The attention and effort you’re asked to give to managing blood glucose levels with medication, testing your blood, physical activity, and especially diet is to reduce your risk for complications associated with diabetes.
In everyday life you probably use the word complication to describe something that disrupts your plans slightly, but can be resolved with a minor adjustment or two. A flat tire, unannounced guests, or a power outage all qualify as a complication in everyday life.
Used in a medical context for describing the potential health effects of diabetes, the word has a much more serious meaning. Don’t be fooled by the innocent word complication — in diabetes, the stakes are literally life and limb.
In general, the complications of diabetes can be separated into short-term complications and long-term complications. Short-term complications are related to the level of your blood glucose right now. Long-term complications are related to your success managing blood glucose levels and overall cardiovascular health markers, like blood pressure, over many years.
There are only two short-term complications — very low blood glucose levels (hypoglycemia), and very high blood glucose levels (hyperglycemia).
Hypoglycemia is a complication of diabetes treatment, but it can be extremely serious so deserves some emphasis. When insulin levels are too high compared to blood glucose, your brain runs low on fuel. Hypoglycemia can result from too much injected insulin, too little food to match medications that stimulate natural insulin release from the pancreas, or from alcohol consumption.
Symptoms may mimic intoxication, and accidents are common on account of disorientation. But hypoglycemia can progress to coma and death without treatment.
Hyperglycemia results when there is not enough insulin available to reduce blood glucose levels. DKA remains a risk for anyone with type 1 for a lifetime. DKA is a toxic state and can be fatal if untreated.
People with type 2 diabetes don’t ordinarily experience blood glucose levels high enough to develop DKA, but a similar condition called hyperosmolar syndrome can be a life threatening risk. Usually hyperosmolar syndrome is triggered by dehydration associated with another illness like norovirus, sometimes called stomach flu.
The long-term complications develop where diabetes is poorly controlled over the years, and this is where lifestyle choices like committing to a healthy diet play such a crucial role in preserving health. The damage that excessive blood glucose levels cause over time can have debilitating and deadly consequences, but are preventable in large part.
Heart attack and stroke are much more common in people with diabetes, two to four times more likely. And, people with diabetes have a higher death rate, and are more likely to have another event if they survive the first.
The risk for heart disease is often increased by abnormal cholesterol levels and high blood pressure related both to high blood glucose, and to excess weight and a less-than-healthy lifestyle. Treating and managing diabetes with lifestyle must include treating and managing these related risks for heart disease.
Kidney disease affects up to 5 percent of people with type 2 diabetes, and up to 30 percent of people with type 1. In fact, diabetes is the leading cause of kidney failure in the United States that eventually may require dialysis treatment or a kidney transplant.
Anyone who’s frustrated following a diabetes-friendly diet to better manage blood glucose should try the renal diet for dialysis patients just for comparison. A renal diet restricts fluid, protein, sodium, phosphorus, and potassium, and in her view is the most restrictive diet in medical nutrition therapy.
Neuropathy describes conditions resulting from damage to nerves, and is a very common complication of diabetes affecting some 60 percent of patients. Neuropathy can result in pain or numbness of extremities (especially the feet), the inability of some muscles to move, digestive problems called gastroparesis, urinary difficulties, sexual dysfunction, and a range of other difficulties.
Vision is threatened from an increased risk of cataracts, glaucoma, and especially diabetic retinopathy. Retinopathy is another example of how high blood glucose levels can damage small blood vessels.
Diabetic foot disease is the leading cause of non-traumatic amputations in the United States, and the progression of foot ulcers is often complicated by the absence of sensation due to neuropathy (and a neglect of routine self examination of the feet).
Many people with diabetes assume these terrible outcomes are simply part of the normal course of diabetes, but that assumption is dangerously wrong. Controlling blood glucose levels and adopting a healthy overall lifestyle can greatly reduce your risk for all of these long-term complications, and it’s never too late to start.