Diabetes – Not Really Fun
You’ve seen them on TV or viewed them online.
You couldn’t help that they caught your eye or made your ears perk up, in spite of yourself.
We’re talking about those ever-more-prevalent diabetes commercials, most brimming with smiling faces and bundles of energetic excitement about whatever the particular product, medication or message aimed at PWDs (people with diabetes). Sometimes it’s hard to swallow.
Yep, some even have catchy tunes, creative spins, or big-name actors and personalities to bump up interest in whatever’s being marketed.
Here’s an example. These people are too happy and I think they’re giving the average viewer the wrong idea that diabetes management is a casual affair. What do you think?
Though it is becoming increasingly common, type 2 diabetes is a serious disease. If you or someone you care for has been diagnosed with type 2 diabetes, it is very important that the disease be managed proactively.
Long-term effects of diabetes
The most common long-term complications of diabetes include:
- damage to the large blood vessels of the heart, brain and legs (macrovascular complications)
- damage to the small blood vessels, causing problems in the eyes, kidneys, feet and nerves (microvascular complications).
Other parts of the body can also be affected by diabetes, including the digestive system, the skin, sexual organs, teeth and gums, and the immune system.
Diabetes and cardiovascular disease
Cardiovascular disease includes blood vessel disease, heart attack and stroke. The risk is greater for people with diabetes, who often have increased cholesterol and blood pressure levels. Smoking, having a family history of cardiovascular disease and being inactive also increase your risk.
To reduce your risk and pick up any problems early:
- Have your blood pressure checked at least every six months, but more often if you have high blood pressure or are taking medication to lower this.
- Have your cholesterol checked at least yearly, as well as an HbA1c (average blood glucose over the past three months).
- Further pathology tests such as an electrocardiogram (ECG) or exercise stress test may also be recommended by your doctor.
Eye disease and diabetes
Diabetes-related eye problems include:
- Retinopathy – with this condition, the blood vessels in the retina become damaged and eventually this can affect vision.
- Retinopathy has various stages. In its early stages, there are usually no symptoms, so having a full diabetes eye check is essential to detect it early. Regular eye checks help detect any changes and allow for early treatment where needed to prevent further damage.
- Macular oedema – the macular is part of the retina and helps us to see things clearly. Swelling of this area can happen when the blood vessels in the retina are damaged and cause fluid to build up. This can lead to the macular being damaged and vision may be blurry. Treatment is available. Early detection is important.
- Cataracts – the lens of the eye becomes cloudy and can cause things such as vision becoming cloudy, distorted or sensitivity to glare. People with diabetes can develop cataracts at an earlier age.
- Glaucoma – the pressure of the fluid within the eye builds up to a higher level than is healthy. This pressure over time can damage the eye. Glaucoma occurs in people with and without diabetes, but is more common in people with diabetes.
While most damage to the eyes is free of symptoms in the earlier stages, there are certain symptoms that may occur and these need urgent review. If you have flashes of light, floaters, blots and dots or part vision missing, seek urgent medical assessment.
Regular eye checks
Everyone with diabetes should have a professional eye examination by an ophthalmologist or optometrist when they are first diagnosed, and then at least every two years after that.
It is important that you inform the person checking your eyes that you have diabetes. If retinopathy or another abnormality is found, eye tests will be required every year, or more frequently if advised by your ophthalmologist.
Kidney damage and diabetes
People with diabetes are at risk of kidney disease (nephropathy) due to changes in the small blood vessels of the kidneys. Kidney disease is painless and does not cause symptoms until it is advanced.
Screening is very important. Kidney damage can be diagnosed early by detecting microalbumin (very small amounts of protein) in the urine. Everyone with diabetes should have a urine check for microalbumin at least once a year. Your doctor will also monitor your kidney function, including estimated glomerular filtration rate (e-GFR), with a blood test.
If problems are picked up early, nephropathy can be slowed or prevented with the right treatment. Medication called ACE inhibitors and angiotensin receptor antagonists helps to protect the kidneys from further damage. These tablets can also be used to treat high blood pressure.
Nerve damage and diabetes
Nerve damage (neuropathy) is usually caused by high blood glucose levels. Damage can occur to the sensory (feeling) and motor (movement) nerves of the legs and feet, arms, hands, chest and stomach, and to the nerves that control the actions of body organs.
People who drink large amounts of alcohol can have similar nerve damage. Vitamin B12 deficiency can mimic signs and symptoms of peripheral neuropathy. Long-term Metformin (diabetes treatment) use (over three to five years) can increase your risk of vitamin B12 deficiency, and doctors will sometimes test for this.
To help prevent nerve damage:
- Keep your blood glucose levels in target range.
- If you drink alcohol, keep within the recommended guidelines.
- Don’t smoke.
- Talk to your doctor about any problems you have with your hands, arms, feet, or legs, your stomach, bowels, or bladder.
