Category: Complications

Common Complications Among Type 2 Diabetics: This article is offered as a clearinghouse of basic information regarding complications that can and do occur among Type 2 diabetics. Professional advice should be sought from your primary physician.

Heart Health
The American Diabetes Association indicates 2 out of 3 Type 2 diabetics will die from complications regarding the heart. This includes stroke. Managed care for the diabetic is more than just keeping their blood glucose in check. They will also need to pay careful attention to cholesterol levels and watch for hypertension (high blood pressure).

Diabetic Amyotrophy
Damaged nerves (neuropathy) can signal a wasting of the muscles in the lower limb(s) of diabetics. This is often noted in older men. Most experts indicate it is reversable with managed care.

Eye Health
Nerve damage to the eyes (retinopathy) is common among diabetics and can lead to ongoing challenges. However, many diabetics find that the advance of the problem can be halted or even reversed if they seek help quickly. Additional complications include cataracts and glaucoma.

Kidney Health
When blood is filtered through the kidney to eliminate waste only the actual waste should be removed. In the diabetic there may be damage to the blood vessels that allow too much blood to pass through the kidney’s filtering system. This results in overworked kidneys (nephropathy). The end result is kidneys that seem to give up allowing waste and toxins to build up in the blood stream.

Gum Health
Your mouth is also a target for diabetes. Gum tissue diseases seem to affect those with poorly managed blood sugar levels more often than those who do not have diabetes. Your dentist can help you learn signs of gum disease and how to manage oral health.

Mental Health
Diabetes and depression often cohabitate in the same body. Experts aren’t sure if depression plays a role in diabetes development or if onset diabetes creates an atmosphere that is perfect for the development of depression. Either way help is available to deal with depression. When that is dealt with most diabetics are then free to engage in better self-care management.

Foot Health
Due to poor circulation caused by nerve damage many diabetics find they are prone to stubborn sores on their feet. The use of diabetic shoes and socks can help, but regular foot inspections help the diabetic identify problems and seek help. Left untreated these sores can become so infected amputations may be required.

Stomach Health
Like other health disorders this is caused by nerve damage within the stomach that effectively slows down digestion creating heartburn and nausea. Severe complications can occur that in the worst case scenarios may result in the need for a feeding tube.

Sexual Health
Again nerve damage can affect both male and female diabetics in unique ways. There are management methods that can create an environment welcoming to intimacy.

Skin Health
There are a significant number of issues related to the health of the skin of a diabetic. Bacterial and fungal skin issues are common among diabetics, but most can be treated.

The National Institute on Diabetes and Digestive and Kidney Diseases (NIDDK) offers the following encouragement.

• Keep Your Diabetes Under Control
• Keep Your Eyes Healthy
• Keep Your Feet and Skin Healthy
• Keep Your Heart and Blood Vessels Healthy
• Keep Your Kidneys Healthy
• Keep Your Nervous System Healthy
• Keep Your Teeth and Gums Healthy

These objectives can happen when you pay close attention to your blood glucose, work to identify potential problems and visit regularly with your health care provider.

Why Do Type 1 Diabetics Lose Weight Before a Diagnosis: In order to answer this question we need to know something about muscle function in the human body.

Normal glucose levels allow all parts of the body to gain access to the energy to drive the body forward and do all the things the body was designed to do. When blood glucose levels are low the body has it’s own defense system and it can create small amounts of what are known as ketone bodies.  Ketone is flushed into the blood stream and used by the brain for emergency functions.

This phenomenon is most noted in countries where starvation is common. The bodies of men, women and children who do not have enough to eat will be able to carry on for a period of time using these ketone reserves. However, these reserves come at a price.

If the body is starved for blood glucose long enough it will begin to dismantle muscle mass to create ketone for body function. This is why you will routinely see very thin arm and legs when viewing pictures of those who are starving. The brain requires a significant amount of fuel to remain functional so in starvation conditions it will effectively demand the full time production of ketone when blood glucose is unavailable as a fuel.

When there is no fuel to develop muscles the body has been programmed to use those muscles to develop emergency energy. This condition isn’t exclusive to starvation.

Type 1 Diabetes and Ketones
Proper insulin regulation can negate the need for the body to create large quantities of ketone, but without insulin conditions can change rapidly. When a Type 1 diabetic (pre-diagnosed) runs low on blood sugar it creates an environment that can develop into what is called diabetic ketoacidosis (DKA).

Wikipedia suggests the following symptoms are common among Type 1 diabetics who have DKA.

