Tips to Avoid Diabetes Complication

Diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock commitment. But your efforts are worthwhile. Careful diabetes care can reduce your risk of serious complications.

The diabetes complications :

NEUROPATHY (NERVE DISEASE)

Diabetic neuropathies are among the most frequent complication of long-term diabetes. It is estimated that 60% to 70% of diabetics have mild to severe forms of nervous system damage. The femoral nerve is commonly involved giving rise to symptoms in the legs and feet. Pain is the chief symptom and tends to worsen at night when the person is at rest. It is usually relieved by activity and aggravated by cold. Paraesthesias are a common accompaniment of the pain. Cramping, tenderness and muscle weakness also occur but atrophy is rare. Advanced femoral nerve disease is a major contributing cause of lower extremity amputations. Nerves in the arms, abdomen and back may also be affected. Symptoms may include impaired heart function, slowed digestion, reduced or absent perspiration, severe oedema, carpal tunnel syndrome, alternating bouts of diarrhoea and constipation, bladder atony, urinary and faecal incontinence and impotence.

With respect to sexual impotence, diabetes is probably the single most common disease associated with erectile failure (termed neurogenic impotence in the diabetic). Since diabetes is a metabolic disease with vascular and nervous system complications and an erection involves all levels of the nervous system from the brain to the peripheral nerves, lesions anywhere along the path may be responsible for erectile failure. It has been estimated that close to 50% of diabetic males have some degree of erectile dysfunction. Neuropathies usually improve with the control of the diabetes. Severe or chronic changes may require several weeks or months to show maximum improvement.

RETINOPATHY (EYE DISEASE)

Changes occurring in the eye which are distinctive of diabetes involve the narrowing, hardening, bulging, haemorrhaging or severing of the veins and capillaries of the retina. This is a serious complication known as retinopathy and may lead to loss of vision. Visual changes in the earlier stages may include diminished vision, contraction of the visual field, changes in the size of objects or photophobia. In the more advanced stage, termed 'proliferative retinopathy', haemorrhages, retinal detachment and other serious forms of deterioration are observed. When the disease progresses to this late stage total blindness may occur.

It usually takes between 10-13 years for diabetic retinopathy to develop and it is present in some degree in most diabetics who have had the disease for 20 years. In only about half of the diabetics who develop it however, is vision markedly impaired and blindness occurs in only about 6%. Still, diabetes is the leading cause of blindness in adults 20 to 74 years old and is estimated to cause from 12,000 to 24,000 new cases each year. Two other complications of diabetes, cataracts and glaucoma, can also lead to loss of vision

The development of laser therapy will probably reduce the prevalence of diabetes-induced blindness, however this therapy is not without occasional side effects (haemorrhage, retinal detachment and loss of visual field) and is therefore indicated only for the more serious conditions.

ARTERIOSCLEROSIS (VESSEL DISEASE)

The diabetic state is associated with earlier and more severe vascular changes than normally occur at a given age. Cardiovascular- renal disease is the leading cause of death among diabetics. Atherosclerosis can be accurately described as the end stage of Type 1 and Type 2 diabetes, since the vast majority of diabetes patients will die from an atherosclerotic event. Most commonly these events are cardiovascular in nature (an estimated 60% to 65% of diabetics have high blood pressure) although 20-25% of atherosclerotic events may be cerebrovascular or microvascular.

The incidence of coronary occlusion in persons with clinical diabetes has been estimated at from 8-17% with diabetic adults having heart disease death rates about 2 to 4 times as high as the general population. The risk of stroke is also found to be 2 to 4 times higher in people with diabetes. Arteriosclerosis obliterans in the lower extremities, a form of peripheral vascular disease, may produce disturbances in sensation, decrease in muscular endurance, intermittent claudication on effort, absence of peripheral pulses in the lower legs and feet and gangrene, and ultimately lead to amputation of the extremity. Diabetic gangrene usually involves the toes, heels or other prominent parts of the feet and is precipitated by trauma, infection or extremes in temperature. Needless to say, careful attention to proper foot care, avoidance of injury and consistent use of methods to improve peripheral circulation, including withdrawal from tobacco use in any form, are critical for the diabetic. The aetiology of large vessel disease is multi-factorial in the diabetic as well as the non-diabetic population with lipoprotein metabolism, hypertension, physical activity, obesity, cigarette smoking, stress, personality and genetic and racial factors all playing a part.

