Diabetes and Hypertension

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Diabetes and Hypertension both are linked with each other. Both hypertension and Diabetes are metabolic disorders and correlated with each other. Diabetes damage the blood vessels and arteries resulting in increase in atherosclerosis which leads to hypertension, renal disorders and cardiovascular diseases. Hypertension is usually caused in elderly population but off late it is seen in mid 40’s population in India.

hypertension&diabetes_deadly_combination

Common Factors causing both Hypertension and Diabetes:

  • Obesity
  • Stress
  • Bad lifestyle
  • Increased cholesterol
  • Hypothyroidism
  • Improper Diet: Junk food, sweets
  • Smoking
  • Alcoholism

All these are some common factors which one needs to work upon. Type 1 Diabetes occurs in younger age and adolescence. But it can also occur in later age. In type 1 diabetes, immune system hampers the pancreas which produces insulin.

Type 2 Diabetes occurs in later age of life and so does hypertension. Usually there is accidental detection of Diabetes and hypertension by the physician. When a middle aged patient complains of severe headache and goes to the physician where he  actually finds out with the physician.

Epidemiology:

In the US population, hypertension occurs in approximately 35% of patients with type 1 diabetes and in 40% to 90% of patients with type 2 diabetes. A cohort study in the United States revealed that type 2 diabetes mellitus was almost 3 times likely to develop in population with hypertension as in subjects with normal blood pressure.

According to the AHA, blood vessels in the brain are more susceptible to damage due to high blood pressure. This makes it a major risk factor for dementia and stroke.

Gestational Diabetes usually occurs in pregnancy where the blood pressure rises. A lady who manages to maintain her blood sugar levels maintains her blood pressure.

White-coat hypertension is defined as increased office blood pressure (≥140/90 mmHg) usually at doctor’s clinic and normal home blood pressure (<135/85 mmHg).

Role of hyperglycemia:

The biochemical changes of diabetes of both microvascular and macrovascular complications is well established. Hyperglycemia-induced abnormalities in the hexosamine, polyol and protein kinase C pathways have revealed to cause tissue damage in diabetes. In addition to this, hyperglycemia helps the formation of toxic advanced glycated end products and induces glomerular hyperfiltration, growth factor expression, and free radical damage from reactive oxygen genre.

The pathophysiologic link between hyperglycemia and hypertension includes direct effects of glucose, activation of protein kinase C, activation of athero-inflammatory cytokines, endothelial dysfunction from oxidative stress, and epigenetic changes and others. The imposing factor of hypertension on diabetes further aggravates microvascular and macrovascular complications through additive mechanisms that include artery and capillary damage in renal, retinal, cerebral, coronary and peripheral vascular territories.

Management of Diabetes and Hypertension:

  • Diet: Avoid junk food, smoking, alcohol, limit salt intake, sweets, fried, and potatoes. Use plate diet method. Have fruits instead of juices.
  • Improve your lifestyle.
  • Exercising regularly keeps you fit to prevent obesity.
  • Monitor regularly your blood pressure and blood sugar levels to keep a check.
  • Keep yourself well hydrated.

Treatment and Medication:

Most of the diabetologist use ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers). Even though other medicines treat high blood pressure, these medicines also prevent or slow kidney disease in patients with diabetes.

Metformin and it’s combination are used to control Diabetes. Insulin injections are used usually in uncontrolled Diabetes and type 1 Diabetes.

Hence both Diabetes with superimposed hypertension raises an alarming signal if not well treated.

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Diabetes and Aloplecia

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Diabetes and Aloplecia are usually linked but very rarely discussed. Nearly 45% of the Indian population faces Aloplecia areata due to Diabetes and other causes.

