Diabetes and Health Complications: What To Know, What To Do, What To Ask
By Michael Hattori
Michael Hattori – a nurse, diabetes educator, and person with diabetes – explains the health complications associated with type 2 diabetes, how to prevent them, and what to ask your healthcare team
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In my diaTribe article on what to talk about with your healthcare team when you are diagnosed with type 2 diabetes, we discussed that knowledge is power! Although you may feel overwhelmed with the day-to-day concerns of managing your diabetes, it is important to know what might lie in the future – and how to make your future as healthy as possible. That’s why it’s vital, as well, to talk with your healthcare professional about long-term complications. While much of this article was written for people with type 2 diabetes, so much of it also relates to people with type 1 diabetes – that's why we've tagged it for people with type 1 and type 2 diabetes.
Many people newly diagnosed with diabetes may wish to push aside concerns about complications that lie months or even years down the road – that’s type 1 and type 2 diabetes alike. But the honest truth is that many people diagnosed with type 2 diabetes have elevated blood sugars for years before their diagnosis. This means that some damage has probably already been done. But don’t panic! Some of these complications can be delayed, prevented, or even reversed if you act now.
What are long-term complications and why do I need to think about them now?
One hallmark of diabetes is elevated blood sugar levels. One reason diabetes may go undetected for years is that you may have few, if any, noticeable symptoms. Extreme thirst, hunger, and frequent urination may be signs that you have diabetes, but they may only be triggered by very high blood sugar levels. It is possible to have lived for months or even years with high blood sugar levels and not be aware of it. While there are many helpful initiatives that are working to increase screening for prediabetes and type 2 diabetes, we don’t yet have enough preventative screening in place in the United States.
This creates a serious problem: higher blood sugars cause damage to blood vessels and nerves, which can affect your eyes, heart, kidneys, and other organs. The way high blood sugars cause this damage is complicated, but in simple terms, the excess glucose is harmful if it is not treated.
Here are some of the complications that may arise. It’s important to be aware of them so that you can act now to avoid them, but try not to let them frighten you – with the technology and medication available today, many of these can be prevented with appropriate treatment and early action!
1. Diabetes-related retinopathy (DR): this means “disease of the retina cause by diabetes.” This is caused by high blood sugar levels which lead to damage of the retina (the back of your eye, which captures the image you see, kind of like the sensor of a digital camera). If left untreated, DR can cause blindness. In fact, it is the number one cause of blindness in the US. Because it is often a silent complication, it is extremely important that you get a comprehensive, dilated eye examination by an ophthalmologist or optometrist as soon as you are diagnosed with diabetes! Studies estimate that up to 40% of people diagnosed with type 2 diabetes have some degree of DR, so do not wait.
Fortunately, DR is a condition that can be treated. But preventing it should be your main goal. The best ways to prevent DR are by managing your blood sugars, modifying your lifestyle (through diet and exercise), and taking medications as prescribed by your healthcare professionals (remember the ACDES 7?). Read diaTribe’s strategies for eye health and check out their great infographic about retinopathy.
If you are diagnosed with DR, it is recommended that you have a dilated eye exam at least every year; if you are not diagnosed, then at least every two years is recommended. People with type 2 diabetes should get their first dilated eye exam as soon as they are diagnosed. Your sight is precious, so make this a number one priority.
2. Peripheral Vascular Disease (PVD) and Neuropathy: these complications usually take many years to develop. What are PVD and neuropathy? PVD causes the blood vessels in the feet and lower legs to narrow or become blocked, resulting in decreased blood flow. Neuropathy is nerve damage that causes a loss of sensation, numbness, and sometimes pain and sensitivity; it can progress to making it difficult to walk or use your hands. If you have neuropathy, unless you check your feet daily, it’s possible to get a cut or scratch that goes unnoticed and then becomes infected. If you also have PVD, the decreased blood flow means that it will take much longer for your body to heal.
All of this means that these diseases and their associated infections can lead to the amputation of toes, feet, legs, and fingers. Although it sounds very challenging, these are conditions that may be prevented by managing your blood sugar, blood pressure, and cholesterol, and taking care of your feet.
Checking and taking care of your feet should become part of your daily routine. Make sure to always have your feet checked when you see your healthcare professional – they’ll do a simple test in the office to check for numbness or pain. The treatment for both PVD and neuropathy is taking steps to prevent and slow the disease progression. This includes maintaining a healthy diet, taking medications to help manage your blood sugar, blood pressure, and cholesterol, checking your feet daily, and problem-solving with your healthcare professionals. diaTribe has a helpful infographic about neuropathy.
