Long term complications

Diabetic retinopathy

Diabetes-related eye complications are very common. It is the leading cause of blindness and vision problem now. If left untreated, they lead to the deterioration of vision and, ultimately, blindness. There are two eye diseases that result from diabetic micro- vascular complications:
  Diabetic retinopathy   Macular oedema. 

Diabetic retinopathy

Facts by IDF:

Diabetic retinopathy is the leading cause of vision loss in adults of working age (20 to 65 years) in industrialised countries. It is estimated that more than 2.5 million people worldwide are affected by it.
74 percent of people who have diabetes for 10 years or more will develop some form of diabetic retinopathy.
Approximately 14 per cent of people with diabetes have diabetic macular oedema and prevalence increases to 29 per cent for people with diabetes who use insulin for more than 20 years.
Left untreated, 25 per cent of people with diabetic macular oedema will develop moderate vision loss within three years.
Estimates of the rate of annual eye exams vary greatly by country and study, but the rate of screening is generally fairly low (from 40 to 65 percent).

Worldwide guidelines recommend annual screenings with a dilated eye exam from an eye care specialist for people with diabetes.

What is diabetic retinopathy?

Diabetic retinopathy is caused by damage to the small blood vessels of the retina in the back of the eye. The small vessels can be damaged by high blood glucose and high blood pressure. Thus an individual who suffers from hypertension is at an higher risk of developing diabetic retinopathy than those who have a normal blood pressure.  The high blood glucose levels hinder the flow of blood, and thus oxygen, to the cells of retina. This hinders the working of retina and thus leads to improper vision.

The early stage of this disease is called non- proliferate diabetic retinopathy, characterized by the development of occasional small blisters caused by enlarged capillaries and small hemorrhages on the surface of the retina. Moderately severe to very severe non-proliferative diabetic retinopathy is also known as pre-proliferative diabetic retinopathy. The blurred and distorted vision is because of macular edema. blurred or double vision; reduced vision; and dark or floating spots.

 Proliferative diabetic retinopathy is the advanced form of diabetic retinopathy; the new blood vessels break, as they are weak and leak blood into clear gel of the eye, which will lead to floating spots in the eye, blocking vision. The pace of damage is not similar in both the eyes but, both the eyes are affected by this disease. Some times one eye is affected more easily than the other. After some period, the swollen and scar nerve tissue of the retina is totally destroyed and pulls up the entire layer of retina and detaches it from the back of the eye.Retinal detachment is the cause behind blindness among diabetics in middle age. The other two types of eye problems usually seen earlier in the people suffering from diabetes are:
Cataract: A thin cloudy layer appears in front of your eye leading to unclear vision. In cataract surgery this thin layer is removed and setting of a plastic layer in front of the lens is done, thus gives you a clear vision again.
Glaucoma: Due to high pressure on the optic nerve, it gets damaged. The damaged optic nerve creates disturbance in clear vision. Laser surgery or simple eye drops may help in regaining the normal vision.
A diabetic must go for the regular eye checkup so that the early stages of diabetic retinopathy can be detected and treated in initial stages itself, with less harm to the eyes. Blood sugar levels should also be monitored and maintained to prevent blood vessel damage.

Treatment

There is no pharmaceutical therapy available at present that stops the progression of diabetic retinopathy by treating the underlying process of microvascular damage.
Current treatment options (generally reserved for late stage pre-proliferative and proliferative diabetic retinopathy and sight-threatening diabetic macular oedema) include two different forms of laser surgery. Laser therapy seals the leaking blood vessels in the macula, slowing the swelling that causes impaired vision. This procedure does not improve blurred vision but it can prevent it from worsening. While laser surgery can usually prevent vision from deteriorating, in most cases it cannot restore vision that has already been lost.

Diabetic Nephropathy Facts by IDF

• Diabetic kidney disease occurs in approximately one- third of all people with diabetes.
• Kidney failure typically occurs after 20-30 years of diabetes. 
• In type 2 diabetes, the risk of developing cardiovascular disease is 2-3 times higher in someone with micro- albuminuria compared to a person with normal albumin excretion.
• Type 2 diabetes has become the most frequent condition in people with kidney failure in countries of the Western world. The reported incidence varies between 30% and 40% in countries such as Germany and the USA.
• Stopping smoking can reduce the risk of disease progression by 30%.