• Sluggishness, extreme tiredness.
• Extreme thirst, despite large fluid intake.
• Constant urination
• Fruity smell to breath, similar to nail polish remover (acetone).
• Hyperventilation, at first rapid and shallow, then progressively deeper and less rapid.
• Extreme weight loss.
• Oral Thrush and/or persistent vaginal yeast infections may be present; this is because the normal fungal flora present in the oral cavity and cervix is disrupted
• Muscle wasting.
• Agitation / Irritation / Aggression / Confusion
• Vomiting, nausea
• Extreme pain in shoulders, neck and chest

Parents of pre-diagnosed Type 1 diabetic children may actually believe that their child may be drunk.

When an individual expresses symptoms of DKA it may be preceded by noticeable weight loss. Again, the reason this is true is that the body is dealing with a lack of blood glucose and has been feasting on keton created by the consumption of muscle mass.

Many Type 1 diabetics discover their condition following an initial diagnosis of DKA. The diagnosis of DKA accounts for about 25% of subsequent Type 1 diabetes diagnoses.

If not treated right away Wikipedia suggests the following conditions may occur.

• Emesis (vomiting), although this is not always a sign of late-stage ketoacidosis, and can occur both in early-stage ketoacidosis and in non-ketoacidic hyperglycaemia.
• Confusion.
• Abdominal pain.
• Loss of appetite.
• Flu-like symptoms.
• Lethargy and apathy.
• Extreme weakness.
• Kussmaul breathing (“air hunger”). A type of hyperventilation where patients breathe very deeply at a normal or increased rate. This is a sign of severe acidosis.
• Unconsciousness (a variety of diabetic coma) after prolonged DKA. At this stage, speedy medical attention is imperative.
• Death

Although complications can result in death most cases of DKA respond well to treatment and are able to fully recover.

Fingertip Felons in Diabetics: A lancet is the device diabetics use to puncture the outer layer of skin in order to get a drop of blood for glucose testing. This is a common practice for those who live with diabetes.

Many like to use a lancet pen. You simply cock the pen and place it against the testing site. Press the button and the lancet will puncture the skin and should draw enough blood to test. These pens have various settings so you will need to adjust until the pen punctures only as deep as is necessary for testing purposes.

For those new to this procedure you should wash your hands before testing with soap and warm water. Find a comfortable place to sit and place the lancet device on the side of your finger just below the fingertip. It may be hard to get used to the test. If it is very uncomfortable to take the test you might ask your physician for help in locating a lancet that is the least painful.

Diabetics are not generally consistent in when they replace their lancet. Some may only replace the lancet needle every few months while other may insist on replacing it daily – most fall somewhere in between those extremes. Dr. Daniel Einhorn is quoted as saying, “Since the lancet goes into the subcutaneous space and is not being used intravenously, and since blood is flowing out of the body, sterility is generally not an issue. The rate of infections and injury from lancets is extremely low. Many people, however, are not able to reuse lancets because they feel discomfort or they experience scarring if the lancet is not in optimal condition. Once a lancet has been used, its surface is rougher, the lubricant wears off and the point is duller. Any handling of the lancet, such as cleaning with alcohol, tends to worsen it.”

However, ten years ago Japanese doctors suggested that using the fingers for testing blood glucose was not a healthy way to gain test data. These doctors suggested large-scale development of devices aimed at helping patients test using small pricks in their earlobe or even their toe.

The concern these Japanese doctors expressed is found in a condition called Felon. According to Emedicine.com, “Felons are characterized by marked throbbing pain, tension, and edema of the fingertip pulp.”

Essentially it is possible to test and then infect your finger using a lancet. You can typically heal well from Felon, but it often requires antibiotics. The problem is most diabetics already experience pain with testing so they may not recognize there is an issue.

A Felon may be caused by a Staph infection and the staff infection may have been introduced through blood testing in diabetics. There are some Felons that are introduced into the fingers of diabetics when the patient has a habit of chewing their fingernails.

If your fingers continue to experience pain long after your original testing it may be a sign that there are more problems than a lancet prick. Be sure to check with your doctor.

Additionally if you have a dominant hand that you use for certain personally enjoyable pursuits you may want to test the less dominant hand. This allows musicians to keep playing. Typists may ask for options other than fingers if this occupation is their primary livelihood.

There are multiple options with respect to the ultimate sites you use for blood glucose testing. Have your doctor explain options and the difficulties you may experience with each. Assess risks and make a choice that is beneficial to your overall management plan.

Does Ethnicity Have Anything to Do With Retinopathy: Retinopathy is something everyone with diabetes is concerned about. After all the eyes are a window on all we hold dear. With our eyes we have seen husband, wife, children, grandchildren, parents and grandparents. We’ve seen friends and majestic scenes. We’ve watched the sunset and have thrilled to the early morning rise of the sun.

