Common Complications of Diabetes
November 25, 2009 - 11:17 am
Managing diabetes is a full-time job with no holidays and no time off. That may sound bleak, but a lifetime of maintaining normal blood sugar is infinitely preferable to dealing with the devastating complications that can result from uncontrolled diabetes.
The damage inflicted by diabetes can take years to become apparent. The two areas most affected by abnormally high blood glucose are the circulatory system and the nervous system. Every system and every major organ in the body depends upon the circulatory system to function properly, so damage to the circulatory system can cause a wide range of problems. Damage to the nervous system occurs in the form of neuropathy, or disorders of the peripheral nervous system, usually in the extremities.
The combination of reduced blood flow and nerve damage commonly results in foot problems in diabetics who have poor blood glucose control. Diminished sensation in the feet can lead to injuries — such as lacerations from stepping on sharp objects, or abrasions from corns, blisters or calluses — without the diabetic being aware of them. Poor circulation makes healing difficult, and infections can easily result. The combination of neuropathy and poor circulatory function contributes to tissue breakdown. A relatively minor injury to the foot can result in a raging infection that can be all but impossible to get under control. This is why amputations of the feet and legs are unfortunately common among diabetics.
Good foot care is essential. Wash the feet with warm soapy water every day and examine them for injuries. Your physician will test the sensation in your feet with a small brush known as a monofilament.
Vision problems are another common complication of diabetes. Blurred vision is often one of the first manifestations of high blood sugar; the excess glucose in the bloodstream can cause the lens of the eye to distort. Fortunately, for many diabetics this effect is temporary and vision can improve as blood sugar levels are brought under control.
Over time, however, diabetes can cause damage to the retina, known as diabetic retinopathy. Again, this can be minimized and even prevented through tight control of blood sugar levels. The combination of good diabetes management and early detection can slow or even stop diabetic retinopathy in its tracks. Regular visits to optometrists, ophthalmologists and even retina specialists are critical for diabetics.
Damage to the circulatory system can restrict blood flow to the penis and impair the ability to achieve and maintain an erection. Neuropathy can play a role here, too, and diminished sensation can interfere with erections.
As with avoiding and treating all diabetic complications, getting the blood sugar under control is essential and can in many cases dramatically improve sexual function. Even so, any man who experiences erectile dysfunction should see a doctor for a thorough checkup.
Dr. Lawrence Ross, a professor of urology at the University of Illinois-Chicago, says diabetes may be the number one cause of erectile dysfunction. Vascular diseases such as heart disease are a close second. Erectile dysfunction could also be a sign of a lipid disorder such as high cholesterol, Ross said.
“Young men presenting for the first time with erectile dysfunction should have their blood lipids and cholesterol checked,” said Dr. Ross. “It’s been found that erectile dysfunction may be the first warning of a blood lipid disorder like high cholesterol in young men that may eventually lead to coronary artery and other vascular disease.”
Treating erectile dysfunction can be troublesome and embarrassing for some men, but it’s important to discuss it candidly with a physician as soon as possible to treat any underlying conditions.
Damage to the vagus nerve, which controls the rhythmic shivering of the stomach and intestines known as peristalsis, can result from uncontrolled diabetes. This condition causes the stomach to take too long to empty its contents into the remainder of the digestive tract. Food moves slowly through the digestive tract, or sometimes it doesn’t move at all.
Gastroparesis is usually a chronic condition that cannot be cured. It can, however, be treated with medications such as metoclopramide (Reglan), erythromycin, domperidone and others. These drugs can help with stomach emptying and reduce the nausea symptoms that often accompany gastroparesis.
Kidney failure is the final stage of chronic kidney disease, and diabetes is the most common cause of kidney failure, accounting for 44 percent of all new cases.
It gets even worse: even diabetics with good blood sugar control are more likely to develop chronic kidney disease than non-diabetics. According to the Kidney and Urologic Diseases Home Kidney and Urologic Diseases Clearinghouse, nearly 180,000 of the 24 million people in the United States with diabetes are living with kidney failure as a result of diabetes.
Kidney failure means undergoing dialysis, a process to cleanse the blood of impurities that accumulate when the kidneys can no longer function. Most U.S. citizens with kidney failure qualify for federally funded care, which cost the federal government nearly $32 billion in 2005.
The health problems associated with smoking are numerous, but its effects on the diabetic are particularly devastating. Smoking also damages the circulatory system in the extremities, and any diabetic who smokes faces a substantially increased risk of complications, particularly amputations and vision problems.
Diabetics are at increased risk of cardiovascular disease, so smoking increases this risk for diabetics as well. According to the National Center for Health Statistics, diabetics are three times as likely as non-diabetics to have a heart attack. Diabetics who smoke are 11 times more likely to have a heart attack. One cigarette can reduce insulin effectiveness by as much as 15 percent. Smoking interferes with oxygen absorption by the body’s tissues, which can further interfere with wound healing.
Diabetics who smoke are more likely to develop all complications, and complications are likely to be more severe for diabetics who smoke.
Bottom line: don’t smoke. Find a way to quit. You’ll live longer and have a better quality of life. For information on how to quit smoking, go to www.cdc.gov/tobacco.
Maintaining normal blood sugar levels is the best way to avoid, and in many cases prevent, complications of diabetes. If diabetes management seems confining, it may be helpful to give some consideration to the life-changing complications you are avoiding. Blindness, amputations, nerve damage, permanently troubled digestion, heart disease, erectile dysfunction and kidney failure are far more confining than diabetes management.