There are various causes of Aloplecia as follows:

  • Diabetes Mellitus especially type 1.
  • Hypothyroidism
  • Stress
  • Hormonal imbalance
  • Iron deficiency anaemia
  • Hereditary

alopeciaanddiabetes

image credits: yalemedicine,org

Diabetes:

Usually Type 1 Diabetes leads to significant hair loss. When blood sugar levels in your body are uncontrolled, it results in significant changes and damage to the blood vessels. This results in poor oxygen supply to smaller blood vessels leading to damage to the hair follicles. Usually, in normal hair growth cycle, due to anagen catagen activity, the hair falls in the final cycle after which the new hair grows from the hair follicles. But due to uncontrolled Diabetes, the immunity hampers the growth of new hair follicles and thus resulting in patches of baldness. In Type 2 Diabetes similar effects do occur but generally are less extensive.

Hypothyroidism:

Due to endocrine imbalance, there is increased TSH levels and decreased thyroxine production leading to imbalance in hormonal levels. Thus leading to hair loss.

Stress and hormonal imbalance:

Both stress and hormonal imbalance goes hand in hand. Increased stress levels results in Anxiety which in turn disturbs sleeping pattern of an individual resulting in imbalance in hormonal levels . This affects the growth of hair follicles and leads to hair fall.

Iron deficiency Anaemia:

Due to decreased iron in haemoglobin, decreased hemoglobin count resulting in anaemia.

Heriditary:

Genetic cause is ofcourse not ruled out. Aloplecia in early aged population is usually hereditary.

Thus all these factors affect the hair follicle resulting in hairfall and leaving patches of baldness.

But Type 1 Diabetes, usually affects the anagen catagen phase in a more severe manner, affecting the immune response. So there is loss of hair overall like the scalp, over eyebrows, over chest etc. In Insulin resistant cases, hairfall occurs faster due to damage to the hair follicles.

Management and treatment of  Diabetes and Aloplecia:

  • One must monitor and control Diabetes so as to keep the cause under control to control hairfall. In type 1 Diabetes, insulin injections along with medication usually help to control autoimmune Diabetes. Regular checkup with your diabetologist usually helps in monitoring your blood glucose levels.
  • Patches of Aloplecia are usually tackled with Minoxidil tab orally and also local application.
  • Apply onion juice or aloe vera juice locally over the affected area for months together is often of great help (I don’t recommend but some found it useful).
  • Improvement in lifestyle changes benefits an individual to avoid stress and improve good quality sleep.
  • Keeping a check on thyroid hormones, like treatment for Hypothyroidism helps. Eltroxin (Levothyroxin) tab orally helps to keep a check on Hypothyroidism and obesity.
  • Using proper sulphate free shampoo and regular oiling your hair helps to a certain extent for hair growth and prevents dandruff.
  • Ofcourse Tricology has advanced souch in this field of hair grafting which is of help to cover certain patches of hair.
  • Multivitamins like B complex, Vitamin E and Biotin helps in growth of the hair follicle and prevents hairfall.
  • Trace elements like selenium, zinc, etc and vitamin D suppliments found out to be having a good effect on hair growth.

I’m sure most of the Diabetics especially type 1 must be facing this problem but is hesitant to discuss it due to scalp shaming and ignore it unless very severe patches are shown. Hope the significance of hairfall, it’s causes is well understood and it’s correlation with Diabetes!!!

Have a great day!

 

 

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Diabetic Foot – Facts Complications and Management

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A diabetic foot is any pathology caused due to peripheral arterial disease (PAD) affecting the feet in diabetes mellitus. It is a long-term complication of diabetes mellitus. An uncontrolled Diabetes leads to various complications like sensory neuropathy, osteoarthropathy diabetic foot ulcer and changes in the arch of foot. Loss of sensation in foot is the key to diagnose diabetic foot syndrome in diabetic patient.

The feet’s insensitivity to pain can easily be established by 512 mN pinprick stimulation. Research revealed that the lifetime incidence of foot ulcers within the diabetic community is around 18% and may become as high as 30%. In uncontrolled diabetes, peripheral nerve dysfunction causes poor blood circulation to the extremities.

Vitamin D deficiency is related with diabetic foot infections which in turn has increased the risk of amputations and deaths.

diabetes_foot_drnikhilprabhu.com

Peripheral Vascular disease:

Due to less sensitivity to pain, the wound or the injury may go unnoticed resulting in diabetic foot ulcer. When wounds take a long time to heal, infection may spread to bones and joints and lower limb wherein amputation may be necessary.

