Complications

- Diabetic Neuropathy
- Kidney Disease in Diabetes
- Heart Disease and Diabetes
- Erectile Dysfunction and Diabetes
- Diabetic Ketoacidosis

Short-term complications of diabetes, such as hypoglycemia, hyperglycemia, and ketoacidosis, can happen quickly. Patients need to be aware of their signs and symptoms and what to do to reverse them. Long-term complications, such as heart disease, kidney disease, and neuropathy, can seriously compromise a patient with diabetes.

Diabetic Neuropathy

Diabetic neuropathy is a long-term complication of both Type 1 and Type 2 diabetes. It affects the nerves of the body. There is no cure for neuropathy.

Types of Neuropathy

1. Autonomic neuropathy is damage caused to nerves that control the bladder, digestive tract and the reproductive organs.

2. Peripheral neuropathy affects nerves of the extremities, especially the feet and legs. Numbness and tingling, sensitivity to touch or muscle weakness are signs of neuropathy.
Symptoms include chronic pain, numbness and muscle wasting. Sores and ulcers are also a serious threat.

Causes of Neuropathy

An injury or exposure to toxins can harm the nerves. Several chronic diseases can also affect the integrity of nerves over a long period of time. Parkinson's, multiple sclerosis and other conditions such as autoimmune diseases can cause damage to nerves. But diabetes is the biggest risk factor for neuropathy today.

Neuropathy is a long-term complication of diabetes, which means it typically takes many years for neuropathy to develop. Nerve damage happens over time, due to prolonged exposure to the damaging affects of high blood glucose levels. The longer a person has diabetes, the higher the risk of developing neuropathy, especially if their disease is not controlled well.

Preventing or Reducing the Risk

You can reduce the risk of neuropathy by good glucose control, a balanced eating plan and exercise. But sometimes, as in Type 1, no matter how tight the control, how balanced the diet or how much exercise a person gets, neuropathy can strike simply because of the sheer length of time the person has had diabetes. Also, many times, people who suffer from Type 2 diabetes don't even know they have the disease for many years. Much damage can occur during that time.

Treating Neuropathic Pain

- For mild to moderate pain, Tylenol or NSAIDS, such as Motrin or Aleve might be prescribed. Some of the more common medications for neuropathic pain include tricyclic antidepressants (TCAs) such as Elavil and Amitril. When TCAs are used to treat chronic pain, the dosage is much lower than for treating depression. Cymbalta (duloxetine hcl) is an SSRI, another kind of antidepressant medicine which shows success at treating both neuropathic pain and any underlying depression that also might exist.

- Some antiepileptic drugs (AEDs) also are showing success at relieving neuropathic pain. Neurontin and Lyrica are commonly prescribed AEDs. They work by reducing the frequency of pain signals that nerve cells send to the brain.

- Stronger narcotic pain relievers are sometimes used for moderate to severe pain that does not respond to other medications.

Kidney Disease In Diabetes

Kidneys are made up of millions of tiny filters called nephrons. The nephrons have even smaller vessels within them. These are destroyed over time, when glucose levels are consistently too high. This affects the kidneys ability to filter the blood. Waste that would ordinarily be excreted remains in the blood causing severe problems. Usually damage takes years to develop.

Signs Of Kidney Disease

- High Blood Pressure

High blood pressure can be an indication that the kidney function is deteriorating. Blood pressure medications are usually prescribed to keep blood pressure at an acceptable level and also to slow the progression of damage. Usually a combination of medications are used to keep blood pressure normal. ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are the most commonly prescribed drugs.

- Creatinine

Creatinine is a waste product that is normally filtered from the blood and excreted with the urine. When kidneys start to fail, creatinine builds up in the blood. Doctors watch the creatinine levels carefully to determine how much function the kidneys have. A normal level is usually between 0.6 and 1.2 mg/dl. This does vary slightly. As the number increases above 1.2, it shows that kidney function is decreasing. Creatinine levels are obtained by a simple blood test.

- BUN (blood urea nitrogen)

BUN is another marker of kidney function that doctors look at. When blood flows through the body, protein circulates to cells. Cells use the protein and throw away the waste that they don't need. This waste is called urea. Normally urea is filtered out of the blood by the kidneys. Urea also contains nitrogen. If the kidneys aren't working like they should, urea and nitrogen stay in the blood. A BUN of over 20 mg/dl is an indicator of decreased kidney function.

- Kidney Failure

Kidney failure is the last stage of kidney disease. When kidneys can no longer function, no toxins or waste products can be eliminated from the body. All those waste products continue to circulate in the blood, causing it to become extremely toxic. When someone's kidneys have failed, it is known as end stage renal disease (ESRD). No one can live very long with ESRD without intervention. Either dialysis or a transplant is needed.

Reducing The Risk

Because kidney disease can take years to develop, people with diabetes can do many things to lower the risk. Tight control of blood glucose levels can prevent or reduce long term damage to the fragile blood vessels not only in the kidneys but elsewhere in the body. Check blood pressure often, and try to keep it at or under 130/85. Take an ACE or ARB if your doctor prescribes it. Watch your cholesterol and your weight. Quit smoking. All these things can go a long way towards keeping your kidneys working well for as long as possible.

Heart Disease And Diabetes

People with diabetes are twice as likely to develop heart disease than the rest of the population. Among diabetics, heart disease can progress quicker than normal.

