This is my final blog post this month about Type 2 diabetes. This week we’re moving on from control of diabetes to other important, associated issues.
We mentioned cardiovascular risk factors briefly last week. These are our behaviours, genetics, medical conditions and generally the things about us that increase our risk of damage to our heart and blood vessels, and therefore increase our chances of having heart attacks, strokes, poor circulation etc. We can’t do anything about some of these things, like our genetics and our age. However, there are often risk factors that can be modified (ie. changed for the better).
When you go to a diabetes clinic appointment, as well as your day to day sugar testing (if you need to do this) and your overall control (Hba1c blood test), your cardiovascular risk factors are one of the things you will probably discuss. The reason for this is that having diabetes puts you at increased risk. It’s therefore really important that other risk factors are addressed.
I’m sure you’ll be familiar with most of them. The obvious one of course is smoking. Smoking and diabetes are really a bad combination. Other lifestyle risk factors are things that you’ll be very familiar with by now if you’ve read many of our blog posts because they are risk factors for so many medical conditions – obesity, low levels of physical activity, too much alcohol and a poor quality diet.
Good control of blood pressure and of cholesterol will also be discussed. Usually these will be checked at least annually at diabetes appointments, and sometimes more frequently if they have been problematic.
Finally I’m going to talk about the topic that no-one really wants to think about – the complications of diabetes. Screening for complications is a really important element of diabetes care. People that have had diabetes for a long time, and particularly if control has not been ideal, are at higher risk of developing complications.
Damage to the nerves supplying the feet can cause problems with pain and with sensation in the feet. People describe sharp stabbing pain in the toes and feet, which is often worse at night. They may notice that when they walk in bare feet the ground feels uneven, or as if they’re walking on pebbles. In combination with the pain the feet can become numb to the touch, usually it affects the tips of the toes first and gradually over the years spreads up the legs. In severe cases people can’t feel anything from below the knees down. Occasionally the same problem can occur in the hands as well.
You can imagine that if someone can’t feel their feet properly they will be “at risk” of further problems – for example if they stand on something or if there is something inside their shoe. If the loss of feeling is significant they may not notice anything at all and it may be days before they do. If they also have high sugars it can be harder for the body to fight infection. If there’s hardening of the arteries to the legs and feet meaning the blood supply is not as good as it should be it can be harder for the feet problem to heal. A combination of these factors can eventually result in a foot ulcer and in the very worse case scenario, amputation.
That’s why, if you have diabetes, it’s vital to be aware if there is an issue with your feet. Every year or so people with diabetes should have foot screening performed. Whoever does it in your area (it could be your doctor, nurse, podiatry assistant, podiatrist), will check your circulation by feeling for the pulses in your feet, and check the feeling in your feet, usually by touching your toes and feet lightly with a thread.
If there is an issue which causes your feet to be classed as “high risk” you need look after them very carefully. You will be given information about what you need to do eg. avoid walking in bare feet. Everyone with diabetes should get in the habit of doing a daily foot check. If you do notice any problems don’t delay in getting them seen to, either by your own GP or your local podiatrist – however your local system works.
There is not a cure for diabetic neuropathy – the official name for loss of sensation/pain due to nerve damage. Focusing on the risk factors we’ve talked about and working on diabetes control can help prevent progression though. There are a growing number of pain killers available to help with nerve pains as well, if that is a major issue.
People often associate diabetes with kidney failure and dialysis, and it’s true it is the commonest cause of kidney failure. However, we can screen for very early kidney disease by sending a urine sample for microalbuminuria – very tiny amounts of protein in the urine. This can be picked up long before there is enough damage to cause the blood tests for kidney function to change at all.
If someone has microalbuminuria we know they are at increased risk of progressing to more significant kidney disease. By focusing on diabetes control, blood pressure control, and by using certain drugs (ACE inhibitors – drugs that end in pril, and ARBs – drugs that end in sartan) the microalbuminuria can be stabilised or even in some cases reversed. An excellent reason for remembering to bring a urine sample to your clinic appointment with you.
Eye disease occurs in the same circumstances – long duration of diabetes and issues with control, high blood pressure and high cholesterol. In the old days doctors used to peer into the back of peoples eyes with an opthalmoscope as part of their diabetes appointment. Nowadays most people attend for retinal screening – when a photograph is taken of the back of the eyes. These photographs can spot tiny bleeding and damaged blood vessels long before there is any noticeable effect on vision. If there is a minor issue screening may be repeated more frequently. If there is any cause for concern an appointment with an eye specialist will be arranged, and treatment started. Treatment can be using laser, injections into the eye, or occasionally by doing operations.
Because eye screening picks up early problems, before vision is affected it is also really important to attend retinal screening appointments.
Risk of developing eye disease or of it progressing can be reduced by improving blood sugar, blood pressure and cholesterol control.
If you have diabetes and notice a change in your vision it is vital you seek medical advice immediately.
Erectile dysfunction is an extremely common complication of diabetes. We’ve written an article about it here if you want to take a look. https://ayearofsmallchanges.com/2019/04/01/mens-health-sexual-function/
There are other, rarer complications of diabetes like problems with low blood pressure, a condition called gastroparesis and various skin conditions. The conditions I’ve mentioned above are probably the most common.
I guess the take home message is – make sure you have your eye screening, foot screening and urine/blood tests done at least annually and remind your diabetes doctor or nurse if you haven’t. If you do have early complications, all is not lost. Focusing carefully on your lifestyle and working with your diabetes team can slow down or even prevent progression of complications.