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Information for those Newly Diagnosed with Diabetes Complications of Diabetes Important Medical Disclaimer All material found in this publication is intended for general informational purposes only and should not be used for self-diagnosis or as a substitute for professional medical care. IOH recommends that you seek the advice of a competent health professional for diagnosis and treatment options, or before making any changes to your current diabetes care plan.
Section 1. Cardiovascular & Circulatory Heart Problems People with diabetes should keep blood glucose in target ranges whenever possible, exercise regularly, have a stress management plan, and follow a meal plan designed by a registered dietitian especially for their lifestyle and type of diabetes. An overall healthy lifestyle and proper blood glucose control can help reduce the risk of all diabetes complications including cardiovascular and circulatory problems. Several things, including having diabetes, can make your blood cholesterol level too high. Cholesterol is a substance that is made by the body and used for many important functions. It is also found in some food derived from animals. When cholesterol is too high, the insides of large blood vessels become narrowed, even clogged. This problem is called atherosclerosis and causes narrowing and clogs in blood vessels which makes it harder for enough blood to get to all parts of your body. This can cause problems including heart attack, stroke, and circulatory problems. What are the warning signs of a heart attack?You may have one or more of the following warning signs:
Or, you may have no warning signs at all. Or they may come and go. What are the warning signs of a stroke?A stroke happens when part of your brain is not getting enough blood and stops working. Depending on the part of the brain that is damaged, a stroke can cause:
Sometimes, one or more of these warning signs may happen and then disappear. You might be having a "mini-stroke," also called a TIA (transient ischemic attack). If you have any of these warning signs, tell your doctor right away. Clogged vessels can also lead to peripheral artery disease (PAD). See below. High Blood Pressure Diabetes can be associated with high blood pressure (hypertension) and a poor lipid profile (high LDL cholesterol, low HDL cholesterol, or high triglycerides), which can lead to stroke or heart attack. If you have diabetes you should try to keep your blood pressure below certain levels (as determined by your physician) to reduce the risk of developing complications of diabetes such as heart disease, stroke, and eye problems. As a rule, the higher the pressure, the greater the health risk. Treatment of high blood pressure includes a change in lifestyle factors where these can be improved - losing weight if you are overweight, regular exercise, a healthy diet, drinking alcohol in moderation, and a low salt intake. If needed, medication can lower blood pressure. Diabetes kidney disease may cause hypertension. A complication which develops in some people with diabetes is called diabetic nephropathy. In this condition the kidneys are damaged which can cause high blood pressure. This is more common in people with type 1 diabetes but can also occur in persons with type 2 diabetes. Peripheral Arterial Disease (PAD) PAD, is a disease of the blood vessels. The arteries supplying blood to the limbs get blocked and usually affects one or both legs but it can also affect the arms or "peripheral" body organs (that is, any organ other than the brain, the heart, or the lungs). Atherosclerosis, the thickening of the walls of the arteries due to cholesterol-filled plaques, is usually the cause of PAD which on occasion can occur suddenly when a blood clot formed in the heart or in another blood vessel breaks off and wedges itself in a smaller artery. Many people do not know that they have a problem. They may think that they only have back or muscle pain-related problems, when in fact, they could have PAD. The most common symptom is cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again. Other symptoms include:
Approximately 75% of all persons with PAD do not have any symptoms; those that do usually mistake them for something else. PAD affects both men and women but men are more likely to experience symptoms than women. If you have diabetes, you are at risk for developing PAD. When the parts of the body no longer being fed by the blocked blood vessels, organs and tissues don't get enough oxygen and nutrients. This causes damage and tissues ad organs can die if blood flow doesn't improve. Without treatment a person could lose a leg or die, and PAD can lead to gangrene (tissue death) and amputation. Persons with PAD may also experience angina and are at increased risk for stroke. Section 2. Eye Problems Blindness People often think of diabetes and automatically associate blindness and amputation. By keeping your blood glucose in target range as often as possible and seeing your opthomologist regularly, you can greatly reduce the risk of blindness as a complication of diabetes. Also included in our more comprehensive information section are products designed for persons with diabetes and a visual impairment. Diabetic Retinopathy High blood glucose levels damage delicate nerves in the eye. The retina is slowly destroyed and impaired vision or blindness may result. Diabetic retinopathy often has no early warning signs. Even macular edema, which may cause vision loss more rapidly, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read and drive. In some cases, the vision will get better or worse during the day. You may not get any signs of diabetes retina damage or you may get one or more signs:
What can I do to prevent diabetes eye problems?
