Diabetes is an all encompassing condition. When blood sugar levels are chronically out of range the risk of developing complications rises. When the blood sugar is elevated for a long period of time, the body cannot properly manage the vital functions and it will lead to a variety of problems.
The Complications
Retinopathy
Retinopathy is caused by damage to the blood vessels in the eye due elevated blood sugar levels. The retina is responsible for communicating images to the brain. The retina takes in the image and translates it into brain signals so that you understand what the image is. The longer you are diabetic the risk of developing complications like Retinopathy increases. This condition can occur in Type 1 and Type 2 diabetes. "More than 80% of people who have had diabetes 20 years or longer develop diabetic retinopathy."1 Unfortunately, these conditions can develop without symptoms. The damage that occurs will eventually cause visual impairment. Treatment will depend on which type of retinopathy occurs. After diagnosis, your physician can begin the appropriate treatments. Visual effects of retinopathy can be slowed however it is not reversible. Prevention of retinopathy includes not smoking, eating a well balanced diet, exercising at least 30 minutes daily, maintaining a healthy weight. All of these efforts will assist in control of your blood sugar, blood pressure, and cholesterol levels. It is important to check in with your eye doctor annually to be screened for conditions such as retinopathy.
Neuropathy
Neuropathy is caused by damage to the nerves throughout the body. Similarly to retinopathy, nerve damage is caused by elevated blood sugar levels. The nervous system runs throughout the body. The most common type of neuropathy is peripheral neuropathy. When your blood cannot properly circulate and nourish the body, the first areas to notice problems are the feet, legs, hands and arms. Symptoms include: tingling, pain, numbness, muscle weakness, and skin ulcers. Not everyone experiences these symptoms and loses feeling all together. It is important to do regular self foot exams, especially if you are experiencing any symptoms of nerve damage. With the loss of feeling comes the increased risk of skin ulcerations because breakdown goes undetected. Untreated skin breakdown and infections can lead to amputation.
The second form of neuropathy affects almost everything else: the eyes, the heart, the digestive system, the urinary system, the reproductive organs. This form is called Autonomic Neuropathy. This form can lead to symptoms like: little to no bladder control, bloating, constipation, nausea, vomiting, erectile dysfunction, decreased vaginal lubrication, increased or decreased sweat production, feeling lightheaded, dizzy, visual disturbances, etc. Prevention of neuropathy focuses on blood sugar control, eating a balanced diet, maintaining an exercise routine, no smoking, limiting alcohol consumption, and maintaining a healthy weight.
Nephropathy
Nephropathy is damage to kidney function. The kidneys are vital organs as they are responsible for filtering our blood, removing excess waste, and maintaining proper fluid balance. They do a lot of work. Unfortunately, the majority of kidney disease in the United States is due to complications from diabetes. Similar to retinopathy and neuropathy, when the blood sugar levels remain uncontrolled this can lead to high blood pressure and overtime kidney disease. Symptoms can include worsening blood pressure, protein in urine, swelling of the hands, face, and feet, increased urination, loss of appetite, decreased concentration, shortness of breath and many others. If left undiagnosed or unmanaged, the damage will be permanent. Physicians often assess kidney function annually in order to identify kidney disease early. They may follow kidney function more frequently if needed. Treatment is dependent on how advanced the kidney disease is. Prevention is always the goal. Prevention measures are similar for many of these conditions and will be discussed below.
Stroke
Stroke is a brain injury. In the case of diabetes, there is an increased risk of cardiovascular disease which increases the risk of stroke. When the blood sugar is high for long periods of time, the excess sugar the body cannot use remains in the blood. Over time, the excess sugar sticks to the red blood cells and causes a build up. When build up happens, we see damage and/or blockage of the vessels. Depending on where the damage or blockages are it can lead to decreased oxygenation to the brain which can lead to stroke.
There are other causes of stroke that diabetics are also at risk for. High cholesterol and high blood pressure are the other main sources of stroke. In the case of high cholesterol it is the excess fat that is building up in the blood causing damage and blockages. In the case of high blood pressure, there is excess strain placed on the blood vessels. Increasing the stress on the blood vessels makes it harder for the blood vessels to do their job and provide oxygen and various nutrients to places like the brain.