3. Heart disease and Stroke: increased risk of heart disease and stroke is common in people with diabetes due to high blood pressure, high cholesterol, and damage to blood vessels from high blood sugar. Having overweight or obesity can also be a major contributing factor, as high weight is often accompanied by high blood sugar, high blood pressure, and high cholesterol. By taking care of your diabetes, you can slow or prevent these complications. If you do not regularly measure your own blood pressure with an approved device, ask your healthcare team to check your blood pressure at least once a year (or more often if your blood pressure is found to be high or low). You can find diaTribe’s infographic about heart disease here.
4. Chronic kidney disease (CKD): a progressive disease associated with diabetes, which is caused by damage to the blood vessels of the kidneys. One in four adults with diabetes has kidney disease. If action is not taken to help your kidneys, CKD can get worse and lead to kidney failure. It is important to manage your blood sugar, blood pressure, and cholesterol to treat or prevent CKD. The only treatments for kidney failure are to be put on dialysis or to undergo a kidney transplant. Many of the interventions mentioned above go a long way toward supporting kidney health, such as managing blood sugar, cholesterol, and blood pressure, eating a healthy diet, losing weight (if your healthcare professional advises it), exercising, and reducing salt intake. Learn more with this infographic on kidney disease and diabetes.
Ask your healthcare team to check your kidney health at least once a year: a UACR urine test is used to check for protein in your urine, a marker of kidney damage, and a blood test will evaluate your kidney function, known as eGFR. Ask your healthcare professional what your target should be for these important measures.
One of the great things about diabetes is that YOU actually have a great deal of control over the course of your diabetes. It’s a two-sided coin, though, because it means that you must take responsibility for changing your behavior and making lifestyle changes that result in better health, a reduced risk of long-term complications, and a much happier and carefree life. Note that in some cases genetic factors can also play a role in your risk of health complications.
On the bright side, there are two new classes of medications that have been shown to reduce the risk of heart disease and kidney disease! The first is GLP-1 receptor agonists. These drugs have not only been proven to help manage blood glucose and reduce A1C but they also have the added benefits of weight loss and protection against heart disease and stroke. The second class of drugs is SGLT-2 inhibitors. This drug class has been shown to provide protection against not only heart disease and stroke but it can also help treat or reduce the risk of kidney disease. There has never been a better, more exciting time in the world of diabetes treatment! The downside, however, is that these drugs are expensive for those without insurance coverage and GLP-1s require weekly injections. However, a GLP-1 pill called Rybelsus was recently approved by the FDA – there’s a $10/month co-pay card available to anyone in the US with Medicare or commercial insurance; people without either may be able to gain access through Novocare. For more resources on affording diabetes medication click here.
5. Depression and Diabetes Stress: this is something almost all people with diabetes struggle with at some point. Taking care of your mental well-being should be very high on your list, if not your number one priority. You can’t hope to accomplish everything else it takes to manage your diabetes if you don’t have good coping skills – see my article “Coping with COVID-19, Part 1: Eating, Meds, and Activity” to learn more.
One great thing about diabetes is the amazing community of people going through the exact same challenges you might be facing. People with years and years of experience are more than willing to help out and share their experiences, or even lend an ear. There are many online diabetes communities, and for just about any aspect of diabetes you can think of.
Coping with diabetes is probably one of the most complex problems a person can face, but you are not alone! It is so important to remember that this is not your fault. Don’t ever let anyone blame you for diabetes. The important thing is that you seek help when you need it. Don’t try to go it alone; if you have family, make sure you engage them from the start. They can provide you with emotional support and also help you to manage your diabetes. Like any complication of diabetes, early intervention is key! If you feel like you aren’t coping well, don’t wait to seek professional help, and don’t feel embarrassed to ask for help. Your primary healthcare professional can screen you for depression and be able to refer you to a mental health professional. For more, read my two articles about coping for more on this. You can also find resources for coping during COVID here.
It’s okay if this feels overwhelming. Even as a nurse of 23 years, I was still thrown for a loop when I was diagnosed with type 2 diabetes. But being informed and seeking guidance was key to my success: I am now officially in remission (you can read my story here). The best steps you can take right now are to eat healthy food, get regular exercise, and talk to your doctor about the best medications to help you manage your diabetes and prevent future complications.
My final message is this: get informed, stay ahead of the curve, and don’t be afraid to seek guidance and help. YOU CAN DO IT!
Michael Hattori has been a Registered Nurse for 23 years (including 19 years in the Operating Room), and is currently training to become a Certified Diabetes Care and Education Specialist after being diagnosed with type 2 diabetes in 2019. He has since achieved remission, but still closely follows the AADE 7 Self Care Behaviors to keep on track. He is a huge fan and major advocate of continuous glucose monitoring (CGM) and attributes his remission in large part to CGM. Michael is an avid chef, photographer, musician, and fiber artist in his free time.
This article is a part of a series to support people newly diagnosed with diabetes funded in part by the Ella Fitzgerald Charitable Foundation.