Let’s dive in and talk about diabetes complications. What is the issue with high levels of sugar (hyperglycemia) in the blood? It sounds like a mild and relatively harmless condition. It does not cause you to suffer fever, diarrhoea, vomiting, headache or abdominal pain. Is there cause for alarm? Yes. The effects of diabetes are silent over time and result in severe disability and eventually death if untreated.
Acute complications of diabetes include diabetic ketoacidosis and hyperosmolar hyperglycaemic states. These may cause coma and immediate death if untreated. Low blood sugar (hypoglycaemia) is another acute complication that occurs commonly in patients on insulin medication.
Chronic complications occur through damage to small blood vessels (microvascular damage) and damage to large blood vessels (macrovascular damage) by the hyperglycaemia.
Damage to small blood vessels causes:
- Diabetic nerve disease (neuropathy). This is the most common complication of diabetes. One may feel tingling sensations, pain and numbness on the affected nerves. It may cause impotence in men and diabetic foot disorders.
Diabetic foot disorders involve ulceration to the feet. When these wounds are infected and poorly managed, they may lead to amputation of the affected limbs.
- Diabetic eye disease (retinopathy). There is a progressive loss of eyesight and eventual blindness. It affects a third of people with diabetes, being the leading cause of blindness in working-age adults in the world.
- Diabetic kidney disease (nephropathy). There is progressive damage, causing reduced kidney function and eventual failure. When the kidneys fail, one requires dialysis treatment and a kidney transplant.
Damage to large blood vessels causes atherosclerosis which is the deposition of fats and cholesterol in the vessels. Vessels in the heart, brain and legs are commonly affected, causing reduced blood flow to these organs. This leads to heart attacks, strokes, poor wound healing and pain in the legs. These cardiovascular diseases are the leading cause of death in people with diabetes.
Other chronic complications include:
- Raised blood cholesterol levels (hyperlipidemia) that compound the cardiovascular diseases.
- Lowered immunity: hyperglycaemia harms the body’s immune cells, compromising the response to infections.
- Risk of gum disease (periodontitis) and subsequent tooth loss.
Untreated diabetes in pregnancy may cause the foetus to have excess weight, leading to complications during delivery and low sugars in the newborn.
Management of diabetes.
While there is no cure for diabetes, it can be managed effectively. The goal in the treatment of diabetes is to keep the blood glucose levels in the normal range, or closest possible levels to the normal range. It also aims at treating the complications and delaying their progress.
The management involves lifestyle modification and medical treatment while monitoring blood glucose levels at home.
Lifestyle modification.
This includes strict diet control and physical exercises, stopping tobacco use and limiting alcohol intake. Following a diet plan helps control blood sugars and lowers blood fats and manages the body weight. Moderate-intensity physical exercises such as walking, jogging and strength training exercises for about 30-minutes daily help one achieve weight loss and maintain their normal weight. In reports published in online journals, the American Diabetes Association (ADA), there is an increase in insulin sensitivity with weight loss.
Did you know? With lifestyle modifications, individuals have reported partial and complete remission of diabetes.
Medical treatment:
- Individuals with type 1 diabetes require daily insulin injections
- People with type 2 diabetes mainly use oral hypoglycaemic drugs such as Metformin and Glimepiride. However, some may also require insulin.
These hypoglycaemic drugs act by increasing pancreatic insulin secretion, decreasing the liver’s glucose production or increasing the insulin sensitivity of the body cells.
- Blood pressure control
- Drugs that lower blood lipid levels.
Medical treatment also involves regular hospital clinic attendance for blood glucose control monitoring. Annual eye check-ups, dental check-ups, blood lipid levels tests and regular urine and blood tests to check kidney function are components of the routine care.
Advice on leg care and proper wound management is given to avoid diabetic foot disorders.
If you suffer from diabetes, it is imperative to adhere to prescribed medications, diet advises, be physically active and limit your tobacco and alcohol use.
How do you prevent diabetes?
While type 1 diabetes cannot be prevented, factors that cause type 2 diabetes are modifiable. According to the World Health Organization, lifestyle modification will protect one from developing diabetes. It also prevents or delays the onset of the disease in people at higher risk e.g. those with a positive family history of diabetes.
Prevention is better than cure. Adopting a healthy diet, regular physical exercise and avoiding cigarette and alcohol use will not only protect you from diabetes but also the other non-communicable diseases.
COVID-19 and Diabetes:
People living with diabetes have been reported to develop moderate to severe COVID-19 disease. According to the International diabetes foundation (IDF), people with diabetes are more vulnerable to the virus because of the compromised immune systems that take more time to fight the virus and the virus thriving in the high-sugar environment.
