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Diabetes Complications: What's Your Risk?

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."

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Reviewed on December 16, 2009

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