Section 3. Hyperglycemia & Hypoglycemia Complication Diabetic Ketoacidosis (DKA) When not enough insulin is present blood glucose runs too high. The body begins to use fat stores as an energy source. Ketones, a byproduct of burned fat, are produced and quickly reach dangerous levels. High ketones lead to a state called diabetic ketoacidosis (DKA) which can result in coma, or death. Newly diagnosed persons with type 1 diabetes are often in a state of DKA and need to be hospitalized in order to be stabilized. DKA is something that you should never attempt to treat on your own. If you detect moderate or higher ketones in your urine, be sure to immediately call your doctor for instructions. Insulin Shock When too much insulin is given, too little food is eaten with insulin, or during exercise, blood glucose levels can drop dangerously low resulting in "insulin shock." Untreated, a person can lose consciousness, slip into coma, or die. Different people may have various “normal” ranges of blood glucose that feel comfortable to them, and not everyone experiences symptoms of insulin shock at the same range. However, any reading of 50 mg/dL or lower can quickly lead to a situation where a person can lose consciousness, or become confused and disorder to the extent they are unable to care for themselves. Contrary to what many that are uneducated about diabetes may think, sugar does not present the most imminent danger to someone with diabetes – insulin and insulin enhancing/sensitizing drugs do. This is because a person on shot therapy “feeds” the insulin. That is, they eat in accordance to how much insulin is given, and when it cycles through the body. A person on an insulin pump has greater flexibility and no longer has to eat to support the insulin, but can still experience hypoglycemia if basal rates are set too high, or the meal bolus is not calculated correctly. When too much insulin is present blood glucose levels will drop too low. Cells don’t get the sugar energy that they need because not enough glucose is present in the bloodstream and cells can eventually be damaged. Symptoms of insulin shock (hypoglycemia) include
Hypoglycemia can also happen while you are sleeping. You might
You may be interested in printing Islets of Hope's free publications on hypoglycemia (low blood glucose). Seizures and Coma When blood glucose falls too low, seizures can result. Insulin shock, an extreme episode of hypoglycemia (low blood glucose) is caused by too much insulin in the body. Untreated, insulin shock can lead to coma and death. Severe hypoglycemia can occur rapidly, even over minutes, and should always be treated as an emergency. High blood glucose levels can also lead to coma and death but generally takes hours, or days of being in a state of DKA (see above) before coma results. A seizure (or convulsion) occurs as a result of a burst of simultaneous, contradictory signals from brain cells. There are many causes of seizures including head trauma, fever, illness, and in the case of people with diabetes, both hyperglycemia (high blood glucose) and hypoglycemia (low blood glucose) can cause seizure, convulsion, coma, and even death. During a seizure a person is unaware of their surroundings even if they may seem alert on some level. If the seizure is a result of low blood glucose (hypoglycemia) do not attempt to feed the person who can easily choke. Instead, give a shot of glucagon and call 911 if necessary. Section 4. Infections Amputation Amputation is the surgical removal of all, or part, or the body such as toes, a foot, or leg. When nerves are damaged from uncontrolled diabetes (hyperglycemia, or high blood glucose levels) tissues may lose circulation as well as the ability to properly detect pain. This nerve damage, called "neuropathy," can affect fingers, toes, feet, legs, and organs, including eyes and the digestive tract. When nerves in the feet and legs are damaged serious consequences can result. Because neuropathy may cause loss of sensation from nerve damage and reduce circulation throughout the body, including the feet, if you have diabetes you need to pay special attention to your feet. Reduced sensation can interfere with the body’s injury warning system: pain. Even small cuts, blisters, and abrasions can go unnoticed (because they don't hurt) and can become infected due to poor circulation. New procedures in amputation now limit the extensiveness of the operation. Learn about a limb-saving surgical procedure that many American doctors have been slow to perform. Also, causes, treatment, and prevention of ulcerations that can lead to amputation. Foot & Skin Problems Elevated glucose levels damage nerves throughout the body, including the feet. Careful, daily examination of your feet is vital. Small cuts and wounds can become severely infected due to poor circulation resulting from diabetic neuropathy. Wounds not properly cared for can even lead to gangrene and amputation. Preventative Care for Diabetes Foot-Related Complications Since most problems for diabetics begin with small sores on the skin like scrapes and blisters it is important to visually inspect your feet every single day. Other steps you can take to ensure healthy feet include:
