It's important to face the fact that diabetes is a disease of complications, many of which are preventable—if you know what to do.
It's not entirely clear how diabetes causes complications. Some theories blame the direct damage caused by excess glucose in the blood, while others point to indirect mechanisms, such as molecules in the body that have been altered by the presence of glucose or by tissue inflammation. Most diabetes complications fit into one of two broad categories: "microvascular" and "macrovascular."
Microvascular Complications affect small blood vessels, creating problems with the eyes (retinopathy), nerves (neuropathy), and kidneys (nephropathy).
- Diabetic Retinopathy is a leading cause of blindness in the United States, with between 12,000 and 24,000 new cases each year. Diabetic retinopathy is the result of leakage from or abnormal growth of the blood vessels that supply the retina, the light-sensitive and vision-essential region at the back of the eye.
- Neuropathy affects the body's nerves, often manifesting as leg and foot problems. Common symptoms of neuropathy include tingling, numbness, and pain--which can become excruciating--but some people experience no symptoms at all. A lack of sensation can lead to untended wounds, which is especially problematic because wound deterioration and infection can sometimes lead to amputation.
- Nephropathy, or kidney disease, develops when nephrons—the clusters of blood vessels in the kidneys that filter out waste from the body—lose their filtering capacity. To assess kidney health, doctors check the urine for a protein called albumin, which is normally retained in the body but can leak out if the nephrons are damaged. Microalbuminuria--the diagnosis for small leakage levels—can progress to proteinuria and finally to overt diabetic nephropathy. In severe cases, the kidneys can fail, leading to a need for dialysis or a kidney transplant.
Regular eye, foot, and kidney check-ups can help detect complications early, providing ample opportunity to intervene before it's too late. For example, people with nephropathy can benefit from blood pressure treatment, especially with certain classes of drugs.In some cases, retinopathy can be arrested before vision loss occurs if a procedure called laser photocoagulation is performed. While no treatment directly acts on neuropathy, there are drugs to treat the symptoms and methods to prevent and promote wound healing.
Macrovascular complications, which affect the larger blood vessels, take their toll on the heart and brain.
- Cardiovascular disease (CVD) is more likely to afflict people with diabetes than the general population. In fact, CVD is the most common cause of death for people with both type 1 and type 2 diabetes. CVD is generally caused by a process called atherosclerosis, the narrowing of arteries, which can lead to a heart attack.
- Strokes are like heart attacks, but in the brain. They occur when blood can no longer feed the brain. Either an obstruction, like a blood clot, or a break in a blood vessel that leads to the brain can stop the flow of blood. Strokes can lead to disability, brain damage, or death.
The primary strategy for avoiding complications is prevention. Blood glucose control has been shown in major clinical trials to reduce the risk of microvascular complications, and is now also thought to stave off macrovascular complications. In addition, there areother effective ways for people with diabetes to protect themselves. Blood pressure control is key to preventing both macro- and microvascular complications. Lowering your blood cholesterol, taking a daily dose of aspirin, and stopping smoking if you smoke are all effective ways of combatting the development of macrovascular complications.
Other Things to Watch Out For
There are also some complications of diabetes that don't fall into either "vascular" category, like depression, skin disease, and gum problems. If you think you may be depressed, it is important to seek timely treatment because behaviors associated with depression—overeating, lethargy, apathy—can make your diabetes worse. Brushing and flossing every day as well as biannual visits to the dentist can help prevent the tooth and gum diseases associated with diabetes. If a problem is detected—pain, bleeding, loose teeth—you should contact a dentist right away. As for skin problems, washing with a mild soap, thoroughly drying after bathing, applying a lotion, and drinking lots of fluids can help prevent over-dryness and skin irritation.