ScienceDaily.com recently reported on a study by the University of Warwick in the UK. This study shows, “Diabetic retinopathy (damage to the retina) is more prevalent in South Asians and occurs earlier than in White European people with diabetes.”

The original study was published in DiabetesCare and contrasted the health profiles of, “1,035 patients with type 2 diabetes, 421 were of South Asian origin and 614 were White Europeans. The results showed 45% of South Asians had retinopathy, compared to 37% of White Europeans, and 16% of the South Asian group had sight threatening retinopathy, compared to 12% White Europeans.”

The study also indicated that South Asian adults seem to contract Type 2 diabetes about 4 years earlier than White Europeans. The average age for South Asians to contract diabetes is 53. Retinopathy in South Asians is seen an average of seven years earlier than their White European counterparts.

For this study ScienceDaily.com reported, “Researchers collected clinical data from 10 GP practices in the Foleshill area of Coventry. Details on risk factors including blood pressure, duration of diabetes, age at onset of diabetes and cholesterol were recorded.” This information covering hundreds of patients was used to develop statistical data.

The outcome of this study has researchers urging screenings for South Asians in an effort to catch onset diabetes early and treat accordingly.

Professor Sudhesh Kumar, Professor of Medicine, Diabetes & Endocrinology at Warwick Medical School said, “The South Asian participants in this study had significantly higher systolic and diastolic blood pressures and cholesterol levels. Systematic screening for retinopathy, combined with intensive management of diabetes, including reduction of blood glucose and blood pressure, could help to reduce the incidence of visual impairment and blindness in ethnic minority groups across the world, addressing an important health inequality.”

Physicians argue that an early diagnosis can help them slow the deterioration of the retina allowing patience full use of their vision for the longest time period possible.

A press release from the University of Warwick cites fellow research co-author Dr Paul O’Hare as saying: “Screening for diabetic retinopathy is becoming more systematic across the UK and the developed world. However, coverage rates and uptake among ethnic minority groups in inner city areas may be much lower than those for white Europeans. We need to address this to try and rectify these important health inequalities.”

The National Institute on Health reports, “Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.

“In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

“If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.”

The University of Warwick remains an advocate of early screening among all at-risk groups. While this research was isolated to a specific region within the UK it should serve as a red flag for other researchers to explore similar data in their specific regions.

Your doctor has been telling you that tight control over Type 1 diabetes is a good idea. Now there is new proof that your doctor was right.

In the latest issue of the Archives of Internal Medicine researchers say that consistent and positive glucose control in Type 1 diabetics early and always may lead to a life without some of the worst complications associated with diabetes.

Dr. Daniel Nathan, director of the diabetes center at Massachusetts General Hospital is the co-author of the report and says, “We wanted to describe what happens with modern day management, and over a 30-year period, we found that people with type 1 diabetes should no longer be suffering from those most serious complications.”

Those complications include…

• Diabetic eye disease
• Diabetic kidney disease
• Heart disease

Over 1,600 diabetics participated in the study that took place over 3 decades. Researchers are quick to point out that their findings included early glucose control efforts that were not nearly as precise or controlled as they are today. They suggest this means better news in the future because with newer methods of glucose control there may be room to reduce Type 1 diabetic complications even further. “Type 1 diabetes need not be accompanied by the frequent occurrence of long-term complications, and people with type 1 diabetes can look forward to long, healthy, productive lives,” Nathan indicated.

In virtually every case the risk for the most intense diabetic complication was cut in half when measured between the tightly controlled group and those involved in the conventional group.

What this means is a 50% reduction in instances of heart disease, blindness and even amputations among Type 1 diabetics who take an active role in their diabetes management.

One struggle researchers noted was that because Type 1 diabetes often begins in childhood there may be a transitionary phase between a parental insistence on tight control and a Type 1 diabetic youth assuming personal responsibility for that control. There can be a period of time when control is not well regulated, but researchers believe that when the young person acknowledges they feel better when their diabetes is controlled the push for quality control becomes a priority for the Type 1 diabetic.

Nathan points to the positives of that swing, “Physicians and patients can now have a clear idea of what their prospects are over a long period of diabetes. They had a bad outlook — a chance of developing amputation, kidney failure, and blindness. But with modern-day therapy, their outlook is much brighter than it has ever been.”

There can be one complication that comes with the territory of tight glucose control in Type 1 diabetics and that is in regards to A1c levels. Doctors want to see that level lower than a 7, but in many instances this can lead to severe hypoglycemia resulting in a diabetic coma or seizure. Not all patients have a clear understanding of how to manage episodes of hypoglycemia even when they may be managing their diabetes very well.

