Diabetes Complications: What's Your Risk?      Heart
attack, stroke, blindness, amputation, kidney failure. When doctors
describe these diabetes complications, it may sound melodramatic --
like an overblown worst-case scenario. The truth is, these things can
happen when blood sugar, blood pressure, and cholesterol are out of
control.  "A
lot of people don't really think it will happen to them," says David C.
Ziemer, MD, director of the Diabetes Clinic at Grady Hospital in
Atlanta. "For a lot of folks, the wake-up comes when they actually have
a complication ... a bad infection in the foot. That's a nasty wake-up
call."  If
you have uncontrolled diabetes, a serious and deep-seated foot
infection can mean loss of a toe, foot, or leg -- amputation -- to save
your life. Seriously.  How
is this possible? Over time, high bloodsugar slowly injures the blood
vessels, nerves, and organs in your body. The higher your blood sugar
is -- and the longer it stays high -- the worse the damage is. Smoking
and alcohol ratchet up the damage several more notches.  "Damage
is slow and occurs over a period of years -- but it probably begins
when blood sugar is at mildly elevated levels," says Ronald Goldberg,
MD, associate director of the Diabetes Research Institute at the
University of Miami Medical Center. "You may not be diagnosed with
diabetes, but the damage has already begun." The
damage from diabetes shows up a bit differently in everyone -- whether
it attacks the nerves, eyes, or kidneys, Goldberg tells WebMD.
"Genetics probably influence which complications you are more
susceptible to."  The
problem is, "many people have diabetes a lot longer than they 
realize,"
says Ziemer. "Most have diabetes an average of five to seven years
before they're diagnosed."  Diabetes Complications: The Risks You Face As 
blood vessels, nerves, and organs become damaged, your risk of diabetes 
complications increases. These are the most serious:   Heart
disease, heart attack, heart failure, and stroke risks are doubled.
Heart disease and stroke cause at least 65% of deaths from diabetes. Major
eye complications (diabetic retinopathy) are linked to blood vessel
problems in the eyes. Diabetes is a leading cause of preventable
blindness; cataracts and glaucoma are also common. Reduced blood flow to nerves 
and high blood sugar results in nerve pain, burning, numbness (peripheral 
neuropathy).   Serious
leg and foot infections, even gangrene and amputation, are due to poor
blood circulation, lack of oxygen and nutrients to tissue, and nerve
damage. Kidney damage (diabetic nephropathy) is a common risk for people with 
diabetes. The
complications of diabetes are indeed serious-- but they are not
inevitable, Ziemer tells WebMD. "Keeping blood sugar under control is
the single the most important factor in preventing them. But people
have a hard time grasping just how critical that is," he says. "It's
hard to get them to tune into it."  Preventing Diabetes Complications With 
Medication  Getting
blood sugar under control isn't always difficult. Sometimes all you
need are lifestyle changes -- eating right, getting regular exercise,
losing weight -- to get it into a safe range. If you're a smoker,
there's no question -- you've got to quit.  Also,
finding ways to ease the stress in your life helps control blood sugar,
as does treatment for depression. Both stress and depression increase
the level of cortisol, a hormone that affects blood sugar. "Cortisol
makes the diabetes worse," Ziemer tells WebMD. "There is evidence that
treating depression may help blood sugar control." He is heading a
study investigatingthat link.  For
some people, taking just one diabetes medication helps tremendously.
Complex new drugs like Byetta, Januvia, and Symlin work from different
angles to attack high blood sugar. "All the new drugs hold a lot of
promise," says Ziemer, who is also a professor of endocrinology at
Emory University School of Medicine in Atlanta.  If
you need to take insulin, you'll find the injections aren't that bad.
"The new versions of insulin are far less cumbersome," Ziemer 
explains.
You don't need to lay out a lot of needles and vials on the table. The
insulin can be discreetly injected via a little pen -- much like a
cartridge writing pen. An inhaled form of insulin has been
FDA-approved. Insulin mouth sprays and insulin patches are being
developed.  Fewer Diabetes Complications = Less Pain By
reining in blood sugar, you slow down the damage to the body's nerves
and blood vessels. You can even halt damage altogether. Thebenefits
show up in many ways.  You
can ease the pain or numbness you feel in hands, arms, feet, and legs.
"When you prevent more damage to nerves, you keep pain from getting
worse," Ziemer explains. "We don't have any medications to repair 
nerve
damage. Mostly, we're protecting what's left." Gum
disease and tooth loss can be halted when blood sugar is controlled,
adds Ziemer. "In fact, when you get gum infection under control, you
help keep blood sugar under control. Infection in the gums increases
inflammation in the body, which makes controlling diabetes harder."  Don't
put dental visits on the back burner, says Ziemer. "A lot of folks end
up losing lots of teeth. Nobody likes going to the dentist, me
included. But seeing a dentist is very important."  Blood
sugar isn't the only issue, diabetes experts agree. If there are
cholesterol and blood pressure problems -- as there typically are --
they need aggressive treatmentwith medication. Both these conditions
affect the health of large and small blood vessels, and greatly
aggravate the damage done by diabetes.  Cholesterol-lowering
drugs like statins are a mainstay in diabetes treatment. Blood pressure
drugs like ACE inhibitors can also improve blood flow throughout the
body, including legs and kidneys. "These drugs protect kidneys from
damage and they protect the heart muscle, which helps prevent heart
failure," Ziemer tells WebMD. With
these diabetes complications, there's a lot at stake. Can you really
prevent the worst-case scenario? "Absolutely," Goldberg tells WebMD.
"If you do all these things, you can substantially reduce risk of heart
attack, stroke, and the blood vessel damage that leads to blindness,
amputations, and kidney damage. But you must start doing them as early
as possible. And you have to keep things under control ... strict
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