When people ask why diabetes is so bad, often the first thing that comes to mind will be the complications. That is, the complications of years of battling uncontrolled blood sugar and constant highs and lows.
This though is understandably unsettling, both as a diabetic and as a health-conscious individual who wishes nothing more than to live a healthy life free of any debilitating illness. This is slightly easier if you don't have a chronic disease like diabetes, as healthy eating and adequate exercise can take you far in life. However, with diabetes, it is a whole different story. With diabetes, you have to incorporate quality of the life you do have into the equation. It can't just be as simple as cutting out every food or going on walks after every meal for the rest of your life. It isn't fair, and it isn't simple.
In this blog, I'm going to list a few of the common complications of diabetes, to improve everyone's understanding and also to improve the understanding of risks and also prevention methods.
Diabetes Neuropathy
It's not the most common complication, that is reserved for cardiovascular disease and stroke, however it is certainly a common complication experienced by many diabetics. This complication is a result of high blood glucose levels on the nerves of the body such as the hands and feet, or face or organ nerves.
Nerves are very complex cells intertwined with each other indefinitely. There are different types of nerves with different signals. There are sensory, audio-detecting, touch-detecting, smell-detecting nerves, as well as motor nerves (muscle response nerves), and mixed nerves. The ways in which nerves work are as simple as biology has allowed - which for us is not so simple to understand nor to explain.
Each nerve has a certain threshold before an input, such as smell, touch (pressure), audio cues for sensory nerves, or more complex molecule release thresholds for muscles and such have an effect. When this threshold is met, the nerve begins to work, and the nerve's membrane (the lining of all cells) increases in voltage. This voltage then triggers a cascade along all of the nerve cells that are joint together, eventually reaching its target and triggering something, such as a smell, or a muscle movement. This is the oversimplified explanation of how nerves work, but it's needed to understand the consequences of neuropathy.
As sensory nerves are very sensitive to any environmental cue, damage to said nerves can cause a whole host of problems. Nerves are often only surrounded by small blood vessels called capillaries. Capillaries are tiny - like really small. Their width means they can only fit one red blood cell through at a time. When sugars are high, these capillaries become 'backed up,' congested with glucose. Glucose is a fairly reactive molecule to have in the body, it can stick to other molecules and glycate them, causing damage. This is what it does to the capillaries. Other mechanisms trigger this also, oxidative stress, a polyol pathway 'glitch' triggered by high sugars which leads to build up of sorbitol in nerves, disrupting their function and health.
These capillaries then become inflamed and can cease to function properly. Thus, the nerve cells which rely on those capillaries for nutrients slowly perish as this network of intricate blood vessels breaks apart, or molecules which are only there because of high sugars build up, disrupting the biological processes inside that cell.
This leads to nerves that are either dead or damaged or dying, which causes obvious side effects. Common side effects can include:
- tingling sensation
- muscle atrophy
- burning feeling
- extreme touch sensitivity
- urination difficulties
- balance issues
- heat intolerance
- loss of sensation in hands and feet
- excessive sweating
- muscle twitching
- cramps
Other types of neuropathies such as vagus nerve neuropathy can impact much more than just sensation. The vagus nerve, alongside many other key nerves can also fall victim to the effects of high sugars. Damage to the vagus nerve, for example, can delay gastric emptying, meaning the digestion time for food can be delayed hugely, making diabetes management even harder. Many other critical nerves can be affected by high sugars leading to catastrophic damage to the nervous system in the long run.
The best prevention for diabetes neuropathy is preventing and dealing with high sugars quickly. The body's upper threshold for high sugars is typically 7.8mmol/L however this is still high in a non-diabetic population. The common aim is 4mmol/L-10mmol/L for diabetics, but this is arguably too high. There is no differentiation between the bodies of a non-diabetic versus a diabetic when it comes to how high sugars can be damaging. Trying to maintain a tighter 4-7.8mmol/L range is the gold tier of prevention. Lowering your HbA1c to a non-diabetic level of 5.6% can help provided your levels are consistently below 7.8mmol/L.