In context of history diabetes was once viewed as a death sentence. This new study confirms what many health care providers have been saying all along. The better you become at assuming responsibility for your own daily care the fewer potential health issues you may encounter as you age.

Reducing Diabetic Amputations By Healing Wounds Faster: One of the problems diabetic patients have is the slow healing of wounds. Sometimes these wounds become intense enough that an amputation is required. Researchers suggest it may be possible to speed up healing time in wounds among diabetics.

ScienceDaily.com indicates, “The drug, deferoxamine, helped diabetic mice heal small cuts 10 days faster than those who did not receive treatment, according to researchers from Stanford University School of Medicine and the Albert Einstein College of Medicine. The team is now working to arrange human trials for deferoxamine. If the results translate, it could help doctors combat such diabetic complications as foot ulcers.”

Deferoxamine is an iron-binding drug that seems to accelerate wound healing.

According to ScienceDaily.com, “Blisters, cuts or pressure sores on diabetic patients’ lower limbs often heal slowly or not at all, putting patients at risk for infection and amputation. Internal injuries are an issue, as well: More than 40 percent of patients hospitalized for heart attacks have clinical diabetes, and they are less likely to recover fully than their non-diabetic counterparts. The reason, say researchers, is that diabetic tissue fails to reconnect oxygen-deprived areas to the bloodstream with new vessels. What they didn’t know was why the vessels don’t form.”

The problem is in the glucose. High blood sugar in diabetic patients makes it difficult for new vessels to form. The use of deferoxamine in this context is a short jump from it’s approved use for, “The management of chronic iron-overload disorders.” This study demonstrates clinically that there may be a 90% improvement among diabetic patients who would use this type of therapy by effectively negating the effects of high glucose on wound healing.

Why does an iron-reducing drug allow for improved healing among diabetics? The research suggests, “High glucose inside cells results in the creation of free radicals, which oxidize iron. The iron then interacts with other cellular molecules to form DNA-damaging hydroxyl radicals.”

Although researchers had to develop special ways to level the playing field to compare the effectiveness of the inexpensive drug they did see extremely promising results, “Mice treated with the drug healed in 13 days, compared with 23 days in untreated mice. Treated mice also produced almost threefold more vascular endothelial growth factor.”

This research follows on the heals of other research that is finding new uses for existing drugs – new applications for drugs that might be able to facilitate positive results while remaining inexpensive.

Deferoxamine is generally administered through an injection, but scientists are discussing the possibility of a dissolvable sheet that can be placed on the wound and work to facilitate healing directly at the site of the wound.

The implications for this new research are huge. The American Diabetes Association (ADA) reports, “Diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15 to 40 times greater for a person with diabetes. More than 60% of nontraumatic lower-limb amputations in the U.S. occur among people with diabetes. Each year, 82,000 people lose their foot or leg to diabetes.”

Other sources suggest amputations among diabetics are ten times higher than non-diabetics. In finding a way to reduce the wounds that can lead to amputation the end result is both lives saves as well as an improvement in the overall quality of life for many diabetic patients.

The Anemic Cycle of an Impaired Kidney: One of the problems most often associated with diabetes is a decrease in kidney function and disease that often accompanies kidney decline. It appears the kidneys may have more responsibility for good health than you may have thought.

A recent report from the National Anemia Action Council suggests, “Persons with diabetes and hypertension are at risk for kidney disease which can be progressive, leading to reduced kidney function and even kidney failure. One of the consequences of reduced kidney function can be anemia and increased risk for cardiovascular disease and events.”

The Cycle

• Weight. As we gain weight added stress is put on the kidneys – damage can then develop.
• Erythropoietin Reduction. This hormone is created in the kidneys, but can be reduced dramatically as diabetes develops.  MedicineNet.com says, “The kidney cells that make erythropoietin are specialized so that they are sensitive to low oxygen levels in the blood that travels through the kidney. These cells make and release erythropoietin when the oxygen level is too low. The low oxygen level may indicate anemia, a diminished number of red blood cells, or hemoglobin molecules that carry oxygen through the body.”
• Red Blood Cell Production. With a decrease in erythropoietin red blood cells are at risk. Erythropoietin is responsible for developing these cells with a destination of the bone marrow.
• Anemia. As red blood cells decrease anemia can develop.
• Heart Conditions. As anemia develops it can place a strain on your heart and other organs.

For those who don’t know what anemia is MedicineNet.com describes this as the, “Condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.”

