الفهرس 
Complications of Diabetes Mellitus
Oxidative and nitrosative stressOnly 14 pages are availabe for public view
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Abstract
Diabetic nephropathy (diabetic kidney disease) (DN) is the chronic loss of kidney function occurring in those with diabetes mellitus. It is a serious complication, affecting around one-quarter of adult diabetics in the United States. It usually is slowly progressive over years. Pathophysiologic abnormalities in DN begin with long-standing poorly controlled blood glucose levels. This is followed by multiple changes in the filtration units of the kidneys, the nephrons. (There are normally about 3/4-1 1/2 million nephrons in each adult kidney). Initially, there is constriction of the efferent arterioles and dilation of afferent arterioles, with resulting glomerular capillary hypertension and hyperfiltration; this gradually changes to hypofiltration over time. Concurrently, there are changes within the glomerulus itself: these include a thickening of the basement membrane, a widening of the slit membranes of the podocytes, an increase in the number of mesangial cells, and an increase in mesangial matrix. This matrix invades the glomerular capillaries and produces deposits called Kimmelstiel-Wilson nodules. The mesangial cells and matrix can progressively expand and consume the entire glomerulus, shutting off filtration. As this process affects more and more glomeruli, filtration in both kidneys progressively declines: the pathological process called nephrosclerosis (Afkarian et al., 2016).The recent religious opinion of the Mofty of Egypt emphasises the importance of the discussion between physician and patient when considering fasting or not and takes into consideration the ability of the person with diabetes to tolerate the fast. Furthermore, the religious advice of the Mofty of Egypt stresses that where obvious contraindications are present, it behoves the doctor to give categorical advice against fasting and highlights the importance of accepting this advice by the person with diabetes (IDF, 2016).
There should be frequent monitoring of blood glucose, especially for those who are on insulin. A healthy balanced diet should be maintained. Complex carbohydrates are recommended at the predawn meal, which should be taken as late as possible and simple carbohydrates at the sunset meal. Fluid intake should be increased in the non-fasting hours. A normal level of activity should be maintained, avoiding excessive activities in the hours before the sunset meal. The fast should be broken if glucose level is low (<4 mmol L) or patient experiences symptoms of hypoglycemia and if glucose level is >16.7 mmol L (Azad et al., 2012).
Ramadan-focused diabetes education should primarily be targeted to patients with diabetes, but also directed to the HCPs who manage these patients, and more widely to the general public who may support them (IDF, 2016).People with type 1 diabetes mellitus (T1DM) and pregnant women need special attention. Individualisation of treatment options is the proper approach for the management of diabetes during Ramadan. This process can be broken down into a number of steps involving pre-Ramadan patient assessment, medication adjustment during Ramadan and post-Ramadan follow-up (Al-Arouj et al., 2010).
The decision by an individual with T1DM to fast during Ramadan must be respected. There is some evidence to suggest that, as long as they are otherwise stable and healthy, they can do so safely. However, strict medical supervision and focused education on how to control their glycemic levels is essential (IDF, 2016).
This study aimed to demonstrate the impact of fasting on primarily on ẻGFR & microalbuminuria in people with type 1 diabetes and secondarily on neuropathy & retinopathy. It was conducted on 60 patients with T1DM. All patients underwent full history taking, full clinical examination and biochemical tests including FBG, 2h PPBG, HbA1c, fructosamine, s.creatinine, BUN, uACR, eGFR, fundus examination and DN4 Q.
There had been significant difference between pre and post-fasting as regards weigһt and BMI, and non significant difference regards waist circumference.Also highly significant difference between basal and bolus doses before and during Ramadan.
There had been no significant difference between pre and post Ramadan regarding fundus examination and a significant difference regarding DN4 Q.
Regarding no. of successful fasting days and attacks of hypoglycemia, a significant difference was found.
Also regarding laboratory results, there had been significant difference in FBS, 2hr PPBG, BUN, s.creatinine, uACR, eGFR, and fructosamine.