Author: Janette Kirkham, RN, CDE, EMT for the American Diabetes Association
Excerpt from: Mastering Your Diabetes (Before Diabetes Masters You)
I was told about all the problems my diabetes could cause, but nobody explained why. Had someone explained these things to me, I might have tried harder to do what I had been told to do. Complications from diabetes come on over time, and damage has often started before we realize something is wrong. The belief that “as long as I feel well I must be well” does not hold true for the complications of diabetes; they come on quietly.
The heart actually has the largest blood vessels in the body so why is it damaged? First of all, it is the job of the heart to pump the thick, sticky blood through all the narrowed vessels in the body. That is like canoeing in Jell-O compared with canoeing in water. The heart also has many small vessels that feed and nourish it. When blood sugars are high, they do not get the circulation they need. So not only are we asking the heart to work twice as hard, we are depriving it of nutrition to give it strength. Cardiovascular Disease is the most common cause of death in people with diabetes. But there are prevention and treatment strategies that have been proven effective.
Nerve Damage and Disease
Amputations and ulcers, especially in the feet, are more frequent in patients with poorly controlled diabetes. Decreased circulation to feet and legs leads to damage and loss of nerve function. The nerves lose their ability to sense pain, pressure, touch, or temperature correctly, which results in tingling and numbess of the feet and toes (fingers, too). This condition is called peripheral neuropathy.
Autonomic neuropathy occurs when there is nerve damage affecting the automatic processes in your body such as heart rate or sweating, so they do not work as they should. The stomach may not process food correctly. The heart rate or blood pressure does not speed up or slow down in response to exercise, exertion, rest, standing, or sitting. Autonomic neuropathy also contributes to the absence of chest pain with heart attack, and can cause sweating at inappropriate times or in specific areas, leaky bladder, pupils that do not constrict or dilate as needed, sexual dysfunction, and decreased ability to sense an infection or hypoglycemia.
If you already have numbness in your feet, is there any point to controlling blood sugars? Absolutely. Numbness and burning in the feet are signs that nerves have been damaged. Evidence has shown that nerves, when only damaged, can learn to trasmit messages through different pathways. If your feet are so completely numb that you cannot tell where they are because you cannot feel them, managing your blood sugars most likely will not get any sensation back. But it can prevent the numbness and nerve damage from spreading farther up your leg. And controlling your blood sugars will give your damanged nerves and your immune system a fighting chance to help your feet stay healthy.
Retinopathy, macular edema, glaucoma, and cataracts are the more common eye disorders related to diabetes.
Eye disease is typically progressive, and there are usually no symptoms until damage has occurred. You may have 20/20 vision yet one day have complete vision loss due to a hemorrhage. This is the reason a yearly eye exam is so important. An eye doctor will be able to see the changes occurring before vision is at risk. Laser surgery can destroy the abnormal vessels in the eye and prevent their regrowth.
So What’s The Good News?
Believe it or not, there is some good news. The whole process of long-term complications started with sticky red blood cells. The good news is that red blood cells only live two to three months. That means that in three months of keeping your blood sugar levels nearer to normal, you have a whole new set of unsticky red blood cells. This turnover eliminates the cops, slow cars, and semi-trucks from the freeway, and prevents further damage to the road. When blood sugar levels come down, the stickiness decreases on the walls of the arteries and veins, and triglycerides and cholesterol levels are reduced. So where lanes of traffic were closed, we now have open roads. Where damage has been done, we may not be able to repair it, but with improved control, we can prevent further complications and slow or stop the progress of any existing ones. Keeping blood sugars close to normal is the best way to prevent complications. Unlike genetics, age, or sex, it is the one component we have some control over.