Living with Diabetes Module 04

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Living with Diabetes

Module 04

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4. Module 04: Avoiding Diabetes Table of Contents

4. Module 04: Avoiding Diabetes ... 1

4.1 How to Avoid Diabetes Complications ... 2

4.1.1 Cardiovascular Complications ... 3

4.1.2 Neurological Complications ... 5

4.1.3 Other Nerve Related Complications ... 6

4.1.4 Complications in the Teeth and Gums ... 7

4.1.5 Musculoskeletal Complications ... 7

4.1.6 Eye Complications ... 9

4.1.7 Skin Disorders ... 10

4.1.8 Sleep Disorders ... 11

4.1.9 Other Complications ... 12

4.2 Patient Advocacy: Know Your Rights ... 13

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4.1 How to Avoid Diabetes Complications

Diabetes is a disease that impacts every aspect of your physical and mental health. Even with proper treatment with insulin or non-insulin glucose management drugs, you run the risk of developing numerous complications which can affect your health and happiness for the long-term. Taking preventive measures when you learn that you have diabetes can help you to prevent these complications so that you stay as healthy as possible.

Diabetes puts you at risk of developing a variety of issues including but not limited to:

 heart disease and other cardiovascular issues,

 hypertension,

 stroke

 foot problems

 sleep disorders

 restless leg syndrome

 kidney disease

 Glaucoma and much more.

While most preventive measures revolve around getting enough exercise, a healthy diet, and using medication or insulin to keep your blood glucose under control, you should be aware of common complications and how to prevent them.

Importantly, no matter how much you work, exercise, or eat right, some diabetic complications will happen anyway. Preventive measures are not a magic pill, and you can reduce risks or alleviate symptoms, but you can’t make side effects go away entirely.

3 4.1.1 Cardiovascular Complications

The blood vessels and arteries that make up your circulatory system are the part of your body most at risk from diabetes of any type. The U.S. Centers for Disease Control (CDC) claims that nearly 68% of all diabetics over the age of 65 die from heart disease related complications. Taking steps to maintain your heart health, even from a very young age, will help to ensure that you can avoid these issues and stay as healthy as possible.

In most cases, your primary goal should be to get regular exercise, do cardio (running, jogging, swimming, cycling, aerobics, dancing, etc.), and watch your cholesterol and saturated fat intake. This typically means lowering your consumption of eggs, processed meats, and fatty meats. Your doctor will likely run tests to determine your current LDL and triglyceride levels, suggest dietary adjustments for you, and if the dietary adjustments do not work, may prescribe a preventive drug even if your profiles are in a healthy range.

Atherosclerosis: Diabetics are at an increased risk of atherosclerosis, or a buildup of plaque or cholesterol in the arteries. This can contribute to coronary artery disease, where arteries to the heart are blocked.

Congestive Heart Failure: CHF or Congestive Heart Failure is marked by symptoms including fluid retention, shortness of breath, heart palpitations, and constant fatigue. Here, the heart is literally not functioning well enough to meet the body's needs, which causes problems throughout your entire system.

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Peripheral Vascular Disease: Peripheral vascular disease is a form of atherosclerosis, typically in the legs.

Symptoms typically include hair loss on the shins, chronically cold feet and legs, bluish or reddish feet and legs, sores or ulcers that won't heal, and cramping.

Hypertension: While hypertension is a cardiovascular problem, it is an extremely common complication for diabetics. The CDC in the USA claims that 67% of persons with any form of diabetes eventually develop hypertension, which then goes on to influence kidney disease and congestive heart failure. Managing your health and blood pressure can help you to prevent or minimize the side-effects of hypertension.

A healthy person typically has a blood pressure reading of less than 130 mmHg systolic and less than 80 mmHg diastolic (130/80) while a person with hypertension will have a reading over 140/90.

Management techniques include weight management, stress management, lowering sodium and cholesterol intake, and if you smoke, stopping smoking. If you continue to have problems, you will likely be recommended medication by your doctor.

Stroke: Diabetics suffer a strongly increased risk of ischemic strokes, which happen when arteries leading to the brain are blocked or cut off. Because this form of stroke is strongly linked to atherosclerosis, managing your sodium and cholesterol intake can help you to reduce the risk and to keep your heart healthy.

