The Complications Diabetes Can Cause

The complications of diabetes are a topic few doctors even mention unless specifically asked. Recently, I have asked two doctors and one could only mention heart disease and blindness. The second doctor was able to mention most of them, but missed sexual dysfunction and deafness. He would not agree to deafness and had his doubts about sexual dysfunction.

We also had a difference of opinion about several items, hypoglycemia, hyperglycemia, diabetic ketoacidosis, and hyperglycemic hyperosmolar nonketotic. He said the first two were symptoms of diabetes and the second two were not part of type 2 diabetes. When I said that the hyperglycemic hyperosmolar nonketotic was limited to people with type 2 diabetes, he went to a book and when he read about it changed his mind. While he was there, he also looked up diabetic ketoacidosis and agreed that this happened to both types.

I suggested he look up sexual dysfunction and deafness. He finally changed his mind and agreed, but added there is conflicting evidence about deafness. I said I agreed, but a recent study showed in young people there is a definite relation, but among the elderly, there could be doubt.

Then he asked why I was concerned. I told him because few doctors even talk about the complications of diabetes and I said many cannot get beyond heart disease and blindness. I said many more cannot accept that diabetes can contribute to cataracts and glaucoma. He admitted he did not think that they were linked, but said he would look them up. I also mentioned that the website WebMD did a poor job of mentioning all the complications of diabetes.

Since I was the last patient of the day, he opened his computer on the web, typed in WebMD, and did a search for diabetes complications. When he had this article, he said they did a better than average job, but you are right that they ignore several, especially women's sexual dysfunction, and only cover a limited amount of heart disease. At least they covered infection and dental problems, which many do not consider. I added foot and lower leg problems and slow wound healing.

Outside of many doctors not being able to list most complications, what other reasons did you bring up this topic? I said that I have several blogs on the complications, and then several more on related problems affecting diabetes and diabetes management.

I admitted that I blog about the complications and related issues and that was the main reason I have been asking doctors to name complications. He asked me to show him and I moved to the computer, entered my blog address, and brought it up. He looked at it and asked me to click on the profile. After that page was up – he read it and said you have four blogs. I said I had, but two are inactive and I concentrate on diabetes at present. Then I clicked on this blog and went to the series on nephropathy.

I moved so he could read the screen and he skimmed the first three and said that he would send the URL to his home computer and read more as he had time. He thanked me and took me to be checked out.

Nephropathy – Part 2

Kidney disease or kidney damage that occurs in people with diabetes is called diabetic nephropathy. This condition is a complication of diabetes. Each kidney is made of hundreds of thousands of small units called nephrons. These structures filter your blood, help remove waste from the body, and control fluid balance. In people with diabetes, the nephrons slowly thicken and become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin.

Kidney damage is more likely if you:

1. Have uncontrolled blood sugar
2. Have high blood pressure
3. Have type 1 diabetes that began before you were 20 years old
4. Have family members who also have diabetes and kidney problems
5. Smoke
6. Are African American, Mexican American, or Native American

Looking at the list above, two things should stand out because of their importance. First, you must manage your blood glucose levels. Second, you must manage your blood pressure.

Often, there are no symptoms as the kidney damage starts and slowly gets worse. Kidney damage can begin 5 to 10 years before symptoms start. People who have more severe and long-term (chronic) kidney disease may have symptoms such as:

1. Fatigue most of the time
2. General ill feeling
3. Headache
4. Nausea and vomiting
5. Poor appetite
6. Swelling of the legs
7. Itchy skin

Other symptoms and signs of nephropathy when kidney function is impaired include:

• Cola- or tea-colored urine (caused by red blood cells in the urine)
• Repeated episodes of cola- or tea-colored urine, sometimes even visible blood in your urine, usually during or after an upper respiratory or other type of infection
• Pain in the side(s) of your back below your ribs (flank)
• Foam in the toilet water from protein in your urine
• Swelling (edema) in your hands and feet
• High blood pressure

Your health care provider will order tests to detect signs of kidney problems. A urine test looks for a protein called albumin leaking into the urine.

