys, become leaky and allow albumin, a protein made by the liver, to pass freely into the urine. The damage to the kidney may be ongoing for many years before a patient becomes symptomatic and loses the ability to filter the blood, control the fluid balance of the body and remove waste products.

Evidence implicates the role of oxidative stress in different stages of the development of diabetes mellitus, starting from the pre-diabetes state, impaired glucose tolerance, postprandial hyperglycemia, mild diabetes and finally to overt diabetes mellitus. Besides β -cell dysfunction, insulin resistance is a major characteristic feature of type 2 diabetes mellitus in which oxidative stress plays an important role (Erejuwa, 2012).

One of the diseases is diabetes mellitus which is a major cause of renal failure. This disease can be defined as an increase of fasting blood glucose that is affected by a deficiency in insulin hormone. The normal range for glucose (fasting) in the blood is 2.8-6.0 mmol/L. It is classified into two groups, type 1 (insulin-dependent diabetes mellitus) and type 2 (non insulin-dependent diabetes mellitus). Stein (2008, p.6) points out that kidney failure happens most often when patients have suffered from diabetes mellitus for more than 10 years. According to United States Renal Data System (USRDS) report in 2007, approximately 44% of primary causes of renal failure is diabetes mellitus in the United States in 2005. Also, Stein (2008) indicates that 15% of dialysis patients are influenced by diabetes mellitus in the United Kingdom. Diabetes mellitus has negative affects throughout the kidneys where the increase of the range of blood sugar causes the damages to the cells in the kidneys. This leads to the presence of the glucose in the urine which is known as glycosuric.