Decreasing your stroke risk is very important as stroke can have devastating effects. Damage from stroke can look like many things: decreased muscle tone, inability to speak or swallow, inability to comprehend others speech, change in behavior, memory problems, emotional dysregulation, increased pain, etc. The list is so vast because it is dependent on where the stroke takes place and what kind of stroke it is. Minimizing risk can look like maintaining control of blood sugar, blood pressure, eating a healthy diet, avoiding smoking, limiting alcohol, maintaining a healthy weight, and working closely with the medical team to achieve an adequate regimen.
Cardiovascular/ Heart Disease
When we think of vital organs we first think of the heart. Understanding how diabetes affects the body is important. Once again, when blood sugar levels remain unmaintained the excess sugar stays in the blood. The sugar will stick to the red blood cells which over time will cause damage and blockages in the vessels. When this occurs, the blood cannot circulate properly and increase the risk of disease. Above we also mentioned high cholesterol and high blood pressure as risk factors for stroke. They are also culprits in cardiovascular disease.
High cholesterol is the buildup of fat. The fat sticks to the blood vessels and creates plaques. These plaques build up and can narrow the vessel and eventually block the vessel. This reduces blood flow and eventually will lead to a heart attack. High blood pressure creates an increased burden on the blood vessels and heart. Over time, the increased burden can weaken the heart and create further problems. Diabetics are 2 to 4 times more likely to develop heart disease.
Prevention measures are the same as the measures discussed above. Blood sugar management, Eating a balanced diet, Maintaining an exercise routine of at least 30 minutes daily, No smoking, Limiting alcohol, Maintaining a healthy weight and Routinely following up with your medical team.
Gum Disease Gum disease is very common but like everything else diabetes increases the risk. Some of the reason for this increased risk is found in saliva production. Diabetes decreases the amount of saliva in the mouth. Diabetes also increases the amount of glucose found in saliva. Why is saliva so important? Saliva has a lot of roles: protects the teeth from decay, moisturizes the mouth, and prevents bacterial build up. Diabetes decreases the overall amount of saliva which puts the mouth at increased risk of disease. The added layer of increased glucose further increases the risk by allowing bacteria and plaque to grow.
Symptoms of gum disease include: red, bleeding gums, loose teeth, dry mouth, bad breath. Preventative behaviors are focused in diabetic management and good oral hygiene. Brushing and flossing are daily behaviors that help to minimize the risk of disease. Routine dental check ups are also important. The current recommendation for dental check ups are twice a year.
Diabetes is not just a hormonal disease. This disease in all forms is complex. The consequences of this disease are felt throughout the entire body. Prevention is key. This begins with proper glucose control. Following a prescribed regimen, eating a well balanced meal, exercising for at least 30 minutes daily, weight management, reducing stress levels, getting enough sleep, avoiding smoking, and limiting alcohol consumption are all steps in the right direction. Recognizing that diabetes is hard is also important. Oftentimes, we can get caught up in everything that we are supposed to be doing and when missteps are taken we beat ourselves up for it. Maintaining a support system and practicing positive self reinforcement can help you achieve the goals you set forth.
References:
1. Endocrine Society. 2022. “Diabetes Complications.” Www.endocrine.org. January 24, 2022. https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-complications.
2. Diabetes UK. 2017. “Diabetes and Heart Disease.” Diabetes UK. 2017. https://www.diabetes.org.uk/guide-to-diabetes/complications/cardiovascular_disease.
3. Diabetes UK. n.d. “Diabetes and Stroke.” Diabetes UK. https://www.diabetes.org.uk/guide-to-diabetes/complications/stroke.
4. Hu, Qichao, Yuan Chen, Xinyu Deng, Yubing Li, Xiao Ma, Jinhao Zeng, and Yanling Zhao. 2023. “Diabetic Nephropathy: Focusing on Pathological Signals, Clinical Treatment, and Dietary Regulation.” Biomedicine & Pharmacotherapy 159 (March): 114252. https://doi.org/10.1016/j.biopha.2023.114252.
5. Ritchie, Hannah, and Max Roser. 2018. “Causes of Death.” Our World in Data. 2018. https://ourworldindata.org/causes-of-death#what-do-people-die-from.
Comentarii