5 4.1.2 Neurological Complications

Over time, high levels of glucose in the body can cause damage to nerve cells. Because nerve cells don't have a limit on how much glucose they can take in, high glucose levels can deplete nitric acid in the cells, cutting off blood supply, in turn contributing to cell death. Without proper management, this can contribute to stroke, nerve damage, and cognitive impairment, as well as a wide range of other issues. Strong glucose management, including managing your diet, insulin, or oral medication, will help you to reduce risks and keep your nerves healthy.

Peripheral Neuropathy

 PN or Peripheral Neuropathy affects the feet and hands, causing pins and needles, tingling and burning, numbness, balance problems, muscle weakness, and reflex problems.

 PN is often compounded because most people don't realize when they have it and continue to use their hands and feet without treatment, adding more damage on top of the nerve damage.

 Treatment typically includes antidepressants, anticonvulsant medications, and some topical treatments, which help to reduce symptoms and pressure on the nerves.

Autonomic Neuropathy

 Autonomic neuropathy is a less common and less intrusive form of never damage, but is more dangerous.

 Damage occurs to the autonomic nervous system, which controls the blood pressure, heart rate, perspiration, salivation, gastrointestinal function, bladder function, sexual function, and vision.

 Early symptoms include diarrhea, dizziness, excessive sweating, etc.

 When autonomic neuropathy primarily affects the heart rate and blood pressure, it is known as cardiovascular autonomic neuropathy. This can cause serious problems, like myocardial infarctions (death of part of the heart muscle).

 In severe cases, autonomic neuropathy will make it difficult to determine when your blood glucose is too low.

6 4.1.3 Other Nerve Related Complications

Restless Leg Syndrome

Restless leg syndrome is a nerve related disorder very common in Type 2 diabetics. Here, the leg cramps, tingles, burns, or is otherwise uncomfortable, forcing you to move it. This typically worsens at night when you stop moving, and the symptoms can keep you awake or reduce the quality of your sleep. Managing weight, caffeine, nicotine, alcohol, and walking or exercising can help to prevent or reduce the problem.

Foot Complications

High levels of glucose in the body damage and deaden nerves, and the feet are often the first to suffer. Nerve damage and cardiovascular issues can result in cold feet, deadened nerves and therefore fewer sensations of pain, and increased risk of infection. As a result, you are less likely to feel blisters and cuts on the feet, but they are more likely to become problematic if they become infected.

While there is no cure once you start to experience foot problems, you can manage symptoms by checking your feet daily, maintaining good hygiene, and keeping feet moisturized will help to protect them. You can also invest in comfortable shoes (not heels) to ensure that your feet stay safe and comfortable.

Cognitive Impairment

 Neurological damage can eventually result in cognitive impairment, as nerve cell death contributes to memory problems and slower thought processes.

 In most cases, this can be a result of two factors, including nerve cell death caused by high glucose, and by a lack of insulin absorption in the brain, as is the case with Diabetes Type 3 (Alzheimer's).

 A reduced glucose tolerance can cause atrophy of the hippocampus if not managed, resulting in memory loss and reduced cognitive functioning.

7 4.1.4 Complications in the Teeth and Gums

High levels of glucose in the blood affect every part of the body, and the teeth and gums are very much at risk.

When glucose builds up, it increases in your saliva, enabling bacteria to build up well beyond healthy levels.

As a result, nearly one-third of people with diabetes suffer from gum disease and tooth decay.

While glucose management is the best prevention method, you should also take care of your teeth and gums.

Brushing and flossing before and after bed, and after each meal, in combination with antiseptic mouthwash, will help to reduce bacteria to keep your teeth and gums healthy. These preventive measures will also help to reduce bad breath, which is also associated with increased bacteria in the mouth and a common problem for diabetics. If you have excessive problems, consult with your dentist to see if you need a prescription mouthwash.

4.1.5 Musculoskeletal Complications

The musculoskeletal system can be affected by diabetes complications, although how and why often depends on the complication. In most cases, maintaining regular exercise, weight management, glucose management, and diet are the best ways to prevent these complications. However, they may appear even with the best management program.

Duputryen's Contracture: Duputren's Contracture is caused by a contraction in the tendons in the palm, causing the fingers to thicken and curl inward. This typically starts with the little finger or the ring finger and may be preceded by pain the palm. Once the fingers are moved, you will need physical therapy or surgery to fix the problem.

