The primary physiological disturbance associated with diabetes is the interference in blood sugar level regulation (Campbell & Drucker, 2013). Through insulin, sugar is maintained within the correct physiological ranges. In the event that he blood sugar falls below or rises above the normal glucose ranges, nutritional disorders that affect body systems and organs tend to develop. This phenomenon is referred to as diabetes complication (Campbell & Drucker, 2013). The resultant complications hamper normal biochemical processes and contribute to organ malfunction. The impeded normal physiology occurs in the kidney, heart, circulatory system, and the nervous system. Principally, the management of diabetes is based on the acquisition of an in-depth understanding of the pathology of this nutritional disorder.
Nathan et al. (2014) asserts that poor blood sugar control in the course of diabetes management deteriorates the normal functioning of the digestive system. A myriad gastric problems arise as a result of hyperglycemia. An example of resultant dysfunctions is acid reflux, also referred to as gastroesophageal reflux disease. The condition results in gastric acid refluxing to the esophagus . Normally, the stomach has concentrated gastric acid. When the acid is in excess, it tends to retreat to the esophagus . Clinically obesity has been found to be a contributor to such symptoms. Notably, hyperglycemia causes damage to the nerves that control gastric emptying, hence, hyperglycemia is debilitating and a significant contributor to acid reflux.
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Gastroparesis is a condition whereby there is an abnormality in the emptying of contents of the stomach to the subsequent gastrointestinal organ . The condition is characterized by pain in the chest, nausea, vomiting, and stomach upsets such as bloating. According to Nathan et al. (2014), gastroparesis has been observed in long-term diabetes patients, regardless of whether their blood sugar is well controlled or not. Nevertheless, the precise reason as to why these individuals have a sensitive stomach has not been empirically deduced.
Diabetes enteroneuropathy is a condition where gut nerves are damaged resulting in malfunctioning of the gastrointestinal tract. Most of its symptoms are similar to those of irritable bowel syndromes like constipation and diarrhea . In case of high blood sugar levels, glucose is deposited in the gut nerves and it act as a poison to the aforementioned nerves (Campbell & Drucker, 2013). In the event that the glucose level remains higher for a long time, the nerves eventually lose their normal functionality. Such an event is deleterious, and it can influence complications like kidney dysfunction or retinopathy.
Diabetes affects the normal functioning of the retina. A condition referred to as retinopathy. Retinopathy is amongst the most common complications resulting from diabetes. The retina is light sensitive and is responsible for sending images perceived through the eyes to the brain. Long-term diabetes causes damage to the retina by weakening the blood vessels supplying oxygenated blood to the organ (Forbes & Cooper, 2013) . The result is leakage of these blood vessels causing disturbances in vision. Using an ophthalmoscope, it has become possible to view and quantify the degree of damage as affected areas appears as dots referred to as ‘dot hemorrhage ’. Lipid will also be deposited at the retina as hard exudates. With time, new blood vessels are formed , though weaker than the damaged vessels. The new vessels break causing more bleeding into the eye and propagating the formation of scar tissue. In chronic conditions, the scar will push the retina away from its normal position, and such detachment may cause blindness. Retinopathy usually develops depending on the severity and duration of diabetes . For patients with type 1 diabetes, retinopathy may develop within 20 years while for type 2, it may come as early as 7 years after the diagnosis of diabetes.
The human body needs to maintain normal kidney function for the elimination of waste or excess products. Accumulation of wastes in the body is toxic and lead to physiological dysfunction, which in severe cases cause death. In the case of patients with diabetes, the kidney function is compromised; a condition referred to as diabetic kidney disease (nephropathy). In the United States alone, diabetes is the leading cause of end-stage kidney failure (ESRD). ESRD normally requires dialysis or a new kidney transplant. One major role of the kidney is to remove toxins (mostly metabolic waste products) from the blood. When such wastes accumulate they lead to symptoms like loss of weight, nausea, coma, loss of appetite and even death. Dialysis is a procedure that artificially removes toxins from the patient’s blood. It can be carried out using a dialysis machine at least thrice a week for four hours in each session.