Diabetes speeds up hardening of the arteries (also known as atherosclerosis). This can occur when cholesterol levels get too high. You may have heard of LDLs and HDLs. These are the lipoproteins that carry the cholesterol that circulates in your body. LDLs, or low-density proteins, take the cholesterol through the circulatory system to where it is needed. HDL's, or high-densitiy proteins, carry what isn't used back to the liver.

When there is too much cholesterol, the LDLs deposit the left-over cholesterol into the blood vessels. Even though the HDLs try to carry the excess back to the liver, they can't take it all. The extra cholesterol that gets left behind forms plaque on the vessels walls, which makes them less flexible and more narrow. This raises the risk for blood clots, heart attacks and strokes.

When someone has diabetes, the glucose in the blood can slow down the LDLs which makes the cholesterol build up much faster on the blood vessel walls. That's why people with diabetes have to watch their cholesterol levels more closely and start cholesterol lowering medications sooner than people who do not have diabetes.

Recommended Cholesterol Levels

- LDL cholesterol: <100 mg/dl
- HDL cholesterol: >45 mg/dl for men and >55 mg/dl for women
- Triglycerides: <150 mg/dl

How to Lower Cholesterol

A Healthier Diet

- Avoid "tropical" fats such as coconut and palm oils
- Use less fats overall when cooking
- Eat more whole-grain breads and cereals and eat fewer products made with refined flour
- Choose low-fat dairy products
- Eat less red meat and more fish and skinless white meat chicken or other healthy sources of protein, like beans and tofu
- Eat more fruits and vegetables

Other Tips

- Try to exercise for at least 30 minutes everyday
- Quit smoking, or don't start
- Keep regular appointments with your doctor
- Take cholesterol medications as prescribed

Heart Attack Warning Signs

- Pressure, squeezing, fullness or pain in the chest
- Discomfort in one or both arms, back, neck, jaw or stomach
- Shortness of breath
- Breaking into a cold sweat, nausea or lightheadedness

Stroke Warning Signs

- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause

Diabetes And Erectile Dysfunction

Erectile dysfunction is a condition that affects a man's ability to get and sustain an erection that leads to positive sexual experiences. Although most men do encounter trouble having an erection from time to time, the problem is not generally thought to be Erectile dysfunction unless the symptoms are consistent for 3 months or more.

According to the Canadian Diabetes Association (CDA), erectile dysfunction is common for men who have diabetes. Often, it's the first symptom that men may notice and the one that leads them to the doctor in the first place. Only after they have sought medical help for erectile dysfunction do they also receive a diagnosis of diabetes. Fifty percent of men with diabetes will suffer from erectile dysfunction within 10 years of diagnosis.

The same elevated blood glucose levels that cause blood vessel and nerve damage in other parts of the body can also lead to complications in blood flow and nerve damage to the penis.

Factors That Can Lead To Erectile Dysfunction

The longer a man has had diabetes, the more likely he will suffer from erectile dysfunction. Also if blood glucose levels have not been well controlled throughout the illness, blood vessel and nerve damage will be greater. Complications of accompanying heart disease such as high blood pressure and high cholesterol can also affect erectile dysfunction. A man with diabetes who also smokes increases his risk of developing erectile dysfunction

Medications That Treat Erectile Dysfunction

Prescription medications such as Viagra, Cialis, and Levitra are used to treat erectile dysfunction. All three of these medications work the same way, by helping increase blood flow to the penis. This helps erectile function and enables a man to have and sustain an erection during sexual intimacy. The medications are taken a half hour before sex and the effects can last from 4 to 5 hours. These drugs do have some serious side effects so be careful when using them and ask your doctor.

Diabetes And Diabetic Ketoacidosis

DKA: A Serious Complication of Diabetes

There are many complications that can occur with diabetes. One serious complication is diabetic ketoacidosis (DKA). It most commonly occurs with Type 1 diabetes and is often the first symptom of Type 1, because it can often strike without warning. DKA is caused when the body has little or no insulin to use. The blood glucose level keeps rising to dangerous levels. This is called hyperglycemia.

If the blood glucose continues to increase, the body goes into an "energy crisis" and starts to break down stored fat as an alternate energy source. This produces ketones in the blood as the fat is burned for energy. As the ketone levels rise, the blood becomes more and more acidic.

Causes of DKA

- The sudden start of Type 1 diabetes is one cause of DKA.
- Common infections like pneumonia or urinary tract infections
- Insulin pump failure can lead to DKA
- Kids who are going through adolescence can experience endocrine changes that can alter glucose levels and insulin effectiveness.

Signs And Symptoms of DKA

Early signs:

- Feeling tired or fatigued
- Excessive thirst and/or excessive urination
- Signs of dehydration such as dry mouth

Later signs:

- Nausea/vomiting
- Abdominal pain
- Confusion
- Rapid, deep, labored breathing (Kussmaul's respirations)
- Breath that smells fruity
- Fever
- Unconsciousness

Medical Treatment of DKA

Treating DKA means medical intervention. It's important to treat dehydration by replacing fluids that have been lost, so most likely IV therapy will be used. Electrolyte imbalances need to be corrected and insulin therapy started to control hyperglycemia. All of this must be done under careful medical supervision.

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