• Too much albumin in the urine is often a sign of kidney damage.
• This test is also called a microalbuminuria test because it measures small amounts of albumin.

Your doctor will also check your blood pressure. This is because if you have diabetic nephropathy, you likely also have high blood pressure. A kidney biopsy may be ordered to confirm the diagnosis or look for other causes of kidney damage. If you have diabetes, your doctor will also check your kidneys by using the following blood tests at least annually:

• BUN - Blood urea nitrogen test is used to evaluate kidney function, to help diagnose kidney disease, and to monitor acute or chronic kidney dysfunction or failure.
• Serum creatinine - This test measures how effectively the kidneys are filtering small molecules like creatinine out of the blood.

If you have diabetes, make sure that your doctor does these tests described above, because you want the doctor to catch these signs early and this will allow you and your doctor to take precautionary steps to prevent further damage. It may be necessary to get a referral to an urologist to obtain the best care.

Treatment and other preventive steps will be discussed in the next blog.

Complications from Diabetes

In the last month, I have been writing about some of the complications of diabetes or related problems of diabetes. I will list several of the blogs about complications of diabetes, retinopathy and related, neuropathy which affects me and then I will write about those I have not written about in detail. This will be about nephropathy or kidney damage, atherosclerosis, and deafness are the most common, and many don't include deafness. The first three and deafness are grouped together under the term microvascular complications because they result from damage to the small blood vessels. The macrovascular complication is atherosclerosis, which is caused by damage to the large blood vessels.

There are several others that affect type 1 diabetes and seldom affect those with type 2 diabetes. Then there are those that affect both types, depression, hypoglycemia, hyperglycemia, and a few others. Over the next few months, I hope to write about all the complications.

Retinopathy – eye damage & diseases Your eyesight is too important to ignore and keeping your blood glucose levels near normal is the best treatment for your eyes.

http://bobsdiabetes.blogspot.com/2014/01/eye-disease-diabetic-retinopathy.html

http://bobsdiabetes.blogspot.com/2014/01/eye-disease-diabetic-macular-edema.html

http://bobsdiabetes.blogspot.com/2014/01/eye-disease-glaucoma.html

The above three blogs are about eye diseases affected by high blood glucose levels.

http://bobsdiabetes.blogspot.com/2014/01/many-patients-claim-not-informed-about.html

http://bobsdiabetes.blogspot.com/2013/08/is-there-best-way.html

http://bobsdiabetes.blogspot.com/2013/08/is-there-best-way-part-2.html

Neuropathy – nerve damage About two-thirds of the people with diabetes do develop neuropathy. Some are more affected by this while others are able to continue doing what they have been doing and are able to exercise. Others are prevented from exercising because of the pain level. I urge everyone to read the nine blogs as they contain a lot of information.

http://bobsdiabetes.blogspot.com/2012/01/diabetic-neuropathy-part-1.html

http://bobsdiabetes.blogspot.com/2012/01/diabetic-neuropathy-part-2.html

http://bobsdiabetes.blogspot.com/2012/01/diabetic-neuropathy-part-3.html

http://bobsdiabetes.blogspot.com/2012/01/diabetic-neuropathy-part-4.html

http://bobsdiabetes.blogspot.com/2012/01/diabetic-neuropathy-part-5.html

http://bobsdiabetes.blogspot.com/2012/05/neuropathy-causes.html

http://bobsdiabetes.blogspot.com/2012/05/what-is-diabetic-neuropathy-part-1.html

http://bobsdiabetes.blogspot.com/2012/05/what-is-diabetic-neuropathy-part-2.html

http://bobsdiabetes.blogspot.com/2012/05/what-is-diabetic-neuropathy-part-3.html

In the next blogs, I will write about nephropathy. In my research, I apparently have not really done much reading about nephropathy, as I made some surprising discoveries. Hope that you will learn from the information as well.

