Eyes

Eye complications. Diabetes can affect the circulation to the back of the eye. The most serious form of this complication causes the production of fragile new blood vessels which can easily burst causing a hemorrhage which can blind the eye. Laser therapy is effective in preventing these vessels proliferating so it is important to attend for regular eye screening - usually at the optician's. This complication gets increasingly likely with time, however many non-insulin dependent diabetics have possibly had diabetes for quite a long time before diagnosis so eye problems may be present in them even at the time of diagnosis.

Feet

Diabetes tends to attack the smaller blood vessels and the feet and toes are particularly vulnerable. At worst this can lead to ulcers that are difficult to heal and even gangrene. As a consequence to elevated blood glucose levels, tissue and damage to nerves occurs. This can occur in any type of diabetes. It does not matter if the patient is on insulin, is taking pills, or is diet controlled. The nerve damage that occurs is considered to be permanent. As the nerve damage occurs, the protective sensations are affected. These include a person's ability to determine the difference between sharp and dull, hot and cold, pressure differences, and vibration. These senses become dulled and/or altered. The process begins as a burning sensation in the toes and progresses up the foot in a "stocking distribution". As the condition progresses, the feet become more and more numb. Some people will feel as though a pair of socks on their feet, when in fact they do not. Other patients will describe the feeling of walking on cotton, or a water-filled cushion. Some patients complain of their feet burn at night, making it difficult to sleep. The feet may also feel like they are cold, however, to the touch, they have normal skin temperature. Diabetic peripheral neuropathy is not reversible. The progression of the condition can be slowed or halted by maintaining normal blood glucose levels. As the patient develops diabetic neuropathy, they have a greater risk of developing skin ulcerations and infections. Areas of corns and callouses on the feet represent areas of excessive friction or pressure. These areas, if not properly cared for by a foot specialist, will often break down and cause ulcerations. Ulcerations and infection can form under the calloused area. These calloused areas may not be painful. As a result, they can progress to ulceration without being noticed. Ingrown toenails can progress to severe infections in people with neuropathy. Simple things like trimming the toenails present a risk to these patients because they may accidentally cut the skin and not feel it. People with neuropathy must be very cautious and inspect their feet daily. They should not soak their feet in hot water or use heating pads to warm their feet. This can result in accidental burns to the skin. Barefoot walking should be avoided because of the risk of stepping on something sharp and not being aware of it. The inside of the shoes should be inspected before putting the shoes on to insure that no foreign object is inside the shoe. Our office is equipped with a machine called the Doppler. This exam measures the vascular blood flow in the foot and ankle through a non-invasive procedure. Like a sonogram, a gel is spread over the ankle and foot, and the doctor can assess the blood flow by computer readout. The test is quick, easy, and accurate.

Heart

Heart disease. Cardