Overview

What is diabetes?

Diabetes is a chronic condition with no known cure, but there are ways of managing this condition.

Diabetes affects how your body uses insulin, either because your pancreas doesn't produce enough insulin or because your body doesn't use insulin effectively. When you eat, the food is broken down into a sugar known as glucose. Glucose circulates around your bloodstream. After eating, your body sends signals to the pancreas to release insulin. This insulin allows glucose in your bloodstream to enter your cells, lowering your blood sugar levels

 Glucose is then used by your cells for energy and their continued survival. When your pancreas doesn’t produce enough insulin (in the case of type 1 diabetes) or your cells do not respond to the insulin your pancreas produces (in the case of type 2 diabetes) too much glucose circulates in your bloodstream. In time, this can cause serious health problems that affect your different organ systems.¹

How does diabetes affect your organ systems?

Cardiovascular system

The impact on blood vessels

Diabetes can cause high levels of glucose to circulate in your blood, leading to elevated blood sugar levels. These high blood sugar levels can damage your blood vessels.

Increased risk of heart disease

If you have diabetes you are twice as likely to develop high blood pressure (hypertension) than someone who does not have diabetes. In addition, if you have hypertension and diabetes, you are four times as likely to develop heart disease compared to an individual who does not suffer from either diabetes or hypertension. This raises the question: what is meant by heart disease? 

Heart disease is a term that encapsulates several conditions and problems that affect your heart. The most common type of heart disease is coronary artery disease. It affects the coronary arteries, which supply your heart with nutrient- and oxygen-rich blood. In coronary artery disease, your arteries become narrowed by plaques of cholesterol, meaning that less blood flows to your heart. Having less blood flowing to your heart can potentially result in a heart attack.

Kidneys

Development of diabetic nephropathy

If you suffer from either type 1 or type 2 diabetes you are at risk of developing diabetic nephropathy, which is a serious condition affecting t how your kidneys work. In diabetic nephropathy the blood vessels in your kidneys become damaged due to diabetes. This damage extends to the glomerulus (a filtering unit in your kidney consisting of small blood vessels known as capillaries) and the tubules of your kidney, which in turn affects how your kidneys filter out waste products and excess fluid in your body.

Between 30-40% of individuals with diabetes go on to develop diabetic nephropathy, with the exact cause being speculated as possibly insulin resistance, hyperglycaemia and genetics, but not known. Diabetic nephropathy has a high mortality rate and can sadly result in complications such as irreversible kidney damage and heart disease. There is no known cure for this condition, but this condition can be prevented by properly managing your blood sugar levels.²

Eyes

Diabetic retinopathy can develop in those with type 1, type 2 or gestational diabetes.

Damage to blood vessels in the retina

High blood sugar can damage the retina (the light-sensitive tissue at the back of your eye that detects light in your environment). As a result of damage to the blood vessels in your retina, it can make it harder for blood to flow through these blood vessels, and the blood may leak out of these vessels.

Risk of vision impairment and blindness

As damage to the blood vessels in your retina continues, new blood vessels will begin to form. This may be perceived as being positive, however, these blood vessels are much more fragile and start to bleed into the vitreous. This bleeding can result in small red spots in your vision. However, if the bleeding is more severe you may lose your sight.

Nervous system

Nerve damage leading to neuropathy

If you have diabetes, high blood sugar levels, and high levels of fats, known as triglycerides, can cause nerve damage.

What is diabetic neuropathy?

The nerve damage caused by either type 1 or type 2 diabetes can progress and result in diabetic neuropathy, which over time affects at least 50% of those who have diabetes. In diabetic neuropathy, you begin to lose your body’s sensory function, and this typically begins in the lower extremities of your body, such as your feet and legs.

This condition has been shown to elicit pain and numbness. However, there is hope of halting the progression of this disease by controlling your blood sugar levels if you suffer from type 1 diabetes. Whereas, controlling your blood sugar levels in type 2 diabetes has a much less significant impact in halting the progression of diabetic neuropathy.³

Feet and extremities

What are peripheral vascular diseases?