Diabetes Does Cause Hearing Loss

This is another diabetes complication that often is ignored. It is ignored because people do not consider hearing loss as being a complication. Consider how many of our organs may are affected by diabetes. If you have diabetes, you may figure that you are at twice the risk of having hearing loss.

One way to avoid this and most diabetes complication is to manage your diabetes by maintaining careful management of your blood glucose levels. Keeping these as close to normal or at normal is good for keeping complications away. This applies to all complications. Let your blood glucose levels take off for the stratosphere and your odds of developing the complications go up with them.

With hearing, it is the small blood vessels and nerves in your inner ear that become damaged by high blood glucose over a period of time. Autopsy studies of diabetes patients have shown the evidence of this damage.

The study researchers discovered the high rate of hearing loss with diabetes after analyzing the results of a nationally representative sample of U.S. Adults. The hearing tests measured the participants' ability to hear low, middle, and high frequency sounds in both ears. The researchers discovered the link between diabetes and hearing problems and that it was evident across all hearing frequencies, but was more pronounced in the high frequency range.

Comparisons between those without diabetes and those with diabetes were this. At the low to mid-frequency sounds for people without diabetes at nine percent to people with diabetes of 21 percent. The high frequency hearing loss was 32 percent (without diabetes) to 54 percent (with diabetes).

The alarming fact for me was for people with prediabetes. Just because they do not have diabetes, does not exempt them from hearing loss. They exhibited a 30 percent higher rate of hearing loss than those with normal blood glucose.

This is just another reason for preventive action for people with prediabetes and strict blood glucose management for all people with diabetes. If you think you are immune to hearing loss, you are in for a shock if you let your blood glucose management have an extended holiday.

Lessons Diabetes Teaches Us – Part 2

Hopefully you have read David Spero's blog from my last blog. If not, go back and read the previous blog here. Now for some more lessons from the college of hard knocks about diabetes.

These are some of the problems associated with diabetes and some are considered short-term complications. A brief list includes hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar nonketotic coma (HHNKC). The last two need immediate medical intervention. Hypoglycemia may require immediate medical intervention of the blood glucose levels gets too low.  Read about the short-term complications here.

Certain oral medications can cause hypoglycemia and is is very common for those on insulin. People that become hypoglycemically unaware need to be especially cautious about letting their blood glucose levels get low. DKA is normally associated with Type 1 diabetes, but a few Type 2's can have this problem. HHNKC is generally for those with Type 2 diabetes who let their blood glucose levels get above 600 mg/dl for extended periods.

A word of caution to all people with diabetes, if you live alone, make sure that you have family or friends available for assistance if needed. If you live in an area and know other people that have diabetes, get to know each other for support and to check on each other.

Other effects that are associated with diabetes are loss of sexual drive – erectile dysfunction in men, urinary track infections (UTIs) in women. Also relevant are heart disease and diabetes, stroke and diabetes, and high blood pressure and diabetes. Most doctors will automatically screen for these and prescribe medications to alleviate the problems, but a few do not. So be prepared to ask for these screenings.

If you are able to manage your blood glucose levels, then there are some sneaky problems that still can make themselves present. Depression can assert itself. Most people with diabetes, about 67 percent, are likely to develop mild depression and then there is about 19 percent that may develop severe depression. Mild depression can be helped with antidepressants and the more severe should be treated under the care of a doctor. Read my blog on depression here. Even excellent management of diabetes is not a guarantee that you will not have depression.

Over 50 percent of people with diabetes, are likely to develop sleep apnea. Most because they are overweight and have apneas up to several hundred times a night which interrupts your sleep and you feel over tired during the day. There are several treatments available depending the the severity of the sleep apnea and the type. See my blogs here for further details: blog 1, blog 2, blog 3, blog 4, and blog 5. There are other blogs, but I have provided those relevant for this discussion.

Another link to diabetes is dementia, in particular, Alzheimer's disease. There is a proven link between the two now so that it cannot be ignored. So for those of us in our golden years, you do need to be concerned.  Read David Mendosa's blog here and my blog here.

