After the introduction of insulin in 1923, it was suggested that people with diabetes would no longer die from hyperglycemic comas, but from complications of the disease; that has indeed been the occurrence in the years since. Just as repeated exposure to sunlight causes skin damage and sometimes skin cancer, chronic high blood sugar levels, or hyperglycemia, causes damage to the body. Specifically, diabetes damages the lining of blood vessels and results in the complications we see in patients today.
One of the most common complications of diabetes is neuropathy, or nerve damage, which occurs in about half of people with diabetes. Neuropathy may occur in various places in the body. Frequently it causes numbness, tingling or burning pain in the feet. It may result in erectile dysfunction, and it may slow the movement of food from the stomach to the intestine. Neuropathy to the heart may result in problems with maintaining a normal blood pressure.
People with diabetic neuropathy affecting the feet must take measures to prevent injuries. Lacking sensation to the feet, people have been injured by walking barefoot on hot concrete, by walking all day with a rock in a shoe, or by stepping on sharp objects and being unaware of the injuries. These wounds do not always heal well, and complications may include infection and, when necessary, amputation. Other complications include kidney damage called nephropathy, damage to the retina of the eye called retinopathy, and cardiovascular diseases including heart attacks and strokes.
The Good News
A decline in the rate of diabetes complications was noted in 1995 and has been consistent since that time. A recent study of people with type 2 diabetes compared the numbers of lower leg amputations, end-stage kidney disease cases, heart attacks, strokes, and deaths from hyperglycemic crisis. Rates of all of these complications went down, with the greatest decline seen in heart attacks and deaths from hyperglycemic crisis. In the past, heart diseases, and especially heart attacks, were the most common complication of diabetes. Retinopathy has also been found to be declining, though it is still the most common cause of blindness in the United States for adults between the ages of twenty and seventy-four.
How to Decrease Your Risk of Complications
It is believed that the decreased rates of heart disease are the result of strict control of blood glucose, blood pressure, and cholesterol levels. These factors, along with medications used for control of blood pressure and kidney protection, are thought to account for the improved survival of people with diabetes complicated by kidney failure. People with diabetes are also at high risk for depression. Intensive lifestyle changes, which include attention to food intake and increasing activity levels, have been found to reduce the incidence of depression and to increase quality of life ratings.
Elliott P. Joslin, MD, (1869-1962) was the first physician in the US to specialize in the treatment of diabetes. His theory was that tight control of blood sugar through diet, exercise, insulin injections, and constant blood sugar testing could extend the lifespan of someone with diabetes and prevent complications. And, he was right! That is the recommendation today. A person with diabetes can decrease their chances of complications by “knowing your numbers” and striving to keep those at appropriate levels.
If you live with diabetes or pre-diabetes, discuss suitable blood sugar levels with the provider guiding your diabetes care, and follow your treatment plan to keep those numbers at your goal. Most people should keep their blood pressure below 140/90 and LDL cholesterol levels below 100. Follow a healthy diet plan, be physically active, and take your medications as instructed. See your dentist and eye doctor at least yearly, or as they advise. You should visit your diabetes provider as instructed, usually every three to six months. If you see an endocrine specialist for your diabetes care, it is very important to also have an established relationship with a primary care provider. He or she will monitor your overall health, arrange for routine health screenings, and manage any non-diabetes related health concerns.
“The patient who knows the most lives longest.” Elliott P. Joslin, MD (1869-1962)
The Future
The actual rates of diabetes complications have decreased over the past 20 years within the population of people living with diabetes. However, the huge burden of diabetes and its complications continues to grow due to the increase in the number of people being diagnosed with diabetes. It is estimated that in the US there are 26 million people with diabetes and 79 million with pre-diabetes. By 2030, it is believed the number of adults with diabetes will exceed 55 million.
Currently there are about 11 different classes of medications available to treat diabetes, including pills, injected medications, and injected insulin. Lifestyle interventions such as eating healthy foods, increasing activity, and weight loss are always to be included in treatment. There continues to be a great deal of encouraging research investigating additional therapies for diabetes.
Diabetes is a chronic disease, and for most people with diabetes, good management will require viewing it as a daily part-time job. Just as we plan for our financial future by investing money today, plan for your medical future by investing attention to the disease now to prevent complications in the future.