Foot problems and diabetes
The feet of someone with diabetes are at risk of damage when the blood supply in both large and small blood vessels is reduced. Nerve damage (peripheral neuropathy) often results and structural abnormalities can also occur, for example, clawed toes.
Reduced blood supply and reduced nerve function can delay healing, increase the risk of infection, reduce feeling in the feet, and lead to ulcers and structural foot problems.
Look after your feet by:
- seeing a podiatrist at least once a year. They will assess the health of your feet by checking the blood supply, nerve function and looking for changes in the structure of your feet.
- Checking your feet every day or get someone to help you if you are unable to check them yourself. Look for cuts, blisters calluses, corns, tinea (especially between the toes) and any changes you notice. If treated early and without delay, you can help prevent complications occurring
- moisturizing using a moisturizer (such as sorbolene), especially if you have areas of dry, rough or cracked skin on your feet and heels, can help keep your feet healthy
- protecting your feet by wearing comfortable, supportive shoes that fit well.
Skin problems and diabetes
People with diabetes may experience very dry skin due to damage to the small blood vessels and nerves. A common problem for people with diabetes is very dry skin on the feet, but this may be more generalized.
There are also other skin conditions related to diabetes. High blood glucose levels over time can affect the health of the skin. The skin acts as a barrier to protect our bodies from infection so it is important to keep the skin as healthy as possible. If the skin becomes dry, it can lead to cracks and possibly infections.
To reduce the risk of skin problems:
- Make sure your blood glucose is well controlled – keep your blood glucose levels and HbA1c within recommended ranges to reduce the risk of skin infections.
- Wear gloves when you use household cleaners and solvents.
- Avoid very hot baths and showers.
- Take care not to have your feet too close to heaters, especially if you have neuropathy, as you may not be able to feel the intensity of the heat.
- Use a cream or lotion on your skin after bathing, preferably one that is not perfumed. Use non-scented soaps or soap alternatives.
- If you notice you have a skin problem, see your doctor.
Teeth and gum problems and diabetes
People with poorly managed diabetes are at increased risk of tooth decay and gum infections. This is due to damage to the small blood vessels supplying the gums and teeth. Dental and gum infections can also lead to high blood glucose levels.
Not looking after your teeth and gums can cause the gums to become inflamed and loosen around the teeth. Poor oral care is also strongly linked with an increased risk of heart disease.
To reduce your risk of teeth and gum problems:
- See your dentist regularly (every six months) for a check-up.
- Brush your teeth at least twice a day (a soft toothbrush is generally recommended) and floss once a day.
- If you have dentures, make sure you brush your dentures and gums with a soft tooth brush.
Mental health and diabetes
Living with and managing either type 1 or type 2 diabetes can lead to stress, anxiety and depression. This can affect your blood glucose levels and how you manage your diabetes in general. Over time, this can affect your health.
It is important to talk to your doctor if you are going through times of stress, depression or anxiety. Your doctor can refer you to a counselor, psychologist or psychiatrist by providing a diabetes mental health plan.
Recommended: Diabetes Burnout
Diabetes, particularly type 2, has been linked with Alzheimer’s disease and vascular dementia. Brain changes, resulting from reduced blood supply to the brain over time, appears to be associated with an increased risk for development of these conditions.
Diabetes and infections
Your immune system helps to prevent and fight infection. High blood glucose levels slow down the action of infection-fighting white blood cells. This makes it more difficult for the immune system to do its job.
Support your immune system and reduce your risk of infections by:
- making sure your blood glucose levels are controlled – keep your blood glucose levels within the recommended ranges
- getting plenty of rest
- washing your hands often
- protecting yourself against infection
- having a yearly influenza (flu) immunization.
- ask your doctor about the pneumonia vaccine, especially if you are over 65
- seeing your doctor if you have an infection or are unwell.
Thyroid problems and diabetes
People with either type 1 or type 2 diabetes are at increased risk of thyroid disease. This includes both overactive and underactive thyroid. Thyroid disorders can affect general health and may affect blood glucose levels.
Thyroid function is assessed by a blood test. Check with your doctor if you are not sure whether you have had your thyroid function checked.
Sexual dysfunction and diabetes
Reduced blood supply and nerve damage can affect sexual function. Erectile dysfunction (impotence) in men is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. This is a common problem for men of all ages and is more common in men with diabetes.
Erectile dysfunction is not a disease, but a symptom of some other problem – physical, psychological or a mixture of both. Most cases of erectile dysfunction are physical, such as nerve or blood vessel damage.
In women, sexual dysfunction is also reported, although there is a lack of research in this area. It is difficult to know whether this is directly related to hormonal changes such as menopause, or to diabetes.
It is important to seek help from your doctor or diabetes educator.
Managing Your Diabetes
Managing diabetes is something that you do not have to do on your own.
There are health professionals available to help you. Take charge of diabetes management by doing your part and communicating regularly with your healthcare provider.
Proactive diabetes management can go a long way toward reducing the risk of long term complications.
Please share your experience or tips on type 2 diabetes and it’s complications.
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