Molecular Cell Biology of Diabetes Complications

Molecular Cell Biology of Diabetes Complications

Diabetes causes a progressive disorder in the hormone insulin leading to a deficit in its secretion and action (Brownlee 813). Where insulin action is inhibited, then the uptake of glucose into the body cells from the blood is also hindered, resulting in a high blood sugar level, a condition referred to as hyperglycemia (Brownlee 813). Hyperglycemia over a long period might lead to two major blood vessel diseases, which are commonly referred to as microvascular complications and macrovascular complications of diabetes (Brownlee 813).

According to the 2020 National Diabetes Statistics Report released by the Centers for Disease Control and Prevention (12) in the United States, diabetes continues to be one of the leading causes of death. According to the report, it also causes other related terminal diseases such as heart disease, and it is also associated with stroke (12). The disease seems to have taken root into the American population, with a rough estimate of about 10% of the population affected (2). Sad to say that the report estimates an increase in adults close to 7 million adults of 18years and above who were categorized as undiagnosed diabetes, which is close to 27% of the adults in the United States population (2). Adult diagnosis is reported to increase with age, being most prevalent from 65 years and above (2).

This paper focuses on the microvascular and macrovascular complications of diabetes and attempts to shed more light on these complications.

Microvascular and Macrovascular complications

These complications are characterized by the thickening of the basement membrane of the endothelial vascular cells (Fowler 116). The thickening is associated with hyperglycemia, as the higher the sugar levels remain high for a prolonged time, the higher chances for one to develop these complications (Fowler 116).

When hyperglycemia affects smaller blood vessels, it causes microvascular complications of diabetes. Microvascular complications result into three main conditions discussed below;

Nephropathy

Diabetes nephropathy is mainly associated with the thickening of the capillary basement membrane resulting in increased permeability (Lim 363). The increased permeability affects the filtration process at the kidney glomerular. Filtration ought to be based on molecular size, where small molecules like water and amino acids can pass through the filtrate but can be reabsorbed. However, with an increased permeability larger molecule may pass thorough, hence explaining the traces of albumin into the glomerular filtrate (363). This is a condition known as glomerular hyperfiltration, where even albumin, which is a plasma protein, can start to leak out into the glomerular filtrate. Proteins are physically too big; therefore, they ought not to be filtered out, but where traces of albumin are evident in the urine, it should be a diagnosis for nephropathy (362).

The thickening of the basement membranes of the capillaries also leads to their hardening, a condition known as glomerulosclerosis, which leads to kidney failure. Blood flow at the kidney is affected in such a way that the aphrodite arterial brings in blood. Still, the blood is not able sufficiently to go round the glomerular to the efferent arteriole. This results in low blood supply leading to ischemia of the rest of the blood tubular (363). The remedy to nephropathy is to try and reduce to blood sugar levels that lead to hyperglycemia, which affects the basement membrane of capillaries (366).

Retinopathy

The retina is the light-sensitive of the eye. Diabetes retinopathy tends to affect the normal functioning of this are and might render the affected person blind. Due to hyperglycemia resulting in the basement membranes of the capillaries thickening and becoming more permeable, plasma fluids tend to leak to the retina, forming exudates around the regions of the retina (Wong 417). These exudates, if left u attended to result in damaging the light-sensitive cells of the retina (417). The thickening of the basement membranes can also cause the formation of an ischemic region on the retina. As the thickening continues, it reduces the muscle relax and contractions of the capillaries that regulate blood flow to tissues, resulting in ischemic and, therefore, retinal hypoxia (418).

The retina develops temporal blood vessels to try and supply blood to the hypoxia; however, due to their weak nature, the blood vessels rapture to leak blood into the retina. The leaking of blood gives retinal hemorrhage that kills the cells of affected areas, which might lead to blindness (418). To best combat diabetes retinopathy, one should consider control measures to prevent hyperglycemia, the derail the start and progress (419).

Neuropathy

Diabetes neuropathy is majorly characterized by subclinical traits that seem to affect the peripheral nervous system (Paulo 46). It is most manifested in the mechanism of metabolic microvascular hypoxia (47). This is where the nerve tissues are not in a position to get oxygen as a result of diabetic complications. The nerve tissues are living tissues, and so it follows that they need oxygen to survive. However, with a raised blood sugar level, the uveric nerves arteries that carry oxygen to the nerve, become impaired to function correctly. Their walls exhibit proteins, and the structures are bound in a process called glycosylation that causes thickening (49). It is this thickening that reduces the diffusion of oxygen across the walls to the nerve tissue, causing hypoxia and, ultimately, nerve damage that might cause death (49). Like the other two microvascular complications, the best remedy would be to work around reducing the blood sugar level to avoid neuropathy.

