Diabetes Complications: What's Your Risk?

[Guest guest]

Why are people with diabetes at high risk of nerve pain, heart disease, and

blindness?

By Jeanie Lerche

WebMD Feature

Reviewed by Brunilda Nazario, MD

Heart attack, stroke, blindness, amputation, kidney failure. When doctors

describe these diabetes complications, it may sound melodramatic -- like an

overblown worst-case scenario. The truth is, these things can happen when blood

sugar, blood pressure, and cholesterol are out of control.

" A lot of people don't really think it will happen to them, " says C.

Ziemer, MD, director of the Diabetes Clinic at Grady Hospital in Atlanta. " For a

lot of folks, the wake-up comes when they actually have a complication ... a bad

infection in the foot. That's a nasty wake-up call. "

If you have uncontrolled diabetes, a serious and deep-seated foot infection can

mean loss of a toe, foot, or leg -- amputation -- to save your life. Seriously.

How is this possible? Over time, high blood sugar slowly injures the blood

vessels, nerves, and organs in your body. The higher your blood sugar is -- and

the longer it stays high -- the worse the damage is. Smoking and alcohol ratchet

up the damage several more notches.

" Damage is slow and occurs over a period of years -- but it probably begins when

blood sugar is at mildly elevated levels, " says Goldberg, MD, associate

director of the Diabetes Research Institute at the University of Miami Medical

Center. " You may not be diagnosed with diabetes, but the damage has already

begun. "

The damage from diabetes shows up a bit differently in everyone -- whether it

attacks the nerves, eyes, or kidneys, Goldberg tells WebMD. " Genetics probably

influence which complications you are more susceptible to. "

The problem is, " many people have diabetes a lot longer than they realize, " says

Ziemer. " Most have diabetes an average of five to seven years before they're

diagnosed. "

Diabetes Complications: The Risks You Face

As blood vessels, nerves, and organs become damaged, your risk of diabetes

complications increases. These are the most

serious:

a.. Heart disease, heart attack, heart failure, and stroke risks are doubled.

Heart disease and stroke cause at least 65% of deaths from diabetes.

b.. Major eye complications (diabetic retinopathy) are linked to blood vessel

problems in the eyes. Diabetes is a leading cause of preventable blindness;

cataracts and glaucoma are also common.

c.. Reduced blood flow to nerves and high blood sugar results in nerve pain,

burning, numbness (peripheral neuropathy).

d.. Serious leg and foot infections, even gangrene and amputation, are due to

poor blood circulation, lack of oxygen and nutrients to tissue, and nerve

damage.

e.. Kidney damage (diabetic nephropathy) is a common risk for people with

diabetes.

The complications of diabetes are indeed serious -- but they are not inevitable,

Ziemer tells WebMD. " Keeping blood sugar under control is the single the most

important factor in preventing them. But people have a hard time grasping just

how critical that is, " he says. " It's hard to get them to tune into it. "

Why are people with diabetes at high risk of nerve pain, heart disease, and

blindness?

Preventing Diabetes Complications With Medication

Getting blood sugar under control isn't always difficult. Sometimes all you need

are lifestyle changes -- eating right, getting regular exercise, losing weight

-- to get it into a safe range. If you're a smoker, there's no question --

you've got to quit.

Also, finding ways to ease the stress in your life helps control blood sugar, as

does treatment for depression. Both stress and depression increase the level of

cortisol, a hormone that affects blood sugar. " Cortisol makes the diabetes

worse, " Ziemer tells WebMD. " There is evidence that treating depression may help

blood sugar control. " He is heading a study investigating that link.

For some people, taking just one diabetes medication helps tremendously. Complex

new drugs like Byetta, Januvia, and Symlin work from different angles to attack

high blood sugar. " All the new drugs hold a lot of promise, " says Ziemer, who is

also a professor of endocrinology at Emory University School of Medicine in

Atlanta.

If you need to take insulin, you'll find the injections aren't that bad. " The

new versions of insulin are far less cumbersome, " Ziemer explains. You don't

need to lay out a lot of needles and vials on the table. The insulin can be

discreetly injected via a little pen -- much like a cartridge writing pen.

Insulin mouth sprays and insulin patches are being developed.

Fewer Diabetes Complications = Less Pain

By reining in blood sugar, you slow down the damage to the body's nerves and

blood vessels. You can even halt damage altogether. The benefits show up in many

ways.

You can ease the pain or numbness you feel in hands, arms, feet, and legs. " When

you prevent more damage to nerves, you keep pain from getting worse, " Ziemer

explains. " We don't have any medications to repair nerve damage. Mostly, we're

protecting what's left. "

Gum disease and tooth loss can be halted when blood sugar is controlled, adds

Ziemer. " In fact, when you get gum infection under control, you help keep blood

sugar under control. Infection in the gums increases inflammation in the body,

which makes controlling diabetes harder. "

Don't put dental visits on the back burner, says Ziemer. " A lot of folks end up

losing lots of teeth. Nobody likes going to the dentist, me included. But seeing

a dentist is very important. "

Blood sugar isn't the only issue, diabetes experts agree. If there are

cholesterol and blood pressure problems -- as there typically are -- they need

aggressive treatment with medication. Both these conditions affect the health of

large and small blood vessels, and greatly aggravate the damage done by

diabetes.

Cholesterol-lowering drugs like statins are a mainstay in diabetes treatment.

Blood pressure drugs like ACE inhibitors can also improve blood flow throughout

the body, including legs and kidneys. " These drugs protect kidneys from damage

and they protect the heart muscle, which helps prevent heart failure, " Ziemer

tells WebMD.

With these diabetes complications, there's a lot at stake. Can you really

prevent the worst-case scenario? " Absolutely, " Goldberg tells WebMD. " If you do

all these things, you can substantially reduce risk of heart attack, stroke, and

the blood vessel damage that leads to blindness, amputations, and kidney damage.

But you must start doing them as early as possible. And you have to keep things

under control ... strict control. "