Diabetes affects all areas of life, as you well know if you or a loved one has been diagnosed with type 1 or type 2 diabetes. A recent study found that up to 27% of people with diabetes also suffer from depression due to the disease’s complications—of which there can be many.
Thankfully, there are steps you can take today to keep complications like kidney disease, vision problems and nerve damage from impacting your life and long-term health. If we can prevent the progression of diabetes and its many complications, then we can give you the quality of life you were meant to have.
Diabetes does not have to be your lifestyle. Here’s what you need to know.
The long-term effects of high blood sugar
Diabetes is a condition of abnormal carbohydrate (usually called glucose) metabolism. It’s characterized by high blood glucose levels because of deficient or inefficient insulin function.
Why do stable blood sugar levels matter, you ask? Good question. First, volatile blood sugar leads to a handful of dangerous immediate scenarios that can require hospitalization, from seizures to diabetic ketoacidosis.But these short-term risks are just the beginning.When not managed well, the long-term physiological effects of diabetes can sabotage your quality of life, even if you don’t feel you’re in immediate danger.
Here’s how it happens. Higher glucose levels damage the inner layer of blood vessels. In an effort to repair this damage, the body deposits cholesterol, protein and calcium in the blood vessel walls. Think of the immediate fix as a Band-Aid. These deposits form plaque, which eventually leads to a narrowing and thickening of the arteries. Now, the blood supply to the entire body is compromised. As the condition progresses, it can affect the eyes, kidney, heart, brain and nerves—sometimes all at once.
Hearing about this going on in your own body can be upsetting. It’s normal to feel overwhelmed at times when living with a chronic disease like diabetes. Nevertheless, when it comes to your health, remember you are in the driver’s seat. You are very capable of building a healthier life—and you can make changes today that will have a positive impact on your body, health and your future.
Let’s take a closer look at the most common long-term complications of diabetes, and what you can do about them.
1. Diabetic retinopathy (eyes and vision problems)
Diabetes is an a common, tragic, but often preventable or treatable cause of blindness. The most common ways diabetes can impact your vision include damage to the retina or lens, dry eyes and glaucoma.
The good news is that these conditions can—and should—be caught early for the most effective treatment and best possible outcome. To catch these developments, make sure you are seeing an optometrist or ophthalmologist regularly every year for screening, beginning shortly after diagnosis.
If any level of diabetic retinopathy is present, your ophthalmologist or optometrist will recommend dilated retinal examinations more frequently. Pregnant patients in particular are at risk of development and/or progression of diabetic retinopathy so if you are or become pregnant, talk to your doctor about more frequent monitoring.
To prevent and treat diabetic retinopathy, we work to optimize your blood glucose control as well as your blood pressure and cholesterol. We also strive to improve your blood pressure and serum lipid. These efforts reduce the risk and slow the progression of diabetic retinopathy. The traditional standard treatment, pan retinal laser (photocoagulation) therapy, and newer interventions like intra vitreous injections of anti–vascular endothelial growth factor are also options to help reduce the risk of vision loss.
2. Kidney disease
Approximately one-third of people with diabetes also have kidney disease. How does it happen? Your kidneys’ functional unit is a group of capillaries which form the filter. This filter helps the body to eliminate toxic substances and maintain the electrolyte balance. When diabetes damages these capillaries, it debilitates the filtration process, eventually causing potential end stage renal failure and the need for dialysis.
Again, our goal is to catch this complication early. At least once a year, your doctor may check your urinary micro albumin (that is, urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate (eGFR). These tests can detect kidney disease in an earlier stage, where we have more treatment options to choose from.
To prevent or slow the progression of kidney disease, we focus on the optimal treatment of diabetes itself, as well as any other conditions like high blood pressure. We also use medications like Angiotensin converting enzyme inhibitor or Angiotensin receptor blockers, if appropriate.
It’s also helpful to make sure you’re drinking plenty of water, limiting your salt intake to 2 grams per day and monitoring your protein consumption.