Where hyperglycemia affects larger blood vessels, it causes macrovascular complications of diabetes. The two main macrovascular complications of diabetes are;

Myocardial infarction

Diabetes affects one’s heart by attacking their blood vessels and nerve system that regulate the heart (Centers for Disease Control and Prevention). The heart has three main functions that include pump blood and to do it on rhythm, and it needs oxygen. Diabetes works against all these three, by causing a blockage on the coronary blood vessels (Centers for Disease Control and Prevention). This blockage has two main effects on the heart, one; if it is not entirely blocked, then it leads to high blood pressure, which might result in the rapture of the arteries or, secondly, a complete blockage may lead to stroke (Centers for Disease Control and Prevention). All these are as a result of hyperglycemia. Therefore the best recommendation for prevention is to say on a proper diet that has less sugar, and processed foods are also advised against (Centers for Disease Control and Prevention).

Cardiovascular disease

Where one has damaged blood vessels due to high blood glucose with time, they develop heart disease. This might take place in this form, where the heart is not able to get oxygen due to the blockage in the arteries and where the diabetic patient can make energy using glucose (Rahman et al. 75). The heart tends to shift to alternative sources of energy, which are the fatty acids to be able to continue with its functions. However, due to this not being its common source of energy, the fatty acids produce more than the needed energy, thus damaging the heart and leading to its failure (Rahman et al. 74).

Other Molecular Cell complications caused by diabetes

The other prominent but not well comprehended diabetic complication is the skin complication, normally referred to as diabetic dermopathy. This is evident by a distinguishing excessive skin pigmentation situated on the anterior surface of the lower part of the legs of the person with diabetes (Emanuel 988). According to Binkley (625), diabetic dermopathy is a skin complication caused by diabetes originating from complications with the thickening of capillary walls. The thickening reduces blood flow, a condition known as microangiopathy, which results in complications affecting the skin (Emanuel 988). Diabetic dermopathy is said to affect close to 55% of the diabetic cases; however some highly contested reports have it that even those who do not have diabetes might exhibit some of its traits. These reports indicate that lesion on the skin could be as a result of some interference with the flow of blood to the skin (Emanuel 988).

So, studies haven’t given any specific traits relating to diabetic dermopathy. However, some of the inherent characteristics associated with it include different kinds of pigmentations of the basal cells, medial intimal thickening of blood vessels, leaking of erythrocytes, among others (Emanuel 988).

Diabetes at severe levels has also been associated with Limp amputation. For instance, Due to macrovascular disease through the process of atherosclerosis, the blood supply can be reduced to the feet (Bowling, F. L. et al. 607). Coupled with other microvascular disease complications such as sensory neuropathy, some particular tissues can suffer from ischemia (607). So, where a patient puts on their shoe, as a result of pressure, they might develop a callus. Mounting pressure between the callus and the bone might lead to capillaries being clogged, cutting off blood supply, and the area becomes necrotic overtime. Now due to the patient suffering from sensory neuropathy, they may not have this looked into, and it might lead to bacterial infection (607). The best remedy would be to cut off the callus to treat the infection. Nonetheless, if detected late after the infection has reached the bone causing osteomyelitis, then managing might be a challenge hence resolving to amputation (607).

Conclusion

Ideally, it is worth noting that most, if not all, of the complications discussed in this paper, trace back to hyperglycemia. High blood sugar levels seem to affect the normal functioning of the body cells significantly, but most affected are the blood vessels. It is, therefore, imperative for those living with diabetes to work closely with the health practitioners at their disposal to help them manage their blood sugar to avoid such complications. In addition to this, which is of similar importance, is that those not yet with diabetes should also be on the lookout to avert specific diets that might lead to the disease. It is true that the disease has consumed lives around the globe and keeps on doing so, with governments investing a lot into the health care systems to try and manage the disease. Nonetheless, more should also be channeled towards civic education about the condition to allow the public to have good knowledge about the disease.

Investments in the area of research should also be facilitated, one in the field of genetically modified and processed foods and their relation to diabetes. This will help the different agricultural sectors to operate with the parameters of well-researched data on what inputs are likely to have high chances of giving diabetic-related outputs.