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Avoiding the Complications of Diabetes
by Dr. Debra Buckler
Published in The Joplin Globe Senior Outlook Aging Watch column
October 2009

Diabetes mellitus, a common condition, occurs when the body fails to properly utilize glucose. It affects about seven percent of adults in the United States and its prevalence increases with age. The likelihood is high that someone you love has diabetes. The mainstay of treatment involves the control blood sugars. However, it has also been found that most patients with diabetes also suffer from increased cholesterol and triglycerides. Proper treatment of these abnormalities is essential to minimize the long-term complications of diabetes. The main focus of this article is to review the common long-term complications of diabetes and show people how to protect themselves from them.

Complications of diabetes stem largely from disorders of the vascular system (blood vessels) and disorders of the nervous system. Abnormalities in these systems develop slowly over the course of many years. This accumulation of damage leads to the clinical complications often seen in diabetes. These conditions include eye disease (retinopathy), heart disease, strokes, kidney failure, an abnormal state of the nerves (neuropathy), and poor circulation (peripheral vascular disease). Let’s look at each of these problems separately.

Because of the decreased blood flow to the eye that occurs with vascular disease, the back portion of the eye develops a condition called diabetic retinopathy, which can lead to impairment of vision. Fortunately, diabetic retinopathy is treatable. However, there are no warning signs of early disease so people with diabetes need to see an ophthalmologist or optometrist at least once a year beginning as soon as they learn they have the disease.

People with diabetes have a higher risk of heart attacks and stroke and often suffer from these conditions at a much younger age than their nondiabetic counterparts. These problems result from impaired blood flow to either the brain or the heart due to vascular disease. Because people with diabetes often suffer nerve damage, heart attacks often occur without pain. Good control of blood sugar and cholesterol are important to minimize the risk of heart attack and stroke.

Another common problem in patients with diabetes is renal or kidney failure in a condition known as diabetic nephropathy. The kidneys normally cleanse the bloodstream of by-products of metabolism to maintain healthy body chemistry. As vascular disease develops, the blood flow becomes sluggish and puts added strain on the kidneys, which can lead to kidney failure. If it becomes severe enough, a patient will require either a kidney transplant or dialysis. The first sign of kidney failure is an abnormality in the urine and, if found, further damage can be slowed with proper medication. It is important that your healthcare provider perform a urine test annually to detect abnormalities early. Also, blood tests will show if the kidneys work properly.

Poor blood flow to the extremities results in a condition known as peripheral vascular disease. It most often affects the legs because they are furthest from the heart. The earliest symptom is pain in the calves that occurs with exercise; however, many patients do not develop this symptom. For these patients, an ulcer or sore on the foot or ankle that does not heal well can be the first sign. The poor sensation that many diabetics have in their feet due to nerve damage further complicates this condition—patients might not feel a minor foot injury such as stepping on a sewing needle. Consequently, small injuries can develop into severe wounds. People with diabetes should examine their feet and toes routinely to find sores early, when most treatable. Medical treatment of peripheral vascular disease consists of vascular surgery to try to correct poor blood flow, but in many cases, this is not a viable option. Often, amputation needs to occur to prevent infection from a foot wound from turning deadly.

The last commonly seen complication of diabetes is diabetic neuropathy, a condition where damaged nerves lead to numbness or poor sensation, most commonly in the feet. Some patients suffer from severe pain in the leg, often described as knifelike, while others report bothersome burning in the feet. Patients should consult their doctor about medications to treat and relieve this painful condition.

Diabetes is both common and wrought with complications. It is important for people with diabetes to learn about the common complications of the disease so that they can work in partnership with their healthcare provider to catch problems early. For people wanting to increase their awareness of diabetes, the Third Annual Freeman Diabetes Expo, Thursday, October 29, at Freeman Business Center, offers a wide variety of health resources and educational materials for people with diabetes or those at risk of developing the disease.

About Dr. Debra Buckler
Debra Buckler, DO, is a Freeman Health System physician specializing in geriatric and nursing home medicine. Additionally, she serves as Medical Director for Joplin Health and Rehabilitation Center and Co-medical director for National Health Care of Joplin.