Diabetic kidney complication can take up to 25 years to develop. Nephropathy, similar to retinopathy can develop even before a diagnosis of diabetes type 2 is made (Nathan et al. 2014). The first sign of kidney failure manifests as traces of the protein albumin in urine. Usually, no protein can pass through the nephrons, and such is an indicator of an anomaly in the glomerular filtration. This stage is referred to as microalbuminuria . Usually each subsequent year the amount of leaked albumin will increase. Finally, the ability of the kidney to clean blood is compromised hence deteriorating regular functionality leading to the development of kidney diseases (Drummen et al., 2018). Dialysis could also be required when the kidney function is below ten percent .
Nerves are a central part in the transmission of various impulses to the brain and effector organs. Without nerves, most physiological functions will be impaired. In the case of diabetes, patients may suffer neuropathy, which is damage to the nerves in various body parts (Petrovic et al., 2018). For example, the autonomous nervous system is responsible for the control of body functions that are under conscious control. Such functions include breathing, digestion and even sweating. Damage to nerves due to diabetes results to gastrointestinal upsets like nausea, vomiting, and constipation. Also, sweating bladder dysfunction leading to urine incontinence may occur alongside orthostatic hypotension, and erectile dysfunction. When innervations of the heart are also affected, the patient may suffer silent heart attacks or even death.
Petrovic et al. (2018) declare peripheral nerve damage as the most common form of diabetic nerve damage. It first begins with the feet, then subsequently spreads to the arms and hands. The condition is associated with tingling sensations, numbness, burning, and pain. Most of the symptoms are worse at night. For diabetic neuropathy, the constant pain is the most enfeebling stage of the disease. Powerful painkillers like opioid analgesics are ineffective to relieve the severity of the pain.
Look Ahead Research Group (2013) also realized that when diabetes advances, it interfere with large blood vessels. The result is macrovascular diseases which inhibit the normal functioning of blood vessels. For continuous blood supply to most organs, blood vessels must be kept open. Formation of plagues and deposition of fatty material to the walls of the arteries causes arteriosclerosis. Patients with diabetes are at a higher risk of developing the condition. Thus, increasing the probability of them suffering from cardiovascular diseases, which tends to be a leading cause of death for most mortalities associated with diabetics . In the context of atherosclerosis, there is damage to the lining of arteries. When the endothelial lining is damaged, cholesterol particles infiltrate the walls of the arteries resulting in inflammation (Forbes & Cooper, 2013) . The smooth muscles lining the arteries then proliferate accumulating more collagens which further narrows the artery.
Diabetes affects the skin . Skincare is thus an essential factor for individuals with diabetes. It even becomes harder to spot skin conditions when neuropathy sets in due to a reduction in sensitivity and blood flow. As a result, t he skin on the legs needs more attention. In most instances, patients who are diagnosed with diabetic neuropathy may develop a complication like a diabetic foot, which will only be recognized at an advanced stage (Campbell & Drucker, 2013). Diabetes patients are more prone to skin conditions due to high glucose levels that cause high loss of fluids leading to dry skin in most parts of the body. Skin is a primary line of natural defense for the body. Dry skin is more prone to cracks, and this will open up an entrance for germs that cause infections at the sites of the entrance . Skincare will be necessary since most related conditions may advance into severe levels. For instance, a diabetic foot may lead to amputation of the feet.
