People with diabetes are also prone to developing diabetic nephropathy but not all of them develop this type of complication. Technically speaking, the kidneys are responsible for removing the waste products in the blood. These filtered waste products leave the body in the form of urine. When a person has a diabetes, it takes time for the kidneys to filter the blood because it has too much glucose. Hypertension- and hyperglycemia-induced changes in multiple pathways contribute to morphological changes in the glomerulus. Glomerulus is an active filtration system that filters impurities from the blood to form urine.
With diabetic nephropathy, early glomerular hemodynamic changes such as hyperfiltration and hypoperfusion result to microalbuminuria. Increased afferent arteriole dilation due to a dysfunction in basic constrictive autoregulatory response contributes to increase in glomerular pressure which is associated with greater mesangial cell matrix production. Expansion in the mesangial area and early morphological changes with diabetic nephropathy are caused by greater extracellular matrix deposition and mesangial cell hypertrophy.
This expansion is associated with decreased glomerular filtration rate and reduction in surface area of filtration which marks the beginning of renal failure. As this process continues, the glomerular basement membrane thickens and this may eventually lead to glomerular sclerosis. All of these changes in glomerular hemodynamics cause strain and injury on the kidneys, which if left untreated may result in renal failure (3FXAnimation). Hyperglycemia also causes damage to the nerves by altering its metabolism, resulting to a compromised ability of the body to conduct and receive impulses.
When a patient has diabetes, he/she experiences reduced sensation which results from affected sensory nerve whose function is to perceive pain, temperature and other sensations. The loss of sensation on the lower extremities predisposes the client to have wound which can lead to infection if left untreated. Normally, the body is able to fight the infection through the antibodies found in the blood. Because of the poor circulation associated with thick blood vessels found in diabetics, the blood has minimal capacity to reach the site of the wound.
It hampers wound healing causing ulceration, and if left undetected may lead to gangrene. If an infection turns into an ulcer that would not respond to treatment, the toe or foot – or a portion of it – may eventually need to be amputated. An infection can sometimes persist post-surgery, necessitating the removal of the leg from below the knee to try to halt the progression of infection (Jordan, 2006). Knowing that diabetes can lead to some serious complications, it is better if one should know the things that he/she should monitor in order to prevent these complications.
One should have vigilant monitoring of blood sugar. Scientific evidence shows that tightly controlling blood sugar levels can prevent the development and progression of small blood vessel (microvascular) disease and nerve disease (neuropathy) (Wendt, 2009). As discussed earlier, high blood sugar is the culprit to most of the diabetic complications. Monitoring blood glucose by the patient is extremely important to prevent consequences from unmonitored blood glucose. Low glucose level may lead to hypoglycemia.
Mild hypoglycemia can cause a person to feel uncomfortable and can interfere with his normal functioning. However, severe hypoglycemia can cause seizure, loss of consciousness, and coma (Kelly, 2006). Avoiding highs and lows in blood sugar will not only make the patient feel better, but will significantly reduce his/her risk of diabetes complications. Cholesterol levels should also be monitored. A test done to monitor the cholesterol level of a diabetic person is called fasting lipid profile.
It is a blood test that measures the total cholesterol, HDL and LDL cholesterol levels, and triglyceride levels in the bloodstream. It is also used to assess the risk for the development of coronary artery disease, one of the predisposing factors for heart attack (Kaufman, 2010). Knowing that cholesterol affects the blood vessels of the retina and the heart gives the health provider a clue that any significant increase in the level would necessitate immediate monitoring and intervention.
If cholesterol is controlled, the risk of developing complications is greatly reduced. Keeping track of blood pressure is important because people who have diabetes tend to have more trouble with high blood pressure than people who do not have the disease. Having both diabetes and high blood pressure can pack a damaging one-two punch as far as increasing the risk of heart disease, stroke, and eye, kidney and nerve complications (Manzella, 2006). Elevated blood pressure increases blood flow into the eye, accelerating diabetic retinopathy (Chous, 2006).
Knowing the early signs and symptoms are also key in preventing diabetic complications. However, diabetic retinopathy has no early signs and symptoms. Dilated eye examination must be done every year by an optometrist or ophthalmologist knowledgeable about and experienced with diabetes and diabetic eye disease (Chous, 2006) in order to know the extent of eye affectation. Both the patient and the health provider should also monitor some signs and symptoms to prevent blindness. Any concern with regard to the patient’s vision must be taken seriously.
Be aware if the patient complains of suspended dark spots that interferes with his/her vision. It may indicate blood leak to the vitreous humor, which can lead to blindness. Also, take into consideration the increasing difficulty in performing things that require focus such as reading and sewing. Amputations can also be prevented if the patient has vigilant foot care. Foot care is important since the patient has decreased sensation on the lower extremities. Preventive measures would include watching for signs and symptoms of impending ulceration.
The patient and the health provider should be aware of any swelling, thick hard skin or corns, and any blisters or breaks on the skin. Take good care of small cuts and abrasions immediately. When choosing shoes, make sure that they fit well and allow the toes to move freely. In conclusion, the key factor in preventing diabetic complications is vigilant glucose, cholesterol and blood pressure monitoring. Careful assessment of the feet as well as proper foot care prevents ulcerations which may lead to amputation.
Annual eye examination is encouraged for diabetics to prevent blindness. Diabetes is not a simple disease of metabolism. It is like a weed that when not treated seriously can cause severe complications. Take the disease seriously because it will not only take away your eyesight and limbs but also your life. References Chous, P. (2006) Avoiding Eye Complications. Retrieved from http://www. diabetesself management. com/articles/eyes-and-vision/avoiding_eye_complications/all/ Jordan, J. (2006) Diabetes and Amputation: Protecting Your Feet and Limbs.
Retrieved from http://www. puristat. com/diabetes/amputations. aspx Kaufman, F. (2010) Diabetes Diagnosis. Retrieved from http://www. dlife. com/diabetes/ information/type-1/diabetes-diagnosis/panel-blood-test. html Kelly, K. and Gilland, A. (2006) Be Aware of Hypoglycemia Unawareness. Retrieved from http://www. diabetesselfmanagement. com/Articles/Low-Blood Glucose/be_aware_ of_hypoglycemia_unawareness/ Manzella, D. (2006) Blood Pressure and Diagnosis: Keeping It Low Keeps You Healthy.
Retrieved from http://diabetes. about.com/od/preventingcomplications/a/ bloodpressure. htm Oguejiofo, N. (2010) Cholesterol, Diabetes and Triglycerides: Effects of High Blood Sugar Levels on Cholesterol and Triglycerides. Retrieved from http://diabetes- diagnosis. suite101. com/article. cfm/cholesterol-diabetes-and-triglycerides Schneck, M. J. (2008) Cardioembolic Stroke. Retrieved from http://emedicine. medscape. com/article/1160370-overview Wendt, C. (2009) How to Prevent Complications. Retrieved from http://www. health. com/health/condition-article/0,,20189256_1,00. html