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Adhesive Capsulitis: Adhesive Capsulitis, commonly known as frozen shoulder, is a disorder that affects the normal range of motion in the connective tissue of the shoulder. In most cases, it is caused by hyperglycemia, which inflames that tendons and causes the collagen in the shoulder to change. Cortisone injections, anti- inflammatory medications, and physical therapy are used to treat it.

Stenosing Tenosynovitis: Stenosing Tenosynovitis or Trigger Finger is a condition in which the index finger becomes locked into a curved position. You will likely notice inflammation and pain in the finger first, after which flexing the fingers becomes more and more difficult.

Carpal Tunnel: Carpal tunnel is the compression of the medial nerve in the wrist by the carpal tunnel ligaments, affecting the hands. Symptoms typically include pins and needles, burning sensations, and stiffness.

Because high blood glucose changes collagen, it makes carpal tunnel more likely, especially if you frequently type or perform repetitive motions with your hands.

Digital Sclerosis: Digital sclerosis is caused by a buildup of collagen under the skin, resulting in reduced flexibility and stiffness of the hands. While there is no real treatment, a physical therapist can teach you exercises to reduce the stiffness to regain mobility in your hands.

9 4.1.6 Eye Complications

Diabetes greatly increases your risks of developing eye and vision complications, which can range from mild to severe. Of these, retinopathy is the most common, with some studies showing that after 10 years of poorly controlled glucose, you have nearly a 95% chance of developing the disorder. Maintaining your glucose management program is incredibly important for your eye health but you should consider regular eye tests and eye pressure tests every year to ensure that your eyes are not getting worse. Identifying eye complications at an early stage enables you to take corrective measures such as laser surgery which may prevent them from getting worse

Retinopathy

 Retinopathy is the most common cause of new-onset blindness in adults, and is strongly linked to diabetes.

 The disorder is caused by blockage and leakage of the blood vessels feeding the retina, resulting in swelling of the macula and vision loss. Over time, this results in blurred vision, reduced vision, and even blindness.

 Managing glucose is the best way to prevent retinopathy. However, once it sets in, recognizing the symptoms and getting treatment to slow progression is your only solution.

Glaucoma

 A glaucoma is a buildup of pressure behind the eye which causes damage to the optic nerve.

 The earliest symptoms of glaucoma are loss of vision in the side of the eyes, headache, and a feeling of pressure in the eyes.

 Glucose management, special eye drops, and laser surgery are used to treat this condition.

Cataracts

 Diabetes greatly increases the risks of developing cataracts, or clouding of the lens of the eye.

 Cataracts are typically accompanied by fuzzy or double vision and sensitivity to bright light.

 A yearly eye exam is crucial to ensuring that you do not develop cataracts.

 You should also ensure that you eat well, maintain a low blood pressure, manage glucose, manage cholesterol, and quit smoking.

10 4.1.7 Skin Disorders

Diabetes causes nerve and cell damage throughout the body which can affect the skin a great deal. Diabetics are prone to dry, cracking skin, which can become infected if it cracks. Take care of your skin, use a moisturizer, and if you live in an area with dry air, consider using a humidifier in your home and office.

 Invest in a quality moisturizer and apply it after the shower.

 Inspect your skin and identify spots or problems regularly

 Completely dry your feet before putting on shoes or socks

 If your skin is dry, consult your doctor

Diabetes makes you more prone to developing acanthosis nigricans (dark thick patches of skin), bacterial infection, dermopathy (brown scaly patches) fungal infection, and necrobiosis lipoidica diabeticorum (large red, shiny, itchy spots). Should you develop these, you will likely need a topical application or antibiotics.

11 4.1.8 Sleep Disorders

Diabetes greatly increases the risk of developing sleep disorders, which can affect your quality of life, health, and alertness during the day. In some cases, sleep disorders may also interfere with your ability to absorb glucose, produce insulin, or how your body interacts with your medication. Sleep disorders range from inability to fall asleep, inability to stay asleep, energy decreases that cause involuntary sleep, too much sleep, and more. Other complications such as peripheral neuropathy and restless leg syndrome can also your ability to get a good night’s rest.

If you have problems sleeping, it is crucial that you discuss them with your doctor. When you can’t get enough sleep, your energy levels are low, and you eat more to make up for the deficit. This means you may be more tempted to eat sugars and foods that will give you a temporary energy boost, which can cause your blood sugar levels to spike and make you feel even worse.