Some diabetes experts, such as the late Dr Richard Bernstein have stated that diabetes neuropathy manifestations can actually be reversed or at least can be ceased by returning the sugars of a diabetic to that of a non-diabetic. Dr Bernstein recounts in his book, The Diabetes Solution, that his diabetes neuropathy was unnoticeable after he returned his levels to normal through a strict dietary regime. Thus, if you have already been diagnosed with neuropathy, do not let it serve as a sentence for infinite discomfort. Remodel your diabetes management and you might just be able to help your body heal or at least prevent further issues. You see, high sugars are pro-inflammatory and as some diabetics will remark when they have cuts and grazes, their wounds do not heal. This is because the immune system is busy dealing with damage caused by high sugars. Returning your sugars to normal can give the body the edge it needs to help heal some things we believe are permanent - until you try, you will not know.
Diabetic Retinopathy
Another common complication of diabetes, diabetic retinopathy is the destruction of small blood vessels in the retina of the eye, which begin to leak into the surround eyeball tissue causing blurred vision, floaters, or light sensitivity amongst other sight-related issues. The cause? Mainly high sugars. Retinopathy can also be quickly brought on by a rapid reduction in HbA1c, however how this works is not yet fully understood. Furthermore, retinopathy can be made worse by rapid HbA1c reductions leading to what's been termed as early worsening diabetic retinopathy (EWDR). This is why gradual reduction of HbA1c is better than rapid drops if you have early-stage retinopathy already.
Diabetic retinopathy, like many afflictions caused by diabetes, is not reversible but can be halted in its tracks with adequate glucose control and management. However, considering over half of people with diabetes develop some form of retinopathy, according to the national eye institute, these risks of this disease are not conveyed adequately to us diabetics. Prevention methods include maintaining a stable - yes stable, HbA1c, not just a lower HbA1c but a stable. Glucose levels above 7.8mmol/L are extremely toxic to the body and as soon as the body is overcome with glucose, damage in these sensitive capillaries begins to occur, causing leakage in the retina.
Many countries, such as the UK, offer yearly or two yearly diabetic eye screenings to catch retinopathy early in its tracks. Do not be fooled by realisation though; there is no treatment for retinopathy outside of healthy sugar readings and levels. Just because you know you have it, does not mean your eye health is safe. It's crucial to maintain balance within your sugar levels.
Diabetic Nephropathy
Organs in the body are all arguably as important as each other. Without your heart, you would have no blood circulation. Without your liver, you would surely and quickly die from some sort of chemical or molecular poisoning, not be able to digest fat, not be able to maintain fasting sugars, the list goes on. Without your pancreas, you cannot regulate sugars or digest many foods. Without your stomach, you cannot properly digest food or protect yourself from foodborne pathogens. Without your intestines, you cannot absorb what you eat. Without your brain, you cannot do anything. Without your kidneys and you would succumb to acidosis or toxin buildup. Yet we find ourselves with little function in our kidneys, or complete lack of it, in diabetes nephropathy, a disease characterised by high sugars or blood pressure damaging the filtering units (nephrons) of the kidneys, causing lack of function in the two organs. The treatment? Often dialysis. If caught early, you are lucky and can manage it through lifestyle tweaks such as diet and exercise and sugar level management.
Nephropathy manifests with several classic telltale signs which often lead to quick diagnosis if you have diabetes already diagnosed:
- Swelling in peripheries
- Urination changes
- Fatigue
- Weakness
- Loss of appetite
- Nausea
- Shortness of breath
- Hypertension
The good news if caught early is that you can prevent further complications or reduce the risk of such happening by managing your sugars and blood pressure. Often, the two go hand in hand. To reduce your risk of diabetic nephropathy, you guessed it - prevent and deal with those high sugar readings. They really aren't safe. Not for two minutes, not for two days. Diabetes mellitus means 'to pass through sweet as honey.' It is a disease of high sugars and blood sugar dysregulation. The complications are always due to high sugars. Thus, any statement that high sugars even for a minute is 'ok' is false. It is upsetting, but this is where balance needs to occur. I don't mind risking a very slim chance of a complication from a piece of cake on someone's birthday or Christmas, or if I go out somewhere nice. That chance grows the more your sugars have been high lately. Do not risk it for the sake of not wanting to confront diabetes, risk it for the sake of balance instead.
