After many years of dealing with poorly controlled diabetes, an individual’s body may develop serious health problems. Continuously high blood sugars will destroy the various tissues of the body, and these patients will experience damage to the eyes, kidneys, nerves and skin. But the trouble doesn’t end there. A weakening of the body’s immune system will inhibit the body’s ability to fight infection, and the use of excess insulin, in non-compliant patients, or in patients whose have brittle diabetes (diabetes that is hard to control), accelerates the process of arteriosclerosis, with resultant heart and brain disease.
The eye problems may arise from changes in lens thickness. An increase in blood sugar levels will cause the lens of the eye to swell, resulting in blurring of vision. Eventually cataracts develop, requiring surgery. But diabetic vascular problems may cause other eye problems. As mentioned, both high blood sugar and use of excessive amounts of insulin causes the progression of arteriosclerosis. When arteriosclerosis affects the blood vessels of the eyes, the body tries to compensate by growing new blood vessels. Unfortunately, this process of neovascularization produces “leaky” blood vessels, which can directly destroy the retina (macular degeneration). Additionally, the leaking vessels will deposit blood into the central area of the eye (the vitreous). This clotted blood will act as a weight, and pull the retina down from the back of the eye, severely compromising vision. Fortunately, if employed early enough, laser surgery can stop this process and save sight.
The acceleration of arteriosclerosis, with its destruction of small, nourishing blood vessels can lead to heart attacks and strokes. This small vessel disease of the heart is not amenable to cardiac stenting or cardiac bypass surgery, and the multiple small or “silent M.I.s” that occur leave the patient with a poorly functioning heart and congestive heart failure. Similarly, multiple small strokes in the brain will lead to dementia. However, major heart attacks, and extensive, paralyzing strokes are also found in patients with poorly regulated diabetes, as the amplified problem of arteriosclerosis will also target the larger blood vessels. In the same manner, the kidneys can be destroyed, not only by the small vessel destruction, resulting in damage to the small filtering units of the kidneys (the glomeruli), but also from the accompanying high blood pressure developing from the arteriosclerosis.
The destructive nature of high blood sugar and excess insulin, with its resultant small blood vessel disease (microangiopathy), leads to nerve damage as well. The insulating material of the nerves is disturbed, and nerves misinterpret stimuli, resulting in either unrelenting pain or loss of sensation and numbness. This is called peripheral neuropathy. Although difficult to treat, there has been considerable success in the control of pain with the achievement of better diabetic management, and with the administration of a nerve-membrane stabilizing drug called gabapentin (Neurontin). When large vessel disease affects the extremities, peripheral vascular disease occurs. This worsens the peripheral neuropathy, with both processes leading to the destruction of the muscles and skin of the legs. As would be expected, the peripheral neuropathy and peripheral vascular disease are a major cause of erectile dysfunction in males.
Skin breakdown in the extremities, and along the pressure-bearing areas of the body, results in ulcerations. Because the elevated blood glucose inhibits the migration of infection-fighting white blood cells, these ulcerations are slow to heal, if they heal at all. These wounds tend to persist and even worsen. Gangrene may develop, necessitating amputation of the particular digit or limb. In fact, gangrene of the feet is 100 times more common in diabetics than in non-diabetics. In the same vein, this inhibition of white cell migration limits the body’s ability to fight infection. There is an acceleration of periodontal disease and an increase in urinary tract and yeast infections. Pneumonias and post-operative infections are also more likely, and much harder to treat. Overwhelming sepsis (infection) is frequently a terminal event in these diabetics.
In spite of all of this discouraging information, one must be mindful of the fact that good control of one’s diabetes will mitigate these complications considerably. A well-controlled diabetic can avoid many of these issues and lead a productive and satisfying life. It takes work, and a bit of dedication, but the rewards are worth it. This article is only meant as a reminder of what one faces if not meeting the challenges presented by diabetes. In the next article, we’ll review the practices that are required for good diabetic control.
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