Q. I have just been told that I now have diabetes. I know so many people with diabetes. With so many medications available to help control my blood sugar, is there any reason I need to be concerned about having diabetes?
A. You should absolutely be concerned that you now have diabetes. As mentioned in our previous Ask the Pharmacist article, the process leading to some of the nasty long-term complications related to diabetes begins well before we are diagnosed. Among these to be concerned about are heart disease and stroke, nerve damage, chronic kidney disease, eye damage, hearing loss, oral health and mental health concerns. Let’s take a look at each of these complications in more detail.
Heart disease and stroke: You may have heard this before but diabetes increases your risk of heart disease and stroke. Heart disease is the leading cause of death in the United States and it is the second leading cause of death in Canada. If you have diabetes, your risk is doubled. To make matters worse, you may develop heart disease 15 years earlier than those people around you that do not have diabetes. Mostly this is due to the diminished supply of blood and oxygen due to a narrowing (hardening) or a blockage of the arteries that supply the heart (coronary artery disease) resulting in a heart attack or affecting the supply to the brain (resulting in a stroke). All to often these same individuals have other risk factors that further increases their risk of heart disease which include;
· Being overweight; especially if the excess weight is focused about the waist
· Having a sedentary lifestyle
· Having high blood pressure
· Having high cholesterol
· Being a smoker
· Drinking too much alcohol
· Having a diet high in saturated fats, trans fats, cholesterol and sodium
· Having a family history of heart disease or stroke
This hardening of the arteries may occur elsewhere in the body such as the legs and feet. When this happens, it is termed peripheral artery disease. This may be the first sign that you indeed have cardiovascular disease so it is important to be aware and in tune with your body.
People with diabetes are also at a higher risk of developing heart failure. In this scenario, the heart hasn’t stopped beating as it does in the event of a heart attack but rather it just isn’t pumping blood well. When this occurs, you may experience leg swelling and a fluid buildup in the lungs making it difficult to breathe.
Nerve damage and amputation: Over time, having high blood sugar can affect various nerves within the body. This damage to the nerves doesn’t allow nutrients to get through or messages to be delivered or sent. There are four main types of nerve damage.
1. Peripheral nerve damage is the most common type and affects the peripheral body parts such as legs, arms, feet and hands. This is termed peripheral neuropathy and is often described by having the sensation of “pins and needles” or “tingling. Some people may also be sensitive to touch and complain that even a bed sheet can cause much pain. This nerve damage may lead to weakness, numbness and lack of sensations such as pain, heat or cold. When this happens, people may not notice a minor cut, scrape or blister. This minor issue may become infected and the lack of feeling allows the infection to become very serious and out of control. This may result in the death of the affected tissue which is termed gangrene. When this occurs, often the best treatment to get it under control and prevent further spreading is amputation.
2. Autonomic nerve damage affects the organs such as the heart, bladder (urine leakage), stomach (constipation or diarrhea), intestines, sex organs (unable to perform sexually) and eyes.
3. Proximal nerve damage primarily affects the nerves that are located in the thighs, hips, buttocks or legs and results in severe pain in the affected area. It can also impede your ability to get up from a seated position.
4. Focal nerve damage affects some single nerves, the most commonly affected are in the hand, head, torso or leg. Some examples of focal nerve damage are double vision, weakness in hands to the point of dropping items as well as symptoms of Bell’s palsy (unable to move one side of face).
The risk factors that make you more likely to experience nerve damage are;
· Having high blood sugars
· Having high triglycerides
· Having high blood pressure
· Being overweight
· Being a smoker
Peripheral neuropathy is by far the most common type of nerve damage seen by people with diabetes with the feet and legs being the most affected. In fact, half of the people living with diabetes experience nerve damage. For this reason, it is important to take proper care of your diabetes and reduce your other risk factors. Pay close attention to your feet and inspect them daily for any cuts or sores. Keep them clean by washing them every day. Apply a lotion to prevent dryness and cracking but not between the toes as that may lead to another infection. Never walk bare footed but rather always wear properly fitted shoes. Attending a foot clinic monthly is a great way to have a professional inspect your feet and trim your nails for you.