Anemia.org suggests, “There are several complications that can emerge over time with diabetes and the associated elevated blood sugar levels including CKD (Chronic Kidney Disease), hypertension and cardiovascular disease. Additionally, diabetic retinopathy and diabetic neuropathy are prevalent in patients who have had diabetes for many years. Many complications, either directly or indirectly, may contribute to anemia and worsening of clinical outcomes for patients with diabetes.”

Essentially this cycle means that the kidneys become increasingly incapable of delivering the hormone that helps create adequate red blood cells. With a lack of those cells hypertension, heart issues and optical and kidney issues can become a problem for the diabetic. This is often why diabetics have an iron deficiency.

The good news is medical science can provide management goals that can work to keep red blood cells in balance, but this needs to be monitored in conjunction with your doctor.

If you are not diabetic you may be wondering how it is possible to determine if you may be at risk. Anemia.com offers the following checklist.

At-risk for Pre-diabetes & Diabetes

• Family history of diabetes
• Cardiovascular disease
• Overweight or obese state
• Sedentary lifestyle
• Latino/Hispanic, Non–Hispanic Black, Asian American, Native American, or
• Pacific Islander ethnicity
• Previously identified impaired glucose tolerance or impaired fasting glucose
• Hypertension
• Increased levels of triglycerides, low concentrations of high-density lipoprotein cholesterol, or both
• History of gestational diabetes
• History of delivery of an infant with a birth weight greater than 9 pounds
• Polycystic ovary syndrome
• Psychiatric illness (Source: Anemia.org)

If you are a diabetic and you just don’t feel like your normal self it is possible your red blood cell count is low. Check with your doctor to get the help you need to get back on track.

Diabetes + depression = additional disease. That seems to be the multiplication of common denominators in the arena of diabetic care. Why is this so and what can you do about it?

According to EmaxHealth.com, “A new study finds that diabetics who are depressed have a thirty six percent higher chance of developing severe complications from the disease. Diabetics are already at high risk for microvascular disease that can destroy the kidneys, and also cause blindness from diabetic retinopathy.”

How acute is the concern regarding depression? EmaxHealth.com suggests, “Depression was found to increase the chances of kidney disease, blindness, heart attack and stroke risk for diabetics, even after adjusting for other factors. The chances of developing disease of the large blood vessels that can lead to heart attack and stroke was by twenty five percent higher for diabetics with depression.”

Early in this millennium nearly 5,000 participants were followed to view their responses in medical data. In some cases more than 5 years of data was collected from patients. The EmaxHealth.com report suggests, “After making adjustments for weight, smoking, age, insulin use, and other medical conditions, the study still revealed increased risk of severe complications from diabetes among depressed patients. Depression and diabetes has also been found to increase mortality.”

There has been a recognized link between diabetes and depression, but this new study could go a long way in helping to determine why that link exists and how to break it.

Meanwhile, another new study may have some bearing on how diabetics can potentially avoid retinopathy related to their disease.

StateNews.com reports, “Susanne Mohr, an associate physiology professor at MSU (Michigan State University), spent more than two years working with E. Chepchumba Yego, a former graduate student at Case Western Reserve University in Cleveland, to find a way to treat retinopathy. The team’s research appeared in the Jan. 29 issue of the Journal of Biological Chemistry.”

It is important to know exactly what happens to the eyes of a diabetic to result in vision loss. The StateNews.com article suggests, “cells surrounding the vascular die and leave the vascular unprotected with no support from the surrounding cells. Once the protecting cells are gone, different fluids from the brain leak into the retina, causing bruising.”

Current options for treatment are limited to shots in the eye or laser treatments. The trouble is both are uncomfortable and laser treatments are limited to 2-3 surgeries before blindness from the treatment is noted.

In Mohr’s research “the team found a way in which cell death is induced in a high glucose environment. The enzyme glyceraldehyde 3-phosphate dehydrogenase, or GAPDH, moves from its cytosolic environment to the cell’s nucleus to create energy, where cell death occurs.”

Once they figured out how cell death took place they were able to manipulate the siah-1, “to keep any cell death from occurring and therefore reducing the effects of retinopathy,” said StateNews.com.

Mohr is noted in the same article as saying, “About 5 million people have diabetic retinopathy, according to the World Health Organization. It is estimated that 80 percent of Type 2 diabetic patients progress into some stages of diabetic retinopathy, Mohr said. Type 2 diabetes patients are growing exponentially, which causes a much larger number with the disease, she said. Retinopathy develops five to 10 years after a person is diagnosed with Type 2 diabetes.”

The research will be ongoing, but to date the new study has helped identify causes and provide avenues of potential reductions in the incidence of retinopathy.