Diabetes Mellitus: Progression to Microvascular and Macrovascular Complications

Nursing ;
Institutional:

Introduction.
Australia as a nation, has a bigger percentage of its population provided with an option of
quality health services giving its residents a high life expectancy. However, modernization and
industrialization has resulted in a decreased reduction in physical activities and has also led to an
increase in consumption of junk foods that are rich in energy (Tanamas, 2013). Therefore,
lifestyle associated diseases such as type 2 diabetes mellitus have increased rapidly due to the
change in lifestyle. These diseases lead to an increased array of outcomes such as morbidity and
mortality that primarily results from factors such as cardiovascular diseases, eye and kidney
diseases, and limb amputations. Diabetes mellitus, therefore, is among the 21st century public
health problems that are most challenging and requires management. With time, diabetes
mellitus progress to complications that can even lead to some organs becoming dysfunctional.
This essay assignment will, therefore, give me an opportunity to demonstrate the knowledge and
understanding of diabetes progression to microvascular and macrovascular complications. A
description of the pathophysiology, its risk factors, prevention and how it is diagnosed. The
essay paper will, therefore, be organized into three sections. The first section will discuss
findings of a study on the harm caused by prolonged periods of hyperglycemia and the
prevention of the complications that are related to diabetes. The second section will be focused
on Atherosclerosis, one of the diabetes macrovascular complications. The third part will be a
discussion on another complication of diabetes which is nephropathy. Lastly will be the
conclusion whereby the discussion throughout the essay will be summarized.
Question 1.
Metabolic memory is defined as the beneficial outcomes that are as a result of early
intensive treatment of hyperglycemia during its early stages of manifestation. After the early

initial treatment, the observations are maintained for many years regardless of the hyperglycemic
state in the later stages of diabetes (Testa et al. 2014). Literature outlines intensive treatment of
high circulating blood sugars done intensively in the early stages of developing diabetes reduces
the probability of development of conditions affecting the microvascular and macro vascular
tubules. Observations from preclinical and later confirmation from the large clinical trials
suggested that early management of hyperglycemia can stop the pathological processes that are
induced by high blood sugars. These processes are associated with enhanced oxidative stress and
breakdown of cellular proteins and lipids. Metabolic memory as a phenomenon suggests that
using anti-oxidants and end products of glucose breakdown for strict low blood sugar treatment
prevents chronic diabetic complications. The article titled “The role of metabolic memory in the
natural history of diabetes mellitus,” has proved that early intensive treatment of chronic high
blood sugars in its early stages of development yields beneficial outcomes of long-term duration
(de Boer et al. 2014) The rate of development of chronic complications that are as a result of
diabetes decreases significantly in patients who were previously treated whereas lots of
biological reactions occurs on the endothelial cells of the vessels of the diabetic patients whom
treatment of hyperglycemia is delayed. Unfortunately, the biological reactions cannot be stopped
at later stages even when the normal glucose is achieved leading to macrovascular diabetes
complication and dysfunctional endothelium. Some clinical trials have therefore been performed
and have given out results from the numerous clinical experiments and a support on the
hypothesis of metabolic memory is evident.
One of the studies that were carried out found that: " there is a prolonged negative effect of
hyperglycemia on blood vessels despite achieving tight glycemic control." This study was
conducted by Engerman and Kern. The objective of the study was evaluation of improved

glycemic control in inhibiting retinopathy progress in the respondents selected of which in this
case were dogs. These dogs were induced with alloxan diabetes mellitus. They were then
categorized into trhree groups. The categorization was based on methods of glycemic control of
which were done differently to the three different groups. They ensured a poor glycemic control
for the first group of dogs. They then monitored high glucose levels for the first two and half
years for the second group of dogs, and, thirdly they maintained good glucose levels for the
entire five years of observations for the third group dogs. The good glucose level control was
done by administration of insulin which was maintained for the five years. The reference group
was comprised of dogs that were non-diabetic. Observation; the introduction of the insulin
during two months since diabetes was induced lowered glucose levels and therefore inhibited the
development of microaneurysms and other histopathological lesions in their retinal blood
vessels. However, such kind of results were not observed with the second group when the strict
metabolic control was introduced after the two and half years of high blood sugar levels. The
practical findings, therefore, indicated that the progression of diabetic retinopathy can be
inhibited by early initiation of diabetic mellitus treatment (Testa et al. 2014). The benefits of
early and prolonged periods of intensive glucose management are inhibition of the development
of micro and macrovascular diabetes complications. when the management is not initiated as
early as possible it can, therefore, lead to the complications including diabetic retinopathy and
atherosclerosis.
Question 2.
Metabolic syndrome leads atherosclerosis. Metabolic syndrome is a serious health problem
defined as a group of precipitating factors that raises the rate of heart diseases development,