Avoiding the complications of diabetes
Diabetes is costly, both in terms of dollars spent on medical care and the toll it takes on human life. The American Diabetes Association estimates that diabetes and pre-diabetes costs Americans $322 billion per year. That represents one in every five dollars spent on medical care in general and one of every three dollars spent through Medicare, according to the Association.
Uncontrolled diabetes can damage blood vessels, eyes, nerves and kidneys and lead to heart attack, stroke, kidney failure, blindness or amputation. It causes close to 70,000 deaths per year in this country and is listed as a contributing factor on an additional 235,000 death certificates.
Early detection is the key to preventing complications. The American Diabetes Association lists the following common symptoms of type 2 diabetes:
- Urinating often
- Feeling very thirsty
- Feeling very hungry – even though you are eating
- Extreme fatigue
- Blurry vision
- Cuts/bruises that are slow to heal
- Tingling, pain, or numbness in the hands/feet
If you have any of these symptoms, your doctor can order a simple blood test called a random (or casual) plasma glucose test. This test can be done at any time and a blood glucose level greater or equal to 200 milligrams per deciliter is an indication of diabetes.
Most of the symptoms of type 2 diabetes don’t occur until it has become severe, according to endocrinologist Angela Boldo, MD, of Falmouth Specialty Care. She called type 2 diabetes a “silent disease” and said that many people don’t even know they have it,
“Most type 2 diabetics don’t have any symptoms from diabetes, at least in the initial stages,” she explained.
About 9 percent of the general population has diabetes, but that number jumps to 25.9 percent when you look at people over 65. It is estimated that 30 percent of the people who have diabetes are undiagnosed, she said.
“When we treat type 2 diabetes, we are trying to prevent complications,” Dr. Boldo told a group gathered at the YMCA Cape Cod in West Barnstable for World Diabetes Day recently.
“The complications don’t happen initially. You get complications after five to 10 years. The best way to treat complications is to catch them before they start.”
Untreated diabetes can lead to a host of medical problems. In her talk, Dr. Boldo outlined the specific medical conditions that can arise.
Heart Attack and Stroke
People with diabetes are twice as likely to have heart attacks and strokes because the disease damages blood vessels, Dr. Boldo said. For that reason, it is very important to make sure both blood pressure and cholesterol are under control, as part of what she described as the ABC’s of diabetes:
- A – A1C blood test, which checks your glucose levels over the past three months. The goal is for the number to be seven or lower,
- B – Blood pressure, which should be 130/80 or 140/80, if you are older.
- C – Cholesterol
“Virtually all diabetics should be on a cholesterol medication,” she said.
There has been some recent bad press about statins raising people’s glucose levels, but if you look at the studies closely, the rise in glucose is very mild and the benefits of protection against heart attack and stroke far outweigh the risk, she said.
Fifty percent of kidney failures are caused by diabetes, Dr. Boldo said. High sugar levels put a lot of stress on your kidneys because of the way waste gets filtered. Eventually the body begins to leak protein in the urine, so diabetics should be testing for the presence of protein at least once a year. There are medications that can prevent it from worsening, so it is important to catch it early.
Diabetes is the main cause of blindness in this country. When the blood vessels near the optic nerve enlarge, it can cause bleeding and blindness, so people with diabetes should have an eye exam where their eye is dilated once a year. There are medications and laser treatments that can help, so early detection is important. Diabetics also have a 40 percent higher risk for developing glaucoma and a 60 percent higher risk for cataracts.
Neuropathy and Nerve Damage
About 50 percent of all people will suffer from neuropathy or nerve damage. Symptoms include:
- A heaviness or a burning sensation.
The problem can progress to pain so severe wakes people up at night, Dr. Boldo said.
There are two kinds of neuropathy: Autonomic neuropathy and peripheral neuropathy.
Autonomic neuropathy deals with the nerves that go to organs like your stomach, bladder and sexual organs. Gastroparesis is a form of autonomic neuropathy in the stomach. It slows the passage of food and digestion through the stomach so it doesn’t empty as well. It causes nausea, vomiting and feeling over full. Other autonomic neuropathies common in diabetes cause damage to the bladder or erectile dysfunction.
Peripheral neuropathy is pain or nerve damage in the hands or feet. Diabetics should be tested once a year by their doctor to see if they have peripheral neuropathy, according to Dr. Boldo. Poor circulation contributes to the problem.
“Exercise is a great way to improve circulation to your feet, so exercise is critical in diabetics,” she said.
But the best way to prevent complications of diabetes is to avoid getting it. The American Diabetes Association sites studies that show you can cut your risk of developing type 2 diabetes by 58 percent if you lose seven percent of your body weight and exercise moderately 30 minutes a day, five days a week.