Ask the Pharmacist – Diabetes complications

Q. What can I do to prevent the many complications that people with diabetes are at a high risk of getting?

A. The last couple of weeks we have delved into what it means to have diabetes, the various types, and the numerous complications that go along with it. It was startling to learn that nearly half of the people living with diabetes will go on to develop complications. Let us remind you of some of the complications that we are speaking of:

· Kidney failure
· Heart attack/ stroke
· Nerve damage/ amputation
· Blindness

Does it concern you that you or someone close to you might end up with a sufferable complication? Though the risks of developing these undesirable effects are much higher, it does not have to be inevitable. However, the time to act is now. You may have noticed the risk factors for the complications discussed previously had common elements to them. Therefore, is should not surprise you to learn that the best method to reduce the risk of these horrible complications are not only to keep your blood sugar in good control, but it is also important to keep your blood pressure in check as well as maintain a healthy weight and to avoid smoking.

Following the guidelines/rules set out using the ABCDESSS acronym will help to reduce or better yet prevent your risks for complications and help you live a much better life with diabetes.

A1C:   This is a measurement of your average blood sugar level over the previous 3 months and ideally should be less than or equal to 7%. This test does not lie or cheat so if you have been sneaking more than the odd dish of ice-cream or slice of pie, your A1C will reveal it all.

Blood pressure:  People with diabetes are at a much higher risk of developing heart disease, stroke, kidney disease and eye diseases. Having high blood pressure, with or without having diabetes, also increases this risk. Therefore, it is important to keep your blood pressure below 130/80 mmHg. Blood pressure is often termed as the “silent killer” since we often do not feel any different when our blood pressure is high. That makes it all the more important to check your blood pressure. Lifestyle changes through diet and exercise is imperative and medications may also be required to keep your blood pressure controlled.

Cholesterol:  Having high cholesterol increases the chance of having heart disease, stroke, peripheral vascular disease and erectile dysfunction. Combine this with having diabetes and your risk further increases. Therefore, it is vitally important for you to keep your cholesterol levels in check. One key cholesterol level your health practitioner may look at is your LDL (“bad” cholesterol) as it should be <2.0mmol/L. Though people that do not have diabetes may be fine with a higher LDL level, it is a must for people with diabetes to keep their LDL lower to reduce their risks. The best way to help improve your cholesterol levels is to incorporate a healthy lifestyle with physical activity and a heart friendly diet. This includes:

· Reduce saturated fats (found in red meat, full-fat dairy products)
· Avoid trans fats which are also known as partially hydrogenated vegetable oil (found in margarines, store-bought cookies, crackers and cakes)
· Eat foods high in omega-3 fatty acids (found in certain fish, walnuts and flaxseed)
· Include soluble fibre in your diet since the fibre helps to reduce the absorption of cholesterol into your bloodstream (found in oatmeal, kidney beans, brussels sprouts, apples and pears)

Drugs to reduce cardio vascular disease (CVD) risk:  There are certain medications that most people living with diabetes take to help reduce their risk of CVD. These often include an ACEi (angiotensin converting enzyme inhibitor) or an ARB (angiotensin receptor blocker) which are medications often taken to help reduce blood pressure. These medications can also help protect the kidneys from the damaging effects diabetes can have.

Statins are a group of medications that help reduce the cholesterol levels in the body and thereby reduce the narrowing of the blood vessels and reduce the CVD risk. Low-dose ASA (acetylsalicylic acid) is taken by individuals that have CVD already to help keep the blood thin and help to prevent a clot from forming and a recurrent heart event. Keep in mind that ASA is no longer taken to prevent an initial CVD episode. SGLT2i (sodium-glucose cotransporter 2 inhibitors) and GLP 1-ra (glucagon-like peptide-1 receptor agonists) are medications that help reduce blood sugar but have also been shown to reduce CVD.

Exercise and healthy eating:  If you already have a physical activity routine set up, keep it up. It is recommended that we incorporate 150 minutes each week of moderate to vigorous aerobic activity as well as resistance exercises 2-3 times each week. The 150 minutes of aerobic activity can be split up into 21 minutes every day or 30 minutes five days a week or 50 minutes three days a week. Whichever you choose, don’t forget to also include the resistance exercises in your week too. Ask yourself (and be honest), are you getting enough physical activity in your day or week? Being physically active helps our body be more sensitive to our insulin (recall that insulin helps our cells use our blood sugar for energy and that having diabetes impairs our ability to produce insulin or our ability to make use of the insulin), helps lower our blood sugars and our risks of heart disease and nerve damage.

Examples of moderate aerobic activity include:
· Brisk walking
· Water aerobics
· Dancing
· Biking
· Doubles tennis
· Pushing a lawn mower
· Hiking

Examples of vigorous aerobic activity include:
· Jogging or running
· Swimming laps
· Biking quickly or biking on hills
· Singles tennis
· Brisk walking up hills

Examples of resistance exercises include:
· Push-ups
· Sit-ups
· Chin-ups
· Squats
· Lunges
· Planks

Adhering to a healthy diet will not only help you manage your diabetes but will also help prevent or reduce your complications associated with diabetes. Look into the Mediterranean diet which has been shown to help reduce CVD among other diseases.

Within this diet you are encouraged to eat the following:

  • plenty amounts of vegetables, fruits, beans, nuts, lentils, whole grains and plenty of extra virgin olive oil
  • moderate amounts of fish, cheese, yogourt and wine (if you do not drink alcohol, it is not suggested to start)
  • little to no meat (if choosing meat beyond the fish in the diet, opt for chicken instead of red meats), sweets, sugary drinks, butter

Screening for complications:  One of the best ways to help reduce the severity of the complication is to be aware of it in the first place. The following are routine tests that should be performed:

· ECG (electrocardiogram) every 3 to 5 years if you are over 40 years of age or if you already have diabetes complications
· monofilament or vibration testing every year or more frequently to help detect diabetic peripheral neuropathy
· eGFR (estimated glomerular filtration rate) and ACR (urine albumin to creatinine ratio) should be checked yearly to help to determine how well the kidneys are functioning
· annual retinal exam to help identify retinopathy

Smoking cessation (if applicable):  If you are not a smoker, that is great news. Please do not consider taking up this habit. If you are a smoker, you should strongly consider quitting sooner than later. We all know the negative effect smoking has on our lungs. Did you also know that nicotine can also increase our blood sugar? Not only that, it can make it more difficult to manage in the sense that a smoker with diabetes may find that a larger dose of insulin is required to lower the blood sugar. Smoking is known to cause a narrowing of the blood vessels and impair blood flow which further adds to the complications diabetes already has on the heart, the kidneys, the nerves, the eyes etc.

Self management for stress:  Check in with yourself and monitor your own body for signs of stress and/or depression. As discussed in our previous article, mental health is a real concern as many people with diabetes suffer from diabetes despair. When we are in a period of stress, our bodies release specific hormones which in turn increase our blood sugar. This can happen to everybody but will have a more negative impact for someone who already had diabetes.