NEPHROPATHY (KIDNEY DISEASE)

Nephropathy is a common and important accompaniment of diabetes and one that in young diabetics takes precedence over heart disease as a cause of illness and death. As with eye changes, there is a wide variation in the type and degree of renal damage. Nephropathy is less frequent than retinopathy and where it occurs is also a development of long standing diabetes. Nevertheless, diabetes is the leading cause of end-stage renal disease in the US, accounting for about 40% of new cases. In 1995, a total of 98,872 people with diabetes underwent dialysis or kidney transplantation and 27,851 developed end-stage renal disease.

One study reported that among 200 juvenile diabetics who survived 20 years after onset, one half had evidence of renal disease. Another study found that the majority of these patients have hypertension and two thirds show significant albuminuria, but the fully developed nephrotic syndrome of hypertension, proteinuria and oedema occurs in less than 10% and renal function is impaired in only one half to three quarters of those patients.

Like other long-term complications, good blood glucose control goes a long way towards reducing the risk of diabetic nephropathy. In addition to monitoring the blood sugar levels, periodic monitoring of a diabetic patient’s kidney function (blood urea nitrogen, uric acid, creatinine and creatinine clearance) is important.

HYPOGLYCAEMIA

If there is too much insulin in the body compared to the amount of blood sugar, and the blood sugar falls below normal levels, a condition known as hypoglycaemia occurs. This problem of hypoglycaemia due to insulin or oral hypoglycaemic drugs is much more common in Type 1 than Type 2 diabetes since the Type 1 diabetic is directly injecting insulin. If too much insulin is administered, or the person misses a meal or over-exercises, hypoglycaemia may result. In this condition, commonly referred to as insulin shock, the brain is deprived of an essential energy source. The first sign is mild hunger, quickly followed by dizziness, sweating, palpitations, mental confusion and eventual loss of consciousness. Before the condition reaches emergency proportions, most diabetics learn to counteract the symptoms by eating a sweet or drinking a glass of orange juice. In some cases, the only effective measure is an intravenous injection of glucose.

DIGESTIVE DISORDERS

Based on the 1989 US National Health Interview Survey, diabetics are more likely than the general population to report a number of digestive conditions, including ulcers, diverticulitis, symptoms of irritable bowel syndrome, abdominal pain, constipation, diarrhoea and gallstones.

ORAL COMPLICATIONS

Periodontal disease, which can lead to tooth loss, occurs with greater frequency and severity among diabetics. Periodontal disease has been reported to occur among 30% of people aged 19 years or older with Type1 diabetes.

INFECTIONS

Studies in clinic, community and hospital populations indicate that diabetic subjects have a higher risk of some infections, including asymptomatic bacteriuria, lower extremity infections, re-activation tuberculosis, infections in surgical wounds and group B streptococcal infection. Populationbased data suggest a probable higher mortality from influenza and pneumonia.

COMPLICATION OF PREGNANCY

The rate of major congenital malformations in babies born to women with pre-existing diabetes varies from 0% to 5% among women who receive preconception care, to 10% among women who do not receive preconception care. Between 3% to 5% of pregnancies among women with diabetes result in death of the new-born; the rate for women who do not have diabetes is 1.5%4.

KETOACIDOSIS

Another acute complication more likely to occur in the IDDM is ketoacidosis, a condition caused by a lack of insulin leading to a build-up of ketoacids. Chemical compounds called ketones are one of the natural by-products of fat metabolism. Excessive ketone bodies are formed by the biochemical imbalance in uncontrolled or poorly managed diabetes. The condition known as diabetic ketoacidosis can directly cause an acute life-threatening event, a diabetic coma.