The most frequent reason for hospitalization in persons with diabetes is due to problems with their feet. But many of these problems, including amputation and hospitalization, could be prevented through simple, preventive foot care. Gum Disease Tooth and gum problems can happen to anyone when a sticky film full of germs (called plaque) builds up on your teeth. High blood glucose helps germs (bacteria) grow. When this happens you can get red, sore, and swollen gums that bleed when you brush your teeth. People with diabetes can have tooth and gum problems more often if their blood glucose stays high. High blood glucose can make tooth and gum problems worse. You can even lose your teeth. And smoking makes it more likely for you to get a bad case of gum disease, especially if you have diabetes and are age 45 or older. Red, sore, and bleeding gums are the first sign of gum disease. This can lead to periodontitis, an infection in the gums and the bone that holds the teeth in place. If the infection gets worse, your gums may pull away from your teeth, making your teeth look long. Call your dentist if you think you have problems with your teeth or gums. Infections A combination of things can lead to an increase in infections for persons with diabetes. Infections include illness, wound infection, and yeast infections. Diabetics in general, have a tendency towards easier infection, and infections with diabetes are slower and harder to overcome – especially when blood glucose is not under tight control. Hyperglycemia (high blood glucose levels) reduce the body's ability to fight infection normally. Keeping your blood glucose in range will not only help prevent nerve, tissue, organ damage, and infection, but will help your body overcome an infection should you have one. Infections can ulcerate, fail to respond to treatment, and eventually all, or a portion of the area (usually the feet), may need to be surgically removed (amputated). If the infection persists even after amputation, it may even be necessary to remove part of the leg from below the knee in order to halt the deadly progression, which unaddressed, can lead to death. Wound Care Those with diabetes have an increased susceptibility to infections. Wounds must be quickly and properly cared for in order to avoid chronic infection or amputation. The two single most important things that you can do to prevent chronic wounds from developing from infection are:
Section 5. Infertility Diabetes, and certain disorders that are sometimes associated with diabetes (such as polycystic ovarian syndrome and thyroid disorders) may lead to primary or secondary infertility. Those who suffer from metabolic disorders like pre-diabetes and insulin resistance syndrome may also have impaired infertility. Often, simply losing weight and making positive changes in lifestyle may improve ovulatory function and fertility. Primary vs. SecondaryAccording to the American Society for Reproductive Medicine, infertility affects about 6.1 million people in the U.S., equivalent to ten percent of the reproductive age population. Female infertility accounts for one third of infertility cases, male infertility for another third, combined male and female infertility for another 15%, and the remainder of cases are unexplained. Secondary infertility is difficulty conceiving after already having conceived and carried a normal pregnancy. Apart from various medical conditions (e.g. hormonal), this may come as a result of age and stress felt to provide a sibling for their first child. Technically, secondary infertility is not present if there has been a change of partners. Combined InfertilityIn some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance. Unexplained InfertilityIn about 15 % of cases the infertility investigation will show no abnormalities. In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization. How Diabetes and other Metabolic Disorders can Affect Fertility One of the functions of insulin is to act as a "fat" storing hormone. Excess insulin can contribute to weight gain which in turn can decrease fertility. A balance of hormones contributes to the ovulatory cycle of women, and carrying excess weight can cause an imbalance between estrogen and progesterone. This can lead to an interruption of normal ovulation and menstrual cycles. Many with type 2 diabetes are also insulin resistant, that is, they make insulin but do not respond well to the normal action of insulin. Women that are insulin resistance overproduce insulin in order for their blood glucose levels to remain in a normal