Complications
The risk of complications associated with diabetes can be largely decreased with proper blood glucose control and the maintenance of a healthy lifestyle. Early detection of complications by routine medical examination also increases the chances that the damage can be reversed or minimized. It is important for diabetics to be committed to taking an active role in their disease management.
Heart & Blood Vessel Damage
The major complication of diabetes is damage to the heart and blood vessels, which can cause heart attacks, strokes, and poor circulation. These complications are associated not only with elevated blood glucose, but also elevated blood fat (cholesterol). Insulin is also involved in fat metabolism. Cholesterol at elevated concentrations tends to deposit in blood vessels, making them more narrow, thereby decreasing the delivery of oxygen and nutrients to tissues, and increasing the chance that a blood clot will form. Elevated blood glucose is associated with other cellular events that cause progressive narrowing of blood vessels. The effects on blood vessels also increase the risk of developing high blood pressure (hypertension).
Increased Risk of Eye Disease
Diabetics have an increased risk of eye disease. Damage to the retina associated with diabetes is the leading cause of blindness in adults under age 65 in the US. The retina is a layer of blood vessels and nerve endings on the back wall of the eye. Signals generated in the retina travel to the brain where vision is generated. Blood vessels in the retina may swell and leak fluid, or abnormal blood vessel growth may occur. These changes can impair vision or cause blindness. Poor blood glucose control also increases the risk of cataracts and glaucoma. It is important for diabetics to have their eyes examined yearly because the early stages of eye disease are often successfully treated but are generally not associated with symptoms.
Swelling of Nerve Cells
When blood glucose is high, nerve cells swell and scar. Eventually their ability to send proper signals throughout the body is impaired. The disease associated with nerve damage to the nerves outside of the brain and spinal cord is referred to as peripheral neuropathy. The two most common types of neuropathy in diabetics involve impairment of sensory and autonomic nerves. Impaired nerve signals to the brain about sensations such as the detection of heat or pain may lead to burns or undetected cuts that can become infected. If untreated, infected foot and leg ulcers can spread to the bone and may require amputation. Daily examination of the feet to identify sores or cuts at an early stage often prevents this from occurring. Burning, pain or tingling sensations in the hands, legs and feet are also common.
Nerve Impairment
Impairment of nerves that control involuntary activities of the body can affect processes such as digestion. Nerve damage can cause the stomach to empty too slowly and result in nausea and vomiting, bloating, and loss of appetite. Damage to nerves in the esophagus may impair swallowing, and damage to the intestines can cause constipation or diarrhea. Other common occurrences are impotence and impaired bladder emptying which increases the risk of bladder infections.
Kidney Damage
The kidneys are vital for ridding the body of toxic waste products, and maintaining fluid, mineral and electrolytes at levels compatible with life. Elevated blood glucose can damage the cells and small blood vessels of the kidney. The result is that the body retains toxins, and protein is lost in the urine. Symptoms of kidney failure include fatigue, decreased appetite, nausea and vomiting. Damage to the kidneys is not associated with symptoms at the early stages. A test to detect proteins in the urine is used as a screen to detect kidney damage. Controlling high blood pressure also decreases the risk of developing kidney disease. A certain class of high blood measure medication referred to as the angiotensin-converting enzyme inhibitors (ACE inhibitors), including Capoten®, Prinivil® and Accupril®, have been shown to reduce not only the risk of diabetic kidney disease but also heart attack and stroke. Advanced kidney damage results in the need for artificial filtration of the blood by dialysis and potentially the need for a kidney transplant.