Research by Zheng et al. (2018) also found that diabetes causes erectile dysfunction in men since it can cause damage to the blood vessels supplying the penis together with the nerves that control penile erection. In normal physiology, when a man is aroused , nitric oxide is released. Nitric oxide is a vasodilator, and thus relaxes muscles and allows dilation of blood vessels in the penis. Resultantly, there will be an increased flow of blood into the penis resulting in an erection . Male patients with diabetes whose sugar levels keep on swinging due to poor control tend to be affected by erectile dysfunction. Since the blood sugar will be high, secretion of nitric oxide will be reduced . The result will be reduced blood flow into the penis and thus inability to erect. Generally, diabetics will have low levels of nitric oxide.
Efficacy of Diabetes Treatment Options
Better management of diabetes is dependent on proper control of sugar levels. Such a routine approach plays a critical role in the prevention and also staggering the onset or proliferation of complications associated with diabetes. While managing diabetes patients, it is essential that a patient-centered approach is implemented while choosing the correct pharmacological agent. According to Hampp et al. (2014), pharmacological management of diabetes is started when control of sugar has not been achieved or incase glycated hemoglobin levels go beyond 6.5% after over 3 months of lifestyle adjustment. Immediate initiation of pharmacotherapy helps in the prevention of microvascular complications like retinopathy, and patients should thus be encouraged to use the prescribed medication. In most instances, monotherapy is started together with an intensive lifestyle adjustment. There are different classes of antidiabetic medications. They include sulfonylureas, thiazolidinedione (TZD), dipeptidyl peptidase-4 inhibitors, biguanides, and sodium-glucose cotransporter inhibitors. Even though most of these classes of drugs may be used in patients despite their weights, other drugs may have more efficacy in patients with obesity compared to diabetics with a lean body.
The first line drug for the management of diabetes type 2 is metformin. It is classified as a biguanide. It is used in all age group of patients. The drug acts through activation of the liver adenosine monophosphate-activated protein resulting in active uptake of sugar while at the same time preventing gluconeogenesis (Hampp et al., 2014). Metformin has a good tolerance for most patients since it has mild side effects. Use of metformin has had results like the reduced progression of diabetes, lowered the risk of diabetes complications as well as reduced rates of mortality in patients (Hampp et al., 2014). The efficacy associated with the drug is attributed to its ability to reduce liver gluconeogenesis and increasing tissue sensitivity to insulin. Insulin sensitivity is also enhanced through activation of expression of insulin receptors and fostering of tyrosine kinase activity. Recent studies have also shown that metformin can lower lipid levels in the blood by peroxisome proliferator-activated receptor pathway. It is thus efficacious in the prevention of cardiovascular complications. The drug also causes weight loss in obese individuals, hence lowering the risk of diabetes.
Incretin mimetic are also effective oral hypoglycemic. A study by Campbell and Drucker (2013) found that incretin plays a significant role in the production of about 70% of the insulin after oral intake of glucose. Incretins also reduce the rate of gastric emptying and can facilitate weight loss. Due to these effects, these class of drugs has found use in the management of diabetes through targeting the incretin system. Incretin mimetic has two classes, GLP-1 receptor antagonist, for example, exenatide and liraglutide, and DPP-4 inhibitors, for example, sitagliptin, saxagliptin, and vildagliptin .
Glucosuria agents like SGLT2 inhibitors have also found use in the management of glucose. Such agents include canagliflozin and empagliflozin (Hampp et al., 2014). This category of drugs works by preventing reabsorption of sugar in the kidneys by means of blocking the SGLT2. The mechanism of action makes the drugs more effective in the management of advanced stages of type 2 diabetes mellitus when the beta cells of pancreases have been permanently lost . SGLT2 inhibitors provide a moderate weight loss and lowers blood pressure. However, urinal tract infections may result over long-term use of these drugs.
The mode of action for sulfonylurea is reduction of the concentration of blood glucose. Sulfonylurea block potassium ion channels in the pancreas hence increasing secretion of insulin. The drug can also prevent the process of gluconeogenesis. Though effective, sulfonylurea is prescribed as the second line in the management of type 2 diabetes. The sulfonylurea class of drugs encompasses glipizide, glimepiride, and glyburide.