Chronic kidney disease (CKD): The purpose of our kidneys is to remove waste from our blood through our urine. The kidneys also function as a great regulator of fluid and salt which helps keep our blood pressure in check.
One of the leading causes of CKD is diabetes. Of all the people living with diabetes, nearly half of them will endure kidney damage at some point. The higher-than-normal blood sugar in the body can cause damage to our blood vessels in the kidneys which will affect their ability to filter the blood. When this occurs, microalbuminuria results which is when tiny protein particles make their way into the urine. This commonly transitions to proteinuria when the kidney disease progresses further and larger amounts of protein are found in the urine.
When the kidneys begin to malfunction, the waste products that are not being excreted in the urine begin to build up in the blood. If you do not take action and attempt to protect the kidneys, they will ultimately fail resulting in end-stage renal failure. At this point the only treatment is dialysis or a kidney transplant.
Diabetes can affect various nerves in our body which we just discussed above and one of the nerves that can be affected are within our bladder. These particular nerves help to warn you when your bladder is full and if this feeling is left unnoticed, the pressure from the full bladder can also have a negative effect on the kidneys. Having urine sitting in the bladder longer than normal increases your risk of developing a urinary tract infection. Some of the key risk factors for CKD are;
· High blood sugar
. High blood pressure
· High cholesterol
Eye damage and vision loss (retinopathy, macular edema, cataracts, glaucoma): Diabetes can increase your risk of experiencing eye damage which may ultimately lead to vision loss or blindness. Just as the higher-than-normal blood sugars can affect the kidneys, so too can they have a negative effect on the blood vessels located in the eyes. Diabetic retinopathy occurs when the excess blood sugar damages the blood vessels in the retina which may cause them to weaken, swell and leak blood and other fluids into the retina resulting in macular edema. This often causes visual disturbances such as blurred vision, blind spots and if left untreated, blindness. Nearly half of the people living with diabetes will develop macular edema.
Hearing loss: Having high blood sugars can also affect the nerves in the inner ear and ultimately lead to hearing loss. People with diabetes are twice as likely to have hearing loss compared to those people of the same age who do not have diabetes. Even having pre-diabetes are 30% more likely to have hearing loss compared to people with normal blood sugar. Some signs that you might be experiencing hearing loss are if you often ask people to repeat themselves, have trouble keeping up with group conversations, think people are mumbling around you or you need to turn the volume up on your radio, TV or other gadgets.
Oral health: Having high blood sugar also means that your saliva is high in sugar too. This excess sugar in your mouth predisposes you to cavities, tooth decay and gum disease. Having diabetes not only increases your risk of gum disease but it also may increase the severity and make it more difficult to heal. Not only that, having gum disease can make your diabetes more difficult to manage. Floss your teeth once a day and brush them twice a day to keep your mouth healthy. Signs of gum disease that would trigger a visit to your dentist are gums that are red, swollen or bleed easily as well as a dry mouth, loose teeth or mouth pain.
Mental health: As you can see, having diabetes put added stress on the body. Keeping your overall health and your diabetes in control is vital to preventing or at least delaying the onset of these brutal complications. You may have noticed the trend that half of people with diabetes will progress to having these complications. You may have also noticed the common theme to the risk factors (high blood sugar, high blood pressure, high cholesterol, overweight) and it can feel like a burden to try to reduce these risk factors. People can become very overwhelmed and develop diabetes distress. They may want to just give up the fight which leads to unhealthy habits, the stopping of checking blood sugars and not attending doctors appointments. At any given 18 month period, 33% to 50% of people with diabetes have diabetes distress.
Now that we have learned about the complications that can arise with having diabetes, stay tuned for ways that we can help reduce or prevent them from happening.
For more information on this or any other topic, contact your pharmacist.