Back to Basics: Diabetes Complications
The stakes are high. Even though you may not "feel" diabetes, it's there, and effective measures must be taken to avoid the damage it can do. People with uncontrolled diabetes often feel perfectly healthy, and feeling fine isn't the best motivator when you're faced with taking an insulin shot or passing up a tempting dessert.
But consider what's at stake. Uncontrolled diabetes can slowly and at first imperceptibly destroy the heart, nerves, kidneys, and eyes. Here's what you need to know to stay healthy.
The Heart and the Head
Cardiovascular disease (CVD) is a major cause of death in people with diabetes. CVD is caused by atherosclerosis, a narrowing of the arteries. While most people think of CVD as a matter of the heart, so to speak, it also leads to strokes and other problems.
How can you reduce your chances of developing CVD? For starters, quitting smoking is a surefire way to cut down on CVD risk. High blood glucose is believed to be a factor, and that's a reason to maintain good control. Keeping blood pressure and blood fats in check is also critical to the prevention and treatment of cardiovascular disease. People with diabetes should have their blood pressure taken at every routine checkup and strive to keep it under 130/80 mmHg. Losing weight and getting more exercise may do the trick. Eating more potassium and less sodium can also help lower blood pressure. Many people may need to take blood pressure–lowering drugs such as ACE inhibitors and ARBs.
Cholesterol, an essential fat-like substance that travels in the blood, can be "good" (HDL cholesterol) or "bad" (LDL cholesterol). HDL cholesterol should ideally be above 40 mg/dl for men and 50 mg/dl for women. LDL cholesterol goals differ depending on whether or not a person already has cardiovascular disease: For people without CVD, the LDL target is less than 100 mg/dl, while for people with CVD the goal is less than 70 mg/dl. Triglycerides are another blood fat that must be kept in check; ideal triglyceride levels are under 150 mg/dl. You can improve blood fat levels by being more physically active; eating less cholesterol, trans fat, and saturated fat; and eating more omega-3 fatty acids, fiber, and vegetables. Medications called statins have also proved a valuable weapon against CVD. In people with diabetes, statins are recommended for everyone with cardiovascular disease and for those without CVD who are over 40 and have other risk factors for the disease, such as high blood pressure.
Diabetes makes the body's filter, the kidneys, vulnerable. Kidney disease, or nephropathy, occurs in 20 to 40 percent of people with diabetes and can lead to kidney failure. The two most important risk factors for kidney disease are high blood glucose and high blood pressure (hypertension), so getting those in the target ranges is critical. People with diabetes should have a urine test each year to check for albumin, a protein that leaks into urine if kidneys are damaged. A blood test that looks for another sign of nephropathy, creatinine, should be done on all people with diabetes every year. Preventing and treating kidney disease includes controlling blood glucose and taking specific medications to lower blood pressure. For people with advanced kidney disease, eating less protein may be recommended.
Neuropathy (nerve damage) caused by diabetes can lead to a variety of symptoms. Nerve damage that occurs in the arms, legs, hands, or feet can lead to numbness, pain, or both. Feet are particularly vulnerable to damage and require special attention. If neuropathy affects nerves deep inside the body, the result may be stomach, heart, or bladder problems. Screening for neuropathy should be done annually. Controlling blood glucose is the best way to prevent or slow neuropathy. There are medications for neuropathy, though these drugs relieve pain rather than heal the nerves themselves.
High blood glucose can damage the tiny blood vessels that supply the eye with nutrients. The result can be a vision-threatening complication called retinopathy, which is the most common cause of blindness among people between 20 and 74 years old. The longer a person has had diabetes, the greater the risk of developing retinopathy.
Good blood glucose and blood pressure control are keys to preventing and treating retinopathy. People with type 1 diabetes should get screened for retinopathy within five years of diagnosis, while those diagnosed with type 2 should get a dilated eye exam right away, since the disease may have been present for some time before diagnosis. People with diabetes should have a dilated eye exam every year, although some people who have had a run of normal eye exams may be advised to have them less frequently (every two to three years). If retinopathy is detected, more frequent examinations may be necessary to monitor its progression. Pregnant women need to be particularly vigilant about having eye exams, as pregnancy may aggravate retinopathy.