Foot infection is the most common cause due to poor circulation leading to gangrene and further amputation of foot in people with diabetes. There may be excess pressure on one part of the foot resulting in deviation of the arch of foot and arthropathy.

Athlete’s foot:

In Athlete foot, fungus causes itching, inflammation, redness, and cracking. Germs penetrate through the cracks in your skin and cause an infection. Medicines destroying the fungus can treat athlete’s foot.

Fungal infection of nail:

Nails that are infected with a fungus may become discolored (yellowish-brown), brittle and thick may separate from the rest of your nail. The dark and moist environment of shoes can help a fungus grow. Any injury to your nail can also lead to a fungal infection. Fungal nail infections are stubborn to treat. in such cases antifungal treatment may be required for over couple of months.

Callosities and corns:

Corns and callosities are also possible in Diabetic foot resulting in infections. Bunions result when the greater toe is bending on inner side of the smaller toe, thus resulting in difficulty in walking.

Ingrown toenails:

They occur when the edges of the nail grows into your skin. They cause lot of pressure and pain along the nail edges, redness, swelling, pain, drainage, and infection.

Hammertoe:

This is yet another condition where the muscles of the area become so weak that the toe curls below the foot.

All these above mentioned infections are trigger to uncontrolled diabetes.

Complications of diabetic foot problem:

  • Skin and bone infections. A small cut or wound or any injury can lead to infections. Nerve and blood vessel damage are more likely. Infections are usually treated with antibiotics.
  • Abscess. Infections penetrate into bones or tissue and create a small bag of pus called an abscess. The most common treatment is to remove the abscess. It may require removal of some bone or tissue, but newer methods, like oxygen therapy, are also very helpful.
  • Gangrene. There is poor blood supply to your fingers and toes. When blood flow is cut off, tissue dies. Treatment given is usually oxygen therapy or surgery to remove the affected area.
  • Deformities. Nerve damage can weaken the muscles in your feet and lead to deformities like hammertoes, prominent metatarsal heads, claw feet and pes cavus.
  • Charcot foot. Diabetes weaken the bones in your foot to the extend that they break. Nerve damage can reduce the sensation and prevent you from realizing it. You keep walking on broken bones unaware and your foot will change shape.

Signs of diabetic foot:

  • Changes in skin colour of foot
  • Changes in temperature of foot
  • Bad odour from the foot
  • Corns and callosities
  • Gangrene
  • Foot ulcer
  • Ingrown nail.
  • Fungal changes between the toes

Management of Diabetic foot:

  • Take care of yourself and diabetes. Follow up with your Diabetologist‘s advice regarding plate diet, nutrition, exercise and medication. Monitor your blood sugar levels regularly once every week.
  • Wash your feet with warm water using a mild soap. Dry your feet well properly between your toes.
  • Check your feet for sores, blisters, redness, calluses, or any other problems. If you have poor blood flow, it is important to check your feet daily.
  • Moisturizer: If the skin on your feet is dry, try keeping it moist by applying lotion after you wash and dry your feet.

Nail hygiene:

  • Use corn caps for removal of corns or callosities. Trim your toenails with a nail cutter or clipper. After clipping, smooth the toenails with a nail filer.
  • Always wear closed-toed shoes or slippers. Do not wear open sandals and do not walk barefoot.
  • Always wear socks or stockings. Wear socks/ stockings which  are soft and elastic and can fit your feet well.
  • Wear shoes that fit well. Buy Canvas or leather shoes which are comfortable for use. Extra wide shoes are usually preferred due to foot deformity for the comfort level.
  • Always check the inside of shoes to make sure so that no objects are left inside.
  • Protect your feet from extreme heat and cold.
  • Keep the blood flowing to your feet. Keep your feet up while sitting, move or wiggle your toes and ankles several times a day, and don’t cross your legs for long periods to avoid numbness of foot as circulation reduces.
  • Avoid smoking. Smoking can interfere with blood flow making it worse.
  • If you have a foot problem that gets worse or won’t heal, contact your diabetologist.
  • Improving lifestyle helps in reducing Diabetes and stress. Proper sleeping pattern helps reduce anxiety and depression in Diabetes.
  • Medicines like metformin, glimeperide, gliclazide, insulin injections must be taken in timely manner to avoid complications.
  • Avoid drinking alcohol.
  • Mantain your bodyweight. Obesity is one of the factors resulting in diabetes complications.