Sleep Apnea

Up to 23% of people with type 2 diabetes suffer from obstructive sleep apnea. Here, the tissue in the throat occasionally closes, stopping breathing for 10-30 seconds, sometimes causing the person to wake up. This can decrease the quality of your sleep, interfere with insulin uptake, and make your glucose more difficult to manage.

You can work to prevent sleep apnea through weight management, healthy diet and exercise, and by managing your blood pressure.

12 4.1.9 Other Complications

Hearing Loss

Hearing impairment is twice as common among persons with diabetes as among those without. Hearing loss is typically caused by damage to the auditory nerve because of high glucose. Managing it means keeping your blood sugar within recommended levels.

Kidney Disease

Diabetes puts a great deal of pressure on your kidneys, which can result in kidney disease, infection, or other problems over the course of several years. Diabetes causes nearly 44% of all end-stage kidney failure in the United States.

Kidney problems can be caused by coronary damage, hypertension, and high or low blood glucose, with hypertension remaining the highest risk. Managing blood glucose, eating well, and exercising regularly helps to control the complications that contribute to kidney disease, therefore reducing your risks. If you are concerned, your doctor can run a simple urine analysis to determine the health of your kidneys.

Gastroparesis

Gastroparesis affects the stomach, slowing the passage of food through the digestive system. This is caused by glucose damage to the vagus nerve, which then causes constipation, abdominal bloating, nausea, vomiting, weight loss, or other issues. It is especially dangerous for diabetics, because if you cannot predict how quickly your food will digest, you cannot correctly dose your insulin. In most cases, the only preventive measures are strict control of your blood glucose to prevent damage in the first place. Once you have gastroparesis, you must discuss your options with your doctor to create a new diet, new insulin dosing, and better control methods for glucose.

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4.2 Patient Advocacy: Know Your Rights

As a patient, you have the right to be informed, get a second opinion, and to ensure that you know your doctor is recommending what is best for you. Your doctor, dietician, nutritionist, and anyone else you work with should be open and educational about every solution they offer. We’ll go over choosing doctors in later lessons, but in general, you should:

Feel comfortable describing any symptoms or ailments you may be experiencing, as well as disclosing your medical history and lifestyle. Your doctor should put you at ease and ask questions that are relevant to your health. Your doctor should not present judgment or make you feel guilty for things like maintaining a poor diet or smoking. A good doctor will remind you of the health concerns, and then work with you to improve these areas. You should never feel pressured or obligated. Establishing a good relationship with your doctor will make long-term care much easier.

Be given enough time. This is a tough one, because many clinics, particularly in urban areas, are busy.

Doctors have many patients to see in a day, and can’t always devote significant time to any one person. That being said, your doctor should spend enough time in your session to adequately address your concerns, assess your health, and explain treatment.

 If you feel rushed, convey these feelings to your doctor during your session.

 You can also make the most of your time by writing down your concerns prior to the appointment, so you can easily relay these to the doctor.

 It will also save some time to provide an accurate description of the reason for your visit on paperwork, and when asked by clinic staff during triage.

 If you still feel that you aren’t given enough attention, consider going to a private clinic or seeing a practitioner for a specific area, as they generally have less patients to see.

 Be heard. Many people complain of not being heard by their doctor, or not taken seriously. Keep in mind that your doctor is the expert. They’ve had years of training and experience, and have most likely dealt with similar situations many times before. They will present solutions based on

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their experience, but they may not work for you. It’s up to you to voice your concerns, ideas, and opinions, and to paint an accurate picture of your health.

 Be given options. There is no one-size fits all treatment for most medical conditions, and diabetes is particularly sensitive to individual needs. You have the right to ask for all possible treatment options, to be informed of all possible side-effects, and be given the choice as to which option to pursue.

 Get a referral. If you need to be referred to specialists who can help with diabetes management in a particular area, such as a nutritionist, counselor, or podiatrist, your doctor should provide you with this information. You have the right to ask to see other practitioners, and to even get a second opinion if you’d like to consult a doctor other than your own.

 Advocate for your rights: If you feel like you need help, personal patient advocates are available in almost every country. However, costs can be high, and are not covered by insurance. In some cases, patient advocate groups are available on a volunteer basis, but these vary in availability by country.