DIABETES
ComplicationsHeart disease and stroke
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In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.
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In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.
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Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
The risk for stroke is 2 to 4 times higher among people with diabetes.
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High blood pressure
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In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or equal to 140/90 mmHg or used prescription medications for hypertension.
Blindness
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Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.
In 2005-2008, 4.2 million (28.5%) people with diabetes aged 40 years or older had diabetic retinopathy, and of these, almost 0.7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss.
Kidney disease
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Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008.
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In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States.
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In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States.
Nervous system disease (Neuropathy)
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About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.
Amputation
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More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
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In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes.
Effect of insulin on glucose uptake and metabolism. Insulin binds to its receptor (1), which starts many protein activation cascades (2). These include translocation of Glut-4 transporter to the plasma membrane and influx of glucose (3), glycogen synthesis (4), glycolysis (5) and triglyceride (6).
The actions of insulin on the global human metabolism level include:
Control of cellular intake of certain substances, most prominently glucose in muscle and adipose tissue (about two-thirds of body cells)
Increase of DNA replication and protein synthesis via control of amino acid uptake
The actions of insulin (indirect and direct) on cells include:
Increased glycogen synthesis – insulin forces storage of glucose in liver (and muscle) cells in the form of glycogen; lowered levels of insulin cause liver cells to convert glycogen to glucose and excrete it into the blood. This is the clinical action of insulin, which is directly useful in reducing high blood glucose levels as in diabetes.
Increased lipid synthesis – insulin forces fat cells to take in blood lipids, which are converted to triglycerides; lack of insulin causes the reverse.[clarification needed (see talk)]
Increased esterification of fatty acids – forces adipose tissue to make fats (i.e., triglycerides) from fatty acid esters; lack of insulin causes the reverse.
Decreased proteolysis – decreasing the breakdown of protein
Decreased lipolysis – forces reduction in conversion of fat cell lipid stores into blood fatty acids; lack of insulin causes the reverse.
Decreased gluconeogenesis – decreases production of glucose from nonsugar substrates, primarily in the liver (the vast majority of endogenous insulin arriving at the liver never leaves the liver); lack of insulin causes glucose production from assorted substrates in the liver and elsewhere.
Decreased autophagy - decreased level of degradation of damaged organelles. Postprandial levels inhibit autophagy completely.[30]
Increased amino acid uptake – forces cells to absorb circulating amino acids; lack of insulin inhibits absorption.
Increased potassium uptake – forces cells to absorb serum potassium; lack of insulin inhibits absorption. Insulin's increase in cellular potassium uptake lowers potassium levels in blood. This possibly occurs via insulin-induced translocation of the Na+/K+-ATPase to the surface of skeletal muscle cells.[31][32]
Arterial muscle tone – forces arterial wall muscle to relax, increasing blood flow, especially in microarteries; lack of insulin reduces flow by allowing these muscles to contract.
Increase in the secretion of hydrochloric acid by parietal cells in the stomach
Decreased renal sodium excretion.[33]
Insulin also influences other body functions, such as vascular compliance and cognition. Once insulin enters the human brain, it enhances learning and memory and benefits verbal memory in particular.[34] Enhancing brain insulin signaling by means of intranasal insulin administration also enhances the acute thermoregulatory and glucoregulatory response to food intake, suggesting that central nervous insulin contributes to the control of whole-body energy homeostasis in humans
Modification of the activity of numerous enzymes.