Cardiovascular Disease (CVD)
Not many people know that this is the most common manifestation of diabetes complications. Heart disease overall kills 1 in every 3 people. Its causes are often fiercely debated, and this has led to fiery discussions and talks on the matter. Ultimately, we know one thing: diabetics suffer from high blood sugars. Diabetics are also much more likely to develop CVD. A study published by the University of Manchester found that even well-managed adults with type two diabetes are 21% more likely to suffer cardiovascular disease than the average population. That's in well-managed cases! The easy statement to draw for diabetics then is that our high risk is increased due to our characteristic differentiation from the general population - our sugars are higher. This implicates sugar readings in the development of heart disease by default.
There are many factors spouted out there about how to best prevent heart disease, such as red meat intake and lower fat intake. However, I would just say the second longest living population currently resides in Hong Kong, the place which boasts one of the highest red meat and organ meat consumption in the world with high saturated fat intake. The simple distinction to draw for us diabetics is that our sugar levels are responsible for our increased risk, not our diet. Revert your sugars readings to normal to reduce any extra risk and then focus on diet. I would bet that this, too, goes hand in hand with each other. To reduce further risk, reduce sugars. In doing so, we will likely conclude that overall risk goes down too. Diabetes and CVD are like the devil and his henchman; they often walk side by side. Be warned, CVD is on the rise and there are many factors which increase risk outside of diet:
- Genetics
- Smoking
- Activity level
- Environmental toxin exposure
Keeping your diabetes in check will at least keep your risk in line with the average population.
Ulcers and Skin Conditions
Diabetics with high sugars will often find their cuts and grazes do not heal efficiently when their sugars are high. As touched upon earlier, this is because the immune system is overcome by the damage caused by high sugars and cannot adequately help heal in a pro-inflammatory environment. Think of healing wounds as trying to tie a shoelace in the bed of a pickup truck. Now imagine trying to do this with high sugars, envision this as several steep speed bumps - the type you need to actually slow down for, followed by craterous potholes, the type that make you get out and check your wheel for damage. Then, imagine when you finally do get a good hold of the laces, your seatbelt comes off. It's a troubling time for your body when it has high sugars to content with.
Ulcers in diabetes are primarily a result of a combination of ailments, from earlier-discussed neuropathy to capillary damage leading to poor access for the immune system to the site of infection. Over time, the tissue surrounds the cut or graze or wound becomes laden with otherwise commensal (harmless) bacteria that normally reside on our skin. These bacteria do the only thing they serve to do - grow at whatever means necessary. In diabetics, this easily leads to the formation of ulcers and skin afflictions which can lead to sepsis or worse if not treated efficiently. If you live with diabetes and have regular cuts and grazes, from a job perhaps, or a hobby, be careful to keep sugars at bay and dress and treat wounds accordingly. It could be crucial to prevent infection and serious complications.
Other skin ailments can usually be attributed to poor vascularization (blood vessel networks) around the skin due to prolonged damage to capillaries over many years of diabetes, in those with higher average sugars.
Final Thoughts
The consequences of unmanaged diabetes can be and are often severe. Whether it results in another chronic disease, or potentially even loss of the most basic things like touch or smell we take for granted, the complications of diabetes and uncontrolled sugars are not to be taken lightly. This has been an information gathering piece, and not intended to scare diabetics out there, however it is the harsh reality many of us face. If you need support with your diabetes management get in touch. Knowledge and education is the best key to success with diabetes.