Kidney functions as a filtering machine in a human body by throwing out the waste in the form of urine. It maintains electrolyte balance, blood pH level and regulates blood pressure, and also releases some of the hormones. Diabetic Nephropathy is a complication in which kidneys are damaged due to persistent high blood sugar level in the blood. When the kidneys start damaging, they fail to carry out these functions with proficiency. It’s one of the common causes of kidney failure world wide, especially in adults.

Protein molecules along with other bodies which are present in the blood, start appearing in the urine. In the initial phase of nephropathy where damage is not too severe, drugs and diet can control the condition. When protein starts leaking in the urine it is called as microalbuminuria, as the condition starts worsening, large amount of protein is thrown in the urine with heavy losses of protein from the body. This can eventually lead to kidney failure and End Stage Renal Disease (ESRD). Few easily noticed symptoms of kidney failure are:

• fatigue
• decreased appetite
• nausea and vomiting

The disease is characterized by:

• Increased proteins in the urine
• Increasing blood pressure
• Failing kidney function

How to know that I have Diabetic Nephropathy?

Diabetic Nephropathy can be screened in simple urine test at any diagnostic laboratory. When Shall I go for the Test for Diabetic Nephropathy?
Type 1 diabetes: Fourth year of diagnosis of diabetes
Type 2 diabetes: At the time of diagnosis of diabetes
It is always better to go for routine tests in the further years.

How can I treat Diabetic nephropathy?

When it shows albuminiuria, modification of diet, regular exercise with some medication for blood pressure control (an ACE inhibitor or angiotension receptor blocker [ARB]) is generally recommended, even if blood pressure is normal.
Patients with elevated blood pressures and albuminuria are treated with an ACE inhibitor or ARB. These medications can reduce the percent of protein extraction in the urine and help in slowing down the progression of diabetes, nephropathy and related kidney diseases.
The main treatments for diabetic patients with end stage renal disease are:

• Hemodialysis
• Renal transplant

How can I prevent Diabetic Nephropathy

• Maintain blood sugar level within normal range.
• Keep blood pressure under control.
• Decrease intake of salt, fast foods, preserved and baked items to maintain blood pressure.
• Decrease animal protein, simple sugars and animal fats in the diet.
• Check urine regularly for microalbumin.
• Quit smoking.
• Control blood lipid levels.
• Take care of bladder or urinary tract infections and treat them early.
• Exercise
• Reduction of alcohol intake

Diabetic Neuropathy:

Diabetic neuropathy is the complication that develops when the nerves are affected. It affects almost half of the people with diabetes. However, it goes unnoticed for a long period of time till the obvious disorder occurs. It occurs when the small vessels carrying oxygen and nutrients to the nerves are damaged due to high blood sugar levels.

Damage to one small segment can lead to loss of sensation in that area. This loss of sensation can be in feet, hands or other parts of the body. A lack of sensation in the feet can lead to people with diabetes injuring their feet without realizing it. These injuries can lead to ulcers and possibly amputation. It mostly starts in the feet as they are the longest nerves and fed with longest blood vessels of the body. Generally it is seen in the obese people with high blood sugar levels and age more than 40 years. Neuropathy can develop within a span of first few years and it affects approximately 60% of diabetics.

What are the symptoms of Diabetic Neuropathy?

Dry scaly skin with callus formation and no sweating.
Numbness, tingling, and some sort of burning sensation.
Weakness and loss of reflexes.
Decrease sensation to the slight change in temperature.

How can I prevent Diabetic Neuropathy?

The first step is to keep the blood sugar levels and blood pressure under control. You should take care of your feet especially the area between toes, and must not overlook if there is any kind of blisters, ulcer, redness or soreness or formation of callus etc.

If any suspicion or doubt arises for the foot then it should be followed by immediate physical examination. The clinical examination will show the sensation in the feet and determine if it is normal or diminished.

Prevention of Diabetes:

Primary prevention:

Primary prevention is a very promising strategy to prevent or delay the onset of diabetes and its complications for individuals who are at risk of developing diabetes. It is beneficial for older people who are at risk of developing type II diabetes. No researches have concluded that type I diabetes can be prevented by any strategy.

Timely intervention of primary prevention can not only prevent from diabetes but also reduce the risk of developing heart disease other associated disorders. The various components of primary prevention are lifestyle changes to maintain a healthy weight, healthy diet with proper nutrition, regular physical activity and health check- ups at desired intervals.

