Over time, uncontrolled diabetes can damage your cells, tissues and organs. You can prevent these complications by with proper nutrition, exercise, and medication.
Eye disease - retinopathy
Diabetic retinopathy is one of the largest causes of vision loss worldwide and is the primary cause of impaired vision in adults under 75 years of age.
Why retinopathy develops
Chronic high blood sugar damages the blood vessels in the retina, causing blockages in the vessels and decreased flow of oxygen to the retina. In response to these blockages, a substance called vascular endothelial growth factor (VEGF) stimulates the production of new blood vessels in the retina to bring more oxygen to the tissue (we call this proliferative retinopathy) Unfortunately, these tiny new blood vessels that form in the retina in response to VEGF are fragile, leading to fluid leakage, bleeding, and scarring in the retina that causes progressive vision loss.
Blood vessel leakage from diabetic retinopathy can cause fluid to accumulate in the macula, which is the most sensitive part of the retina that is responsible for central vision and color vision. This condition (called diabetic macular edema) is the primary cause of vision loss associated with diabetic retinopathy.
How to prevent retinopathy
- Good blood sugar control is by far the best way to prevent retinopathy (and prevent worsening retinopathy in people who already have it). Multiple studies1UKPDS is the landmark trial in type 2 diabetes that showed the benefit of blood glucose control on retinopathy risk.Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 19992The DCCT is the landmark trial in type 1 diabetes showing the effect of blood glucose control on the risk of retinopathy. Diabetes Control and Complications Trial Research Group.The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993have shown that lowering A1C reduces the rate and progression of diabetic retinopathy; the better the blood sugar control, the greater the benefits.
- Good blood pressure control (systolic blood pressure less than 140, diastolic blood pressure less than 90) has been shown to decrease risk3Do DV, et al,Blood pressure control for diabetic retinopathy. Cochrane Database Syst Rev. 2015
- There is evidence that regular exercise may decrease the development of retinopathy4Praidou A, et al. Physical activity and its correlation to diabetic retinopathy. J Diabetes Complications. 2017.
- Treatment of sleep apnea may reduce risk of development of retinopathy5Altaf QA, et al. Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study. Am J Respir Crit Care Med. 2017
- Early detection is critical in preventing vision loss. You should have yearly dilated eye exams by an optometrist or ophthalmologist.
Diabetic kidney disease
Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) both in the US as well as the rest of the world. CKD is commmon in diabetes, about 25-30% of people with diabetes have it6https://www.ncbi.nlm.nih.gov/pubmed?term=27532915. Despite how common CKD is, there is very poor awareness about it. One study showed that only 10% of people with stage 3 CKD were aware of their diagnosis7https://www.ncbi.nlm.nih.gov/pubmed?term=29457196.
Why diabetic kidney disease develops
Kidney damage in diabetes is not a uniform process, depending likely on genetics, presence of type 1 versus type 2 diabetes, degree of insulin resistance, and presence of other factors such as high blood pressure. This makes it difficult to briefly explain why diabetic kideny disease occurs. However, in general:
- High blood sugars and/or insulin resistance create advanced glycation end products (AGE) and reactive oxygen species (ROS), which cause oxidative stress and trigger an inflammatory response in kidney cells as well as a fibrotic response (you can think of fibrosis as similar to scarring)
- Diabetes is associated with activation of the renin-angiotensin-aldosterone system (RAAS), which stimulates kidney hypertrophy (growth), increased blood flow through the kidney, increased vascular pressure in the kidney, and increased kidney filtration. Overall, this causes an abnormally high glomerular filtration rate (GFR) and strain to the blood vessels and kidney cells (podocytes)
Diabetic kidney disease symptoms
Diabetic kidney disease usually causes no symptoms until at least 75 percent of your kidneys’ function is lost, and people who have the condition often produce normal amounts of urine. To detect diabetic kidney disease, health care providers rely on tests that measure protein levels in the urine and blood tests to evaluate the level of kidney function.
When the kidneys are working normally, they prevent protein from leaking into the urine, so finding protein in the urine is a sign that the kidneys are in trouble. Often people who have diabetic kidney disease also have high blood pressure.
Diabetic kidney disease risk factors
- Having chronically elevated blood sugar levels
- Having chronically elevated blood pressure
- Being overweight or obese
- Smoking
- Having a diabetes-related vision problem (diabetic retinopathy) or nerve damage (diabetic neuropathy)
Nerve disease – neuropathy
Most diabetic nerve damage occurs with the nerves on the bottom of your feet. However, uncontrolled blood sugars over a period of time can also damage nerves that assist with blood pressure control, breathing, digestion and affect your sexual health by causing erectile dysfunction and vaginal dryness.
Daily foot care is important in preventing diabetic foot ulcers or infection that could lead to the amputation of a toe or part of your foot.
- Check your feet daily for redness, cuts, blisters, corns, calluses or anything unusual. See your healthcare provider for any changes you may note.
- Wash your feet daily with warm water and a mild soap and dry them well especially between the toes.
- Apply lotion to the tops and bottoms of your feet to moisturize any dry cracked skin. Do not put lotion between your toes as this could be a source for infection. Keep your toenails trimmed.
- Wear a comfortable shoe that has good support and fits well. Also, keep your feel dry by wearing dry, soft socks that wick away moisture.
- Always shake your shoes before putting them on to remove of any unwanted object such as a pebble. Never walk barefoot inside or outside your home.
Dental disease
Living with diabetes increases the risk for gingivitis, periodontal disease, thrush and dry mouth. Brush and floss your teeth regularly and use an alcohol-free rinse. See your dentist for regular checkups.
Heart disease
People living with diabetes are at 2- 4 times greater risk for a heart attack or stroke, and many have high blood pressure and high cholesterol. You can lower your risk of heart disease by controlling your blood sugar, blood pressure and cholesterol.
Follow this ABC plan for heart health:
- A1C less than 7 percent
- Blood pressure at 130/80 or less
- Cholesterol
- Total cholesterol less than 200
- HDL cholesterol (the healthy protective cholesterol) 40 for males and more than 50 for females
- LDL cholesterol (the bad cholesterol) less than 100
- Total triglycerides less than 150
Peripheral arterial disease
Peripheral arterial disease (PAD) occurs when the vessels in your legs narrow due to plaque buildup and decrease the blood flow to your legs and feet. Warning signs include pain in your legs when walking, weakness, difficulty walking, cramping, numbness, tingling or coldness to your feet, cuts or sore that are not healing, cracked skin on your feet and pain in your feet or toes at rest.
Lifestyle changes to reduce your risk of heart disease or PAD include:
- Weight loss and maintaining a healthy weight
- Regular exercise
- Quitting tobacco
- Taking blood pressure, aspirin and cholesterol lowering medications as prescribed