Conclusion
Homeostasis is an essential mechanism that enables the body to main the correct internal environment. When the internal environment is within the physiological set-points, there will be optimal metabolic activities that sustain a healthy life. Contextually, homeostasis can be defined as a physiological process of the body through which metabolic process run in their right conditions.
A sustainable internal condition that permeates optimal biochemical activity is achieved through the use of feedback mechanisms like the negative or positive feedbacks. In case of a fault in feedback mechanisms, the normal physiology is hampered. In most cases, such condition lead to the onset of metabolic-associated conditions like diabetes. Control of sugar is one of the physiological feedback mechanism of the body. The regulation of serum sugar concentration is achieved through the insulin feedback loop. Insulin plays different roles that induce physiological changes in a bid to ensure that blood sugar levels lie within the normal physiological ranges. In the event that the sugar level is above the normal range, insulin facilitates the conversion of glucose to glycogen in the liver . A drop in sugar levels below the normal range prompts a cascade of insulin-induced reactions such as gluconeogenesis in the liver in a bid to restore the normal sugar concertation in blood plasma. Holistically, the essence of homeostasis in relation to diabetes is to maintain sugar within the required physiological levels. Contrary to this, like many other physiological aspects, complications and disorders may develop.
Principally, some diagnosable conditions may interfere with homeostasis, and inhibit the normal functioning of the body. Metabolic conditions like diabetes affect the ability of a body to control blood sugar levels. As noted earlier, insulin plays an important role in the control of sugar, but in diabetes, the physiological sugar control loop is interfered with. The body loses the ability to normally control sugar depending on the type of diabetes one has been diagnosed with and the severity of the disorder. There exists different types of diabetes namely, type 1, type 2, and gestational diabetes. Type 1 diabetes is insulin dependent; the body’s ability to produce insulin is impaired by conditions like autoimmune conditions of the pancreas. Patients will thus have to be administered with insulin to control the plasma sugar concentrations . Type 2 diabetes is insulin independent ( Javeed & Matveyenko, 2018). In the case of type 2 diabetes, the body can produce insulin, but there is poor sensitivity to insulin. Hence, tissues uptake of glucose is faulty resulting in hyperglycemia. Gestational diabetes develops mostly in expectant mothers.
Though different etiologies exist in the aforementioned types of diabetes, the disorders affect the body physiology since high glucose level in blood propagates a myriad of organ system malfunctions . A rise in blood sugar levels elevates the propensity of an individual to develop diabetes-associated complications. Diabetes affects the eye, digestive systems, nervous system, urinal system, and cardiovascular systems. Conditions associated with diabetes usually manifested due to the damage on blood vessels and innervations of most of the organs . Microvascular complications include retinopathy, where the retina is damaged and could result in blindness. Damage to blood vessels supplying oxygenated blood to the kidney can lead to kidney failure. Neuropathy of innervations of urinal bladder may result in urine incontinence. Macrovascular damage is mostly limited to cardiovascular diseases like atherosclerosis and hypertension.
The diabetes-related complications that develop could be fatal to the point of death. Hence, the need for sugar control is critical. Various hypoglycemic agents are thus used in controlling the serum glucose concentration as well as advising patients on the need to adjust their lifestyles. The choice of antidiabetic medications depends on the type of diabetes, stage of the disease, and the general state of the patient. Type 1 diabetes being insulin depend will prompt an induction of insulin for an effective outcome. For type 2 diabetes, oral hypoglycemic medications are preferred. It is noteworthy to mention that some medications like metformin may be preferred to other medications since they facilitate weight loss and reduce blood lipid levels.
References
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Zheng, H., G. Mayhan, W., & Patel, K. (2018). Erectile dysfunction in diabetes is due to selective defect in the brain. American Physiological Society . Retrieved from http://www.the-aps.org/mm/hp/Audiences/Public-Press/Archive/07/10.html.