Conclusion:

Taking care of your foot is so very important as foot is integral part for walking. Hope the significance of maintaining foot hygiene is conveyed to you in a simple manner and it’s complications. Diabetic foot needs utmost care so as to avoid ulcers, injuries and other complaints. Hence always take care of your foot so as your Diabetes.

 

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Diabetes and Anxiety – A Mental Torment

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Diabetes and Anxiety are linked with each other which takes a mental tole on the patient. Anxiety and depression are the most common problems faced by patients suffering from Diabetes. It is believed that type 1 or type 2 Diabetes is linked with anxiety and mental health issues. There is stimulation of hypothalamus pituitary adrenal gland which in turn releases cortisol, growth hormones, epinephrine, nor epinephrene, other hormones in blood glucose levels. Thus leading to anxiety, depression during diabetes. Also one can not rule out increase in sugar levels or diabetes due to stress, anxiety.

Epidemiology of Diabetes & Anxiety:

According to the recent study in America, around 20 to 25 percent of diabetic people were suffering from anxiety than non diabetics. Around 40 to 45 percent of women population in India who have Diabetes are suffering from anxiety.

Diabetes_anxiety

Ways of identifying anxiety in a diabetic patient:

  • Feeling of fear, nervousness, at the time of commencement of the event.
  • Avoiding visiting public places, events, any occasions.
  • Development of symptoms of headache, palpitation of heart, restlessness, cramps in abdomen, sweating during attack of anxiety.

Patients  get anxious due to diagnosis of complications of Diabetes like neuropathy, retinopathy, nephropathy, gangrene etc. They also face anxiety due to management of Diabetes, following strict diet, taking complicated medications, sometimes insulin injections, exercising, improving lifestyle changes etc.

How to help a diabetic patient suffering with anxiety issues?

Usually in India, the Diabetes of the patient is managed by the diabetologist who is a physician and his mental health issues are treated with psychologist or psychiatrist. This leads to lack of collaboration between the two doctors as far as diabetes and mental health issues are concerned. Hence a Collaborative model of Diabetes and psychologist is practiced in such a way that the Diabetes and mental health issues like anxiety are well managed by the team of physicians working together. Thus the patient is given a self identified goal for Diabetes control and management and also given psychotherapy sessions to identify the mental health issues by the patient.

Management and treatment of anxiety and Diabetes:

  • Management of anxiety by anticholinergic drugs, antipsychotics, beta blockers, nor epinephric drugs, anti depressants, benziodiapides help a lot.
  • Antidepressants help in controlling Diabetes.
  • Psychotherapy is given to patients with anti depressants and cognitive behavioral therapy is proved to be successful in such cases.
  • Counselling sessions are conducted for behaviour therapy and controlling anxiety.
  • Routine check ups for Diabetes is done.
  • Improvement of lifestyle helps tremendously in improving the mental state of an individual.
  • Exercising regularly helps to maintain fitness and control diabetes. It utilizes your glucose for energy this maintaining blood sugar levels.
  • Plate diet is yet another way to improve your lifestyle and eating habits.
  • Having more of fruits and green vegetables helps in boosting immunity and controls diabetes.
  • Taking self care of being cautious of any injury helps preventing any complications.
  • Identifying anxiety at an early stage of onset helps in curing the patient from the mental illness by Counselling and medication.
  • Screening anxiety is extremely important for patients with HbA1C is more than 6.5.
  • Educate the patient on relaxation methods like meditation, yoga, breathe in and breath out exercise, concentrating candle etc.

Thus we conclude that mental illness is equally important as important as Diabetes. Diabetes and anxiety pose a mental torment to the patient. A thorough routine investigation should be done for behaviour changes in such diabetic patients.

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