Peripheral vascular diseases encompasses conditions such as peripheral artery disease (PAD) and venous disease. Peripheral vascular diseases are a leading cause of limb loss, however, early diagnosis and managing risk factors help to ensure the best outcomes for your health are achieved.⁴

PAD is a manifestation of atherosclerosis in the arteries in your legs. Atherosclerosis is when cholesterol-containing plaques build up in your arteries, narrowing the lumen, meaning that less blood can flow through the arteries in your legs to your lower extremities, such as your feet.⁵ Unfortunately, the lack of blood flow to your lower extremities can result in your tissues dying and amputation being needed, with 51-93% of all lower limb amputations being attributed to PAD.⁷

How is peripheral vascular disease related to diabetes?

Peripheral vascular disease has different risk factors including having coronary artery disease, smoking, living a sedentary lifestyle, and diabetes.⁴ Diabetes can accelerate atherosclerosis of the arteries - atherosclerosis is where your arteries narrow and become hardened with atherosclerotic plaques, resulting in PAD.

Digestive system

What is gastroparesis?

Gastroparesis is a condition that affects your digestive system, and how food moves through your digestive tract. Typically, muscles in your digestive tract contract to push food through your digestive system. However in gastroparesis these muscle contractions may slow down, or the muscles may not work at all.

How is gastroparesis related to diabetes?

Similar to when neuropathy was discussed in this article, high blood sugar in diabetes can also damage nerves, slowing down or even stopping the muscles in your digestive system. This affects how quickly your body can absorb nutrients from your food and can result in malnutrition.

Skin

How does diabetes cause your skin to become more susceptible to infections?

Diabetes can affect many different organ systems, which has been discussed previously, and the largest organ in your body: your skin, is no exception. Your skin contains blood vessels and nerves, making it vulnerable to the effects of high blood sugar. If you have diabetes, you are more prone to bacterial infections, particularly those caused by staphylococcus bacteria. This is due to the bacteria that have infected your skin thriving when there is too much sugar in your body. In addition, you may be more susceptible to fungal infections due to high sugar levels within your body.

Delayed wound healing due to diabetes

Delayed wound healing can occur in those with diabetes, as higher blood sugar can result in the hardening of your arteries, meaning that it is harder for oxygen and nutrient rich blood to flow to the wound site to facilitate healing. In addition, blood vessel changes (due to diabetes) can result in less leukocytes migrating to the wound site. Leukocytes are cells that have a key immune role in combating any invading pathogens (micro-organisms that cause infection), thus preventing infection at a wound site.^7,8

Overall impact and management

Importance of early detection and control

Early detection allows medications to be prescribed to both lower blood sugar and blood pressure, which helps decrease the risk of complications.

Lifestyle modifications and treatment strategies

Physical activity and exercise has been demonstrated to be an effective method in preventing the development of type 2 diabetes. In addition, changing your diet to a Mediterranean diet has been shown to be effective in reducing the incidence of type 2 diabetes. f you are categorised as being overweight or obese, weight loss can be beneficial in preventing the development of type 2 diabetes later on in life.⁹

Collaboration with healthcare professionals

Collaboration with a team of health care professionals can be key to managing your diabetes, by liaising with pharmacists, nurses, dieticians and diabetes educators to formulate which form of diabetes care is most beneficial to your health.¹⁰

Summary

• Diabetes occurs if your pancreas does not make enough insulin or your body cell’s become insensitive to insulin
• Insulin allows blood glucose (sugar) to enter your cells and be used for your cell’s continued survival
• High blood sugar in uncontrolled diabetes can damage your blood vessels and increase your risk of developing heart disease
• High blood sugar can also affect the renal system (your kidneys)resulting in diabetic nephropathy
• Diabetes can affect the arteries in your legs in peripheral artery disease, potentially resulting in amputation
• Diabetes can affect your eyes, resulting in blindness if not treated, and your nervous system resulting in diabetic neuropathy
• Diabetes can result in gastrointestinal conditions, and make your skin more susceptible to infection from bacteria and fungi