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 blood sugar 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 investigating that 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. The benefits 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 treatment with 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 control."
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SOURCES: David C. Ziemer, MD, director, Diabetes Clinic at Grady Hospital,
Atlanta; professor of endocrinology, Emory University School of Medicine.
Ronald Goldberg, MD, associate director, Diabetes Research Institute at the
University of Miami Medical Center. WebMD Medical Reference in collaboration
with The Cleveland Clinic: "Diabetes Complications" and "Diabetes Treatment
with Insulin." National Institute of Diabetes & Digestive & Kidney Diseases:
"Diabetes, Heart Disease, and Stroke" and "Diabetic Neuropathies: The Nerve
Damage of Diabetes." Medicinenet.com: "Diabetes Mellitus."
check out my website
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