Diabetes Complications: What's Your Risk?

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

From the WebMD Archives

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 David 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 Ronald 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:

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."

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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."

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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."

WebMD Feature Reviewed by Brunilda Nazario, MD on December 16, 2009

Sources

SOURCES: David C. Ziemer, MD, director, Diabetes Clinic at Grady Hospital, Atlanta; professor of endocrinology, Emory University School of Medicine. Ronald Goldberg, MD, associate director, Diabetes Research Institute at the University of Miami Medical Center. WebMD Medical Reference in collaboration with The Cleveland Clinic: "Diabetes Complications" and "Diabetes Treatment with Insulin." National Institute of Diabetes & Digestive & Kidney Diseases: "Diabetes, Heart Disease, and Stroke" and "Diabetic Neuropathies: The Nerve Damage of Diabetes." Medicinenet.com: "Diabetes Mellitus."

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