There are other problems such as skin problems caused by diabetes. Some skin problems need immediate attention, but others can be treated with various medications and skin conditioners. There are other other minor complications that few people have problems with. The big four were covered by name in the first part.

Some will say I did not cover amputations, but I am. They can result from two of the big four. Neuropathy and atherosclerosis are the cause of poor healing and lead to amputations when not properly and immediately cared for. So make sure that you take excellent care of your feet and legs, inspect them daily and see a doctor if a problem develops.

Many people insist that every little health problem is caused by their diabetes and this is just not so. There are other diseases that people with diabetes can get, but as of yet, there is no firm or related link to diabetes resulting in posing a risk to have the disease.

Most people that manage diabetes and are able to maintain blood glucose levels near normal very seldom develop complications. It is when people do not manage their blood glucose levels that they will develop the complications. Retinopathy seems to happen first, but they may all develop to some level at the same time.

I have had three friends or acquaintances that had diabetes that they did not manage their diabetes and they went on dialysis. All three have passed in the last 18 months because they could not or would not continue the dialysis. Another friend had both her legs amputated above the knees because she did not manage her diabetes. She is now approaching the end of her sight because she has continued to not manage her diabetes.

So life's lessons can be hard for some and others do very well. How are you managing diabetes. Has the college of hard knocks helped? Or have you ignored the lessons of life handed to you?

Lessons Diabetes Teaches Us – Part 1

We all learn from diabetes. Necessity is the teacher and not a patient teacher at that. If we don't follow instructions, we pay dearly for those lessons. If we think we can outsmart diabetes, are we in for a rude awakening. Diabetes does extract a toll whether we are willing to accept the charge or not.

Many of us have experienced college, but the college of hard knocks teaches us the lessons we need for life and living. The grades handed out are how we live and manage our daily living. Diabetes is its own college and can knock us around unmercifully unless we learn how to manage it. Otherwise it loves to manage us.

David Spero at diabetes self management approaches this a different way and has it as a class. To me it is a degree by itself and has many courses to cover the complications and idiosyncrasies of the disease. Some classes are easy to pass and others take some study and much patience to pass the course. Some classes are for the short term and others are lifelong.

One of the hardest lessons that many just never seem to learn is diabetes is not your fault. Whether you have Type 1 or Type 2 diabetes, LADA, or one of the MODY types, they may be caused by genetics, environment, or even some unknown genetic abnormality. This even applies if you have medically induced diabetes, see my blog here.

The second lesson is you must learn that the past is past and you must learn to live in the present and manage your diabetes. This is hard for many people also as they want to continue to heap blame on themselves and then go into denial. Diabetes loves this phase as it gets to do what it wants with your body and you are being managed by diabetes and not the other way around.

Acceptance if the final lesson and is when you have removed your fist from the panic panel and are mastering the lessons of diabetes and how to best manage this chronic disease. These lessons do not not manifest themselves in the same order for everyone and anger is another lesson that some people have a difficult time getting past. For me anger was short lived and denial can later even after I had accepted diabetes. So be careful in how you analyze your situation.

Gretchen Becker in her book The First Year, Type 2 Diabetes, discusses three of the common complications of diabetes as the three O'pathy sisters. I like her humor to get you to remember how serious these complications are. Neuropathy is damage to the nerves and for some can be very disabling. Nephropathy is damage to the kidneys, and retinopathy is damage to the retina of the eye.

Then she adds Arthur O. Sclerosis for atherosclerosis which can lead to heart attacks, strokes and open wounds on the feet and legs. Yes, indeed these can be very serious and debilitating for those that don't manage diabetes. These require you to manage diabetes by maintaining control as near to normal levels of blood glucose as possible. This management may delay or even prevent their development. These are considered the big four and most common complications.

Please read David Spero's blog here. He makes some excellent points that I chose not to cover and they are to the point. My next blog will be about some of the other complications and related problems.