3. Nerve damage
Diabetes can also disrupt many of the body’s nerves. You may have experienced feelings of numbness, tingling, and pins and needles in your fingers and toes. This is because of the disease’s effect on sensory nerve endings. To make matters worse, motor nerve dysfunction can cause muscle weakness and atrophy, a complication that doesn’t just feel bad, but it also inhibits your activities. And finally, autonomic nerve damage can result in impotence, gastropareses, urinary retention and eye muscle dysfunction.
As with the other complications, prevention, early detection and treatment are key. A person with diabetes should be assessed for diabetic peripheral neuropathy starting at diagnosis of type 2 diabetes and five years after the diagnosis of type 1 diabetes. After that, you can be tested at least annually by your primary care physician or endocrinologist. Neuropathy is usually identified by a careful history and assessment and either temperature or pinprick sensation, monofilament and vibration sensation test.
4. Foot injuries
The damaged nerves we just discussed can lead to other serious complications. That’s because nerves play the important role of messenger: they alert you when something is wrong. Without this warning system, a small rock in the shoe or blister from rubbing may go undetected, become infected and resist healing.
This is why one of the most common problems people with diabetes experience is tissue damage on the feet.
Once again, screening helps. People with diabetes should undergo a comprehensive foot evaluation at least annually to identify risk factors. To prevent and slow the progression of neuropathy, we work toward optimal glucose control. And for some people, we also step up testing (no pun intended). People with evidence of sensory loss or prior ulceration or amputation should have their feet inspected at every visit.
5. Coronary artery disease and peripheral artery disease
Did you know that diabetes is classified as a cardiac disease equivalent? That means diabetes is as serious as heart disease. In fact, 70% of diabetes related deaths are due to vascular complications.
The reason diabetes is such a serious heart issue is because a compromised blood supply to the heart can cause heart attacks. These major cardiac events damage the heart muscle, often leading to heart failure or even death. Further complicating matters is neuropathy, which can result in an abnormal heart rate or blood pressure. Therefore, people with diabetes are twice as likely to have a heart attack.
No one wakes up and gets diabetes or heart disease in one day. The good news is, there are both lifestyle changes and treatment options to help. Statin use has shown to significantly decrease the risk of heart attack in people with diabetes. Your doctor can help you decide whether statins might be a good option for you.
Another long-term complication that people with diabetes should be aware of is peripheral artery disease. Oxidative changes due to diabetes affect the inner lining of the blood vessels, creating stiffness, thickening and eventually compromising the blood flow. This causes tissues to die due to lack of oxygen and nutrients, even though tissues are drowning in glucose. This increases your risk of infection and gangrene.
Fortunately, like the other complications we’ve discussed, diagnosing and treating early can decrease the risk of amputations, preserving your limbs and functionality.
6. Cerebrovascular effects (aka the brain)
In order to function properly, the brain requires ketones and glucose as its main energy sources. Because the brain does not store glycogen like your muscles, it depends on constant glucose supply from blood circulation. Fluctuation in glucose or high glucose levels can affect the brain, leading to comatose states. Low glucose levels can also adversely affect the brain.
Chronic vascular changes due to diabetes can cause transient ischemic attacks or “mini strokes,” memory loss or major stroke when the diabetes-induced plaque (atherosclerosis) affects the blood vessels supplying the brain.
The complications listed above are just the most common ones. Bone loss, vitamin deficiencies, increased susceptibility to infections, hearing problems, cognitive decline, dental deterioration, delayed wound healing and more can compound the effects of diabetes on your health.
Keep in mind is that everyone’s health journey is different, especially with diabetes. You may have some days when it feels like it is more difficult to manage, and some days when it is easier. However, your efforts do make a difference! Ultimately, what matters most is making progress toward your goals.
Wherever you are in your journey, know that you have options and that diabetes does not have to hold you back. You can still live your best life. All you have to do is take action and stick with it—and we’re here to help you figure out how.
Find a doctor near you or connect with our diabetes education and support team today.
About the author
Jyothi Rereddy, MD, is an internal medicine physician on the medical staff at Baylor Scott & White Primary Care - North Rowlett. Get to know Dr. Rereddy today.