The possibility of ketoacidosis is suggested by:
• Confusion or coma, the patient almost always appearing extremely ill.
• Air hunger - an attempt to compensate for metabolic acidosis.
• Acetone odor (fruity) invariably on the breath.
• Nausea and vomiting almost always present.
• Abdominal tenderness which may mimic viral gastroenteritis.
• Extreme thirst and dry mucous membranes.
• Diabetic history (present in about 90% of cases).
• Weight loss.

Before the discovery of proper treatment by insulin and other intravenous injections, acidosis was the chief cause of death among diabetics. Today diabetics can use a simple urine dipstick at home to measure the level of ketones (excreted ketoacids) in the urine.


Here are TIPS to take an active role in diabetes care and enjoy a healthier future.

1. Make a commitment to managing your diabetes.

Members of your diabetes care team — doctor, diabetes nurse educator and dietitian, for example — will help you learn the basics of diabetes care and offer support and encouragement along the way. But it's up to you to manage your condition. After all, no one has a greater stake in your health than you.

Learn all you can about diabetes. Make healthy eating and physical activity part of your daily routine. Maintain a healthy weight. Monitor your blood sugar level, and follow your doctor's instructions for keeping your blood sugar level within your target range. Don't be afraid to ask your diabetes treatment team for help when you need it.

2. Schedule yearly physicals and regular eye exams.

Your regular diabetes checkups aren't meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications — including signs of kidney damage, nerve damage and heart disease — as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

3. Keep your vaccines up-to-date.

High blood sugar can weaken your immune system, which makes routine vaccines more important than ever. Ask your doctor about:

• Flu vaccine. A yearly flu vaccine can help you stay healthy during flu season, as well as prevent serious complications from the flu.
• Pneumonia vaccine. Sometimes the pneumonia vaccine is a one-shot deal. If you have diabetes complications or you're age 65 or older, you may need a five-year booster shot.
• Other vaccines. Stay up-to-date with your tetanus shot and its 10-year boosters, and ask your doctor about the hepatitis B vaccine. Depending on the circumstances, your doctor may recommend other vaccines as well.

4. Take care of your teeth.

Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day, floss your teeth once a day, and schedule dental exams at least twice a year. Consult your dentist right away if your gums bleed or look red or swollen.

5. Pay attention to your feet.

High blood sugar can damage the nerves in your feet and reduce blood flow to your feet. Left untreated, cuts and blisters can become serious infections. To prevent foot problems:

• Wash your feet daily in lukewarm water.
• Dry your feet gently, especially between the toes.
• Moisturize your feet and ankles with lotion.
• Check your feet every day for blisters, cuts, sores, redness or swelling.
• Consult your doctor if you have a sore or other foot problem that doesn't start to heal within a few days.

6. Keep your blood pressure and cholesterol under control.

Like diabetes, high blood pressure can damage your blood vessels. High cholesterol is a concern, too, since the damage is often worse and more rapid when you have diabetes. When these conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions.

Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Sometimes medication is needed, too.

7. Take a daily aspirin.

Aspirin interferes with your blood's ability to clot. Taking a daily aspirin can reduce your risk of heart attack and stroke — major concerns when you have diabetes. In fact, daily aspirin therapy is recommended for most people who have diabetes. Ask your doctor about daily aspirin therapy, including which strength of aspirin would be best.

8. Don't smoke.

If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage and kidney disease. In fact, smokers who have diabetes are three times more likely to die of cardiovascular disease than are nonsmokers who have diabetes, according to the American Diabetes Association. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.

9. If you drink alcohol, do so responsibly.

Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation and always with a meal. Remember to include the calories from any alcohol you drink in your daily calorie count.

10. Take stress seriously.

If you're stressed, it's easy to abandon your usual diabetes care routine. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which only makes matters worse. To take control, set limits. Prioritize your tasks. Learn relaxation techniques. Get plenty of sleep.

Above all, stay positive. Diabetes care is within your control. If you're willing to do your part, diabetes won't stand in the way of an active, healthy life.