Question

Diabetes come with many chronic complications, such as heart, eyes, and kidney complications. If patients manage their diabetes properly can they prevent those complications? Is it that simple? WHY?

Answer 1

Diabetes complications can be divided into two types: acute (sudden) and chronic (long-term).

Acute complications

• Diabetic ketoacidosis (DKA)
• Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS)

Acute complications of diabetes can occur at any time in the course of the disease.

Chronic complications

• Cardiovascular: Heart disease, peripheral vascular disease, stroke
• Eye: Diabetic retinopathy, cataracts, glaucoma
• Nerve damage: Neuropathy
• Kidney damage: Nephropathy

Chronic complications are responsible for most illness and death associated with diabetes. Chronic complications usually appear after several years of elevated blood sugars (hyperglycemia). Since patients with Type 2 diabetes may have elevated blood sugars for several years before being diagnosed, these patients may have signs of complications at the time of diagnosis

Prevention of DKA

• Take your medications as prescribed.
• Monitor your blood sugar closely, especially when you are ill.
• Keep a balanced diet with regularly scheduled meals.
• Keep yourself well-hydrated (get plenty of fluids).
• Exercise regularly.
• Call or see your doctor if you or family members notice symptoms of DKA, and/or your blood sugar is elevated (above 300).

Prevention of HHNS

• Similar to DKA.
• Take your medications as prescribed by your doctor.
• Monitor your blood sugars carefully, especially when you are ill.
• Keep yourself well-hydrated.
• Call or see your doctor if you, or a family member, think you may have symptoms of HHNS and/or your blood sugars are elevated

General principles for prevention of heart disease in patients with diabetes

• Aggressive control of blood sugar.
• Aggressively treat other modifiable risk factors for heart disease (high blood pressure, high cholesterol, and smoking).
• Aspirin has been shown to be protective in patients with known cardiovascular disease. Although it has not definitively been shown to prevent heart disease, it should be considered in patients with diabetes, especially those with other risks for heart disease (high blood pressure, high cholesterol). Ask your doctor if aspirin is appropriate for you.
• There are no specific recommendations about routine stress testing to look for heart disease in patients with diabetes. Ask your physician if he or she thinks you need a stress test.

Prevention of eye complications

• Visit your ophthalmologist (eye doctor) at least once a year for a comprehensive eye exam to screen for retinopathy, cataracts, and glaucoma.
• Maintain intensive control of blood sugars.
• Control your blood pressure.

Prevention of diabetes complications involving the feet and legs

• Control blood sugars.
• Keep your feet clean and moist.
• Wear properly fitting shoes and clean socks. Do not walk barefoot.
• Take warm (not hot) showers.
• Examine your feet every day for evidence of skin breakdown, sores, or ulcers.
• See your doctor for any foot injury or ulcer. Do not try to treat them yourself.
• See a podiatrist (foot doctor) for foot and nail care.

Prevention of kidney damage in patients with diabetes

• Visit your doctor at least once a year for blood tests (BUN and creatinine) to measure your kidney function. Your doctor should also check your urine once a year for protein.
• Maintain strict control of blood sugars and blood pressure.
• ACE inhibitors and angiotensin II receptor blockers (ARBs) (blood pressure medications) have been shown to slow down kidney disease in patients with diabetes. Commonly prescribed ACE inhibitors include Altace, Accupril, Zestril, and Vasotec. Commonly prescribed ARBs include Diovan, Cozaar, and Avapro
• Monitor the amount of protein in your diet. Patients with signs of protein in the urine should cut down modestly on protein. You may want to consult a nutritionist or diabetes educator to determine how much protein you should have in your diet