range. This overproduction of insulin, especially when there is an accompanying unhealthy lifestyle, can lead to weight problems, as well as a disruption of normal hormone productions, setting the stage for female infertility. Insulin resistance is commonly seen in women with polycystic ovarian syndrome (PCOS). Treatment often includes insulin sensitizing medication (such as Glucophage) which may help restore normal ovulatory function. Losing weight, even as little as 15% of excess body weight may also result in spontaneous resumption of ovulation. For those considering pregnancy, make sure that your blood glucose levels are well under control prior to becoming pregnant as well as during pregnancy to help reduce the risk of diabetes associated complications with pregnancy. Section 6. Kidney Problems What do my kidneys do?The kidneys act as filters to clean the blood. They get rid of waste and extra fluid. The tiny filters throughout the kidneys are called glomeruli (gloh-MEHR-yoo-lie). When kidneys are healthy, the artery (AR-ter-ee) brings blood and waste from the bloodstream into the kidney. The glomeruli clean the blood. Then waste and extra fluid go out into the urine through the ureter. Clean blood goes out of the kidney and back into the bloodstream through the vein. How can diabetes hurt my kidneys?When kidneys are working well, the tiny filters in your kidneys, the glomeruli, keep protein inside your body. You need the protein to stay healthy. High blood glucose and high blood pressure damage the kidneys' filters. When the kidneys are damaged, the protein leaks out of the kidneys into the urine. Damaged kidneys do not do a good job of cleaning out waste and extra fluids. So not enough waste and fluids go out of the body as urine. Instead, they build up in your blood. An early sign of kidney damage is when your kidneys leak small amounts of a protein called albumin (al-BYOO-min) into the urine. With more damage, the kidneys leak more and more protein. This problem is called proteinuria. More and more wastes build up in the blood. This damage gets worse until the kidneys fail. Diabetic nephropathy is the medical term for kidney problems caused by diabetes. How can I prevent diabetes kidney problems?
Section 7. Neuropathy (Nerve Damage) Diabetic Neuropathy When blood glucose levels are too high, delicate nerves throughout the body can be destroyed. Diabetic neuropathy can lead to blindness, loss of sensation in extremities, amputation, and impotence. Neuropathy can also slow down the digestive process, delaying exit of food from the stomach. This condition, called gastroparesis, can cause hyperglycemia (elevated blood glucose levels). Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, have damage to nerves throughout the body. Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. Problems may also occur in every organ system, including the digestive tract, heart, and sex organs. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk. An estimated 50 percent of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for at least 25 years. Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40. The most common type is peripheral neuropathy, also called distal symmetric neuropathy, which affects the arms and legs. Nerve damage can cause other problems with diabetes including:
Section 8. Urologic & Sexual Problems Erectile Dysfunction (Impotence) Erectile dysfunctions affects up to half of all men with diabetes. It strikes more often in those with type 2, but also affects persons with type 1. Diabetes-related impotence is preventable with tight blood glucose control. Many factors can contribute to the development of impotence, both physical and psychological in nature. And just because a man has diabetes and develops impotence it could still be from some other cause or combination of things including medications, high blood pressure, or high cholesterol. It is important not to self-diagnose impotence, but to see your physician who can help determine the cause and an appropriate course of action. Sexual & Urologic Problems This section contains information about urological (bladder) and sexual problems for both men and women. Men may also wish to see our "Erectle Dysfunction" section. Troublesome bladder symptoms and changes in sexual function are common health problems as people age. Having diabetes can mean early onset and increased severity of these problems. Sexual and urologic complications of diabetes are related to the nerve damage diabetes can cause. Men may have difficulty with erections or ejaculation. Women may have problems with sexual response and vaginal lubrication. Urinary tract infections and bladder problems occur more often in people with diabetes. By keeping your diabetes under control, you can lower your risk of sexual and urologic problems. The nerve damage of diabetes may cause sexual in both men and women.
