Complications In Diabetes
Diabetes is a disease where the body is not able to dispose off glucose in the blood in a proper fashion. This leads to a build up of glucose in the blood, and over a period of time this leads to multiple complications of diabetes. The very diagnosis of diabetes in fact is based on what is the level of glucose when it causes eye and kidney problems. For example, we now say that a fasting blood glucose above 125 mg/dl or a two hour after meal glucose value of over 200 mg/dl means that a person has diabetes. These levels were chosen because it is at these levels that the risk of eye and kidney problems increase significantly. This is not to say the people who have a fasting blood glucose of 123 mg/dl is fine. In fact, there is a wide range between “normal” levels of blood glucose and “diabetic” levels of blood glucose. When blood glucose fall in this range, we talk about “impaired glucose tolerance”. People in this category are also at risk of complications like heart attacks and strokes.
Complications of diabetes can affect every single organ in our body, as every single cell needs glucose for energy. Going from head to foot, diabetes can affect:
- Brain: Diabetes increases the risk of stroke that results in paralysis.
- Eyes: People with diabetes may develop abnormalities in the retina, a layer in the back of the eye that is necessary for vision. They may also be at a higher risk of glaucoma and cataracts. It is very essential that all people with diabetes have a detailed eye exam once a year by an ophthalmologist, whether or not they notice any problems in the eye. This is because eye problems may not cause any problems in the initial stages, but may be present with irreversible changes if detected late.
- Ears/Sinus: People with diabetes can get a rare infection of the ears and sinus, which needs strong antibiotics and aggressive surgery.
- Heart: A significant number of people with diabetes suffer a heart attack. Having diabetes, removes the protective effect that women before menopause have against heart disease. Many people become aware of diabetes at the time of a heart attack. Having diabetes also increases the chances of the heart attack being more severe, and the complications after an attack are even more.
- Stomach: People with long standing diabetes may develop a condition called “gastroparesis”. In this condition, there is a slowing of the emptying of the stomach. People may experience indigestion, a persistent feeling of fullness in the stomach, and nausea and vomiting. It may lead to poor blood glucose control with frequent highs and lows in blood glucose.
- Liver: Diabetes is frequently associated with “fatty liver”. This involves accumulation of fat in the liver due to uncontrolled diabetes, and it can lead to impairment of liver functioning and liver failure in the long term.
- Gall stones: It is not that people with diabetes are more prone to gall stones, but that they are more prone to complications if the gall stones become infected as it happens in diabetes.
- Kidneys: Improper working of these organs is a dreaded complication of diabetes. In fact diabetes is the leading cause of renal or kidney failure worldwide.
- Urination: Long-term diabetes can lead to poor control of the urinary bladder, which in turn may predispose a person to recurrent infections.
- Vaginal infections: Recurrent fungal infections are very common, especially when blood glucose is high. In fact, women can sometimes do their own bioassay for diabetes – they know the sugars are high when they develop itching in the vagina.
- Erectile dysfunction: Men with diabetes frequently complain of difficulty with erections, and this is believed to be due to poor blood flow and nerve dysfunction in the genital area.
- Irregular periods/infertility: The same factors that cause diabetes, i.e., being overweight and lack of exercise, also lead to irregular periods. Having diabetes can make getting pregnant more difficult, but more importantly, if a woman conceives when the blood sugars are high, the baby can develop defects in the heart and nervous system.
- Legs/feet: Problems in the legs arise due to poor blood flow and nerve damage. Due to this, people may complain of aching in their legs, especially in the calves after walking. They may have a feeling of numbness, pricking, tingling or burning in the feet due to the nerve damage. Wounds in the legs may get infected easily, and heal poorly in people with long standing inefficiently controlled diabetes. However, one should not use the fact that if wounds are healing well, their diabetes is under control!
Enough of bad news! The good news is that most of the complications can be prevented with good control of blood glucose. It is also essential to control blood pressure and cholesterol levels to reduce risk of complications. Frequent check ups, and annual full body check-up are an absolute must in the long-term control and management of diabetes.