Secondary prevention:

Secondary prevention is targeted at the early detection of the complications associated with diabetes, so that they can be prevented. Secondary prevention ensures cost effectiveness in terms of reduced treatment cost and hospitalization requirements to treat the complications of diabetes and also helps a diabetic in attaining good quality of life. Researches have proved that diabetic individuals, who are able to manage their blood sugar levels effectively, have reduced incidence of complications related to diabetes and have a better quality of life.

Heart Disease and Stroke

If you have diabetes, you are at increased risk of developing heart disease as a result of changes in your blood chemistry. One of the effects of these changes is the build-up of fatty deposits inside your arteries, the blood vessels that carry blood to your heart, also called coronary arteries. These deposits, which are made up mostly of cholesterol, can narrow the arteries and reduce the blood flow to the brain and the heart. If a fatty deposit is too large, it can totally block the blood flow through the blood vessel, causing a heart attack (damage to the heart muscle due to lack of oxygen ) or stroke ( damage to the brain due to lack of oxygen ). Diabetes can also cause your blood to clot more easily. The formation of blood clots can block the blood vessels and cause a heart attack or stroke. Having diabetes also puts you at increased risk of having high blood pressure, which is a major cause of heart disease and stroke.

Along with this, if you have a high cholesterol levels in blood, you can have more chances of developing these clots and high blood pressure. Cholesterol is a waxy, fat like substance in our blood, which is responsible for few important functions in the body. However, excess of cholesterol can be harmful for us.

The various types of cholesterol are:

LDL Cholesterol (Low Density Lipoprotein- Cholesterol): LDL Cholesterol, often called “Bad Cholesterol”, increases the risk of heart diseases by increasing the tendency of clot formation. LDL Cholesterol increases with the consumption of saturated fats such as ghee, butter, cream, mutton, sausages and other animal products. For prevention, a diabetic should follow a strict regime to keep the LDL Cholesterol under control. A target of 70 mg/ dL is safe for most of the diabetics. However, your doctor will give you your individualized target level of LDL- Cholesterol.

HDL- Cholesterol (High Density Lipoprotein Cholesterol): This is also called “Good Cholesterol”. This cholesterol prevents us from heart diseases by mobilizing the fat accumulated in our arteries to liver. Liver, in turn, excretes this fat out of our bodies. Thus, higher the HDL Cholesterol, better it is. A diabetic should try to aim for HDL Cholesterol as high 45 mg/ dL- 60 mg/ Dl. 

You can prevent heart disease by being diligent about your cholesterol level being below 200mgs%, your blood pressure below 140/90 mm of hg and your weight at a healthy level for you. If you are a smoker, quitting will reduce your risk of heart disease more than almost anything else you do.

You may experience the following symptoms if you have heart disease :

• Mild tightness or heaviness in your chest.
• Severe pain or pressure in your chest.
• irregular heartbeat
• Chest pain or shortness of breath during physical activity, such as climbing a flight of steps.
• Nausea, sweating, or dizziness.
• Difficulty in breathing or shortness of breath.
• swollen ankles

Silent heart disease in young persons with diabetes:

Serious cardiovascular disease can begin before the age of 30 in persons with diabetes. Many studies demonstrate that persons with type 2 diabetes are at increased risk for heart disease. In fact, one study found that persons with type 2 diabetes without apparent heart problems ran the same risk for heart disease as persons without diabetes who had already suffered one heart attack.

How can I Prevent Heart Diseases?

When risk factors are eliminated (or reduced) in a person with diabetes, the risk for heart disease may be reduced. Taking care of yourself and controlling your blood sugar can often slow down or prevent the onset of complications. Other preventive treatment measures may include:

• See your doctor regularly.
• Have annual electrocardiograms (a test that records the electrical activity of the heart, shows abnormal rhythms, and detects heart muscle damage), cholesterol and blood pressure check-ups, and pulse measurement in legs and feet.
• Pay attention to your symptoms and report them promptly to your physician.
• Control your blood sugar levels.
• Control blood pressure levels with lifestyle and diet changes, and/or medication.
• Keep low-density lipoprotein (LDL) levels (the "bad" cholesterol) at less than 70 mg/dL.
• Control your weight.
• Exercise regularly.
• Eat a healthy and balanced diet.
• Do not smoke.
• Limit consumption of alcoholic beverages.