Bladder Problems Bladder dysfunction can have a profound effect on quality of life. Diabetes can damage the nerves that control bladder function. Men and women with diabetes commonly have bladder symptoms that may include a feeling of urinary urgency, frequency, getting up at night to urinate often, or leakage of urine (incontinence). These symptoms have been called overactive bladder. Less common but more severe bladder symptoms include difficulty urinating and complete failure to empty (retention). These symptoms are called a neurogenic bladder. Some evidence indicates that this problem occurs in both men and women with diabetes at earlier ages than in those without diabetes. Neurogenic bladder can be caused by diabetes or other diseases, accidents that damage the nerves, or infections. Symptoms of neurogenic bladder include
Urinary Tract InfectionsInfections can occur in any part of the urinary tract. They are caused when bacteria, usually from the digestive system, reach the urinary tract. If bacteria are growing in the urethra, the infection is called urethritis. The bacteria may travel up the urinary tract and cause a bladder infection, called cystitis. An untreated infection may go farther into the body and cause pyelonephritis, a kidney infection. Some people have chronic or recurrent urinary tract infections. Symptoms of urinary tract infections may include
If the infection is in your kidneys, you may be nauseous, feel pain in your back or side, and have a fever. Since frequent urination can be a sign of high blood glucose, you and your doctor should also evaluate recent blood glucose monitoring results. What can I do to prevent diabetes-related sexual and urologic problems?You can lower your risk of sexual and urologic problems by keeping your blood glucose, blood pressure, and cholesterol close to the target numbers your doctor recommends. Being physically active and maintaining a healthy weight can also help prevent the long-term complications of diabetes. Smoking is a particular problem, and quitting will improve your health in many ways. For example, if you quit smoking, you can lower your risk not only for nerve damage but also for heart attack, stroke, and kidney disease. Section 9. Weight Weight Gain Weight gain can be the result of an unhealthy lifestyle including lack of physical activity and eating too much. But other factors can also contribute to weight gain including certain oral medications prescribed for diabetes, stress, insufficient sleep, and too much insulin. Hashimoto's thyroiditis, a hypothyroid (low) autoimmune disease can also cause weight gain and people with diabetes have a 4 times greater chance of having this thyroid disorder than non-diabetics. Certain metabolic disorders, including type 2 diabetes, pre-diabetes, gestational diabetes, polycystic ovarian syndrome, metabolic syndrome, and insulin resistance can also lead to weight gain. Many people with these disorders may be insulin resistant and therefore overproduce insulin in response to eating. Insulin is not only a fat-storing hormone that instructs the body to store energy, but excess insulin cannot be excreted and can also be stored as fat. When a person with insulin resistance eats certain foods (many types of carbohydrates, excessive protein, or high-fat foods) their body may over respond by producing too much insulin in order to maintain normal blood glucose levels. This is because cells in the body do not respond effectively to insulin so the body keeps on producing more until the cells finally "unlock" and move glucose into cells for nourishment. Insulin resistance can be improved. Exercise, especially anaerobic (such as weight lifting and resistance training) activity can improve muscle sensitivity to insulin and increase insulin sensitivity by as much as 15% -- the same percentage of improvement as may be seen when taking oral insulin-sensitizing medications. Losing weight also improves insulin resistance, as does following a healthy, low-fat, moderate protein diet, rich in complex carbohydrates. Many with insulin resistance find it easier to meet their weight loss goals by following low-glycemic index diets, or carbohydrate controlled plans. True, low-carbohydrate (40 grams of carbohydrate or less per day) that induce ketosis are somewhat controversial as to their long-term health risks and benefits. But many who are metabolically challenged and unable to lose weight on other plans find they can control their weight by more drastic carbohydrate reduction. Sudden weight gain from fluid retention may indicate a serious underlying medical problem including heart disease, kidney disease, high blood pressure, a negative side effect to an oral antidiabetes medication, or even a condition such as irritable bowel syndrome or celiac disease. Be sure to discuss any sudden, unexplained, or significant weight loss with your physician. Weight Loss Weight loss may be part of a healthy approach to managing diabetes, especially for those with type 2 diabetes. But when weight loss is either unintentional, or more than healthy, it could be part of an underlying medical condition or possibly due to an eating disorder. Weight loss can occur when blood glucose levels are too high, or, when those on insulin are not taking enough insulin to cover food eaten. One of the symptoms of type 1 diabetes prior to diagnosis is weight loss because when not enough insulin is present to properly metabolize and make use of food energy glucose (sugars) will build up in the blood stream. To understand why weight loss occurs when not enough insulin is present it may help to think of insulin as a key that "unlocks" cells and allows glucose (from food energy) to enter into cells and nourish the body. Without sufficient insulin the body's cells, tissues, organs, and even the brain begin to starve. As a defense, the body turns to fat stores in an effort to find useable energy. When this happens, in addition to a buildup of glucose in the bloodstream, ketones (a byproduct of fat burning) may also build up in the body. This can lead to a serious, potentially life-threatening condition called diabetic ketoacidosis (DKA) and may require hospitalization. Eating Disorders Why should you know about eating disorders? If you, your child, or loved one has one of the many metabolic disorders that carry a medical demand of closely monitoring eating habits, there is a significant increase in the risk of developing an eating disorder. Eating disorders (EDs) are not just a problem for young girls; an all too common belief. EDs can develop at any age and also affect boys and men. In Australian type 1 diabetic children as young as 11 years old purposely under bolus insulin with meals in order to lose weight. In the United States studies suggest up to 25% of all females with diabetes – a prevalence of 2-6 times higher in women with diabetes than in the general population – have an eating disorder. The findings from a study by Flinders Medical Centre in Adelaide, also showed children in Australia with diabetes were markedly affected by disordered eating behavior:
While diabetes does not actually cause an eating disorder, having to pay close attention to weight management and food choices places an unnatural and unhealthy focus on eating and leads to distortion of self and body image. Once a person has ED issues, it is often easy for them to hide their problem under the guise of “it is part of my diabetes care plan.” Restricting, the elimination of certain foods or entire food groups, is a common factor in ED behavior, as is developing “safe” and “unsafe” food lists. A person may become overly concerned or anxious when offered something from their “restricted or unsafe list.” The initial limitation and focus of a food may stem from legitimate management issues (eating high glycemic index carbohydrates causes a rapid rise in blood sugars, fat prolongs highs) that develop into compulsive avoidance. Fear may also stem from weight gain which can happen with all forms of diabetes, and for diabetics, the body conscious, ultra-thin-is-desirable- culture we live in, is made even worse because diabetics are weighed at every visit and constantly reminded from a health standpoint about excess body weight and diabetes. And those with metabolic challenges, especially type 2 and pre-diabetes, hear the “thin message” from culture, health professionals, parents, and even their own still voice from within. In fact, many believe that diabetics are to blame for their onset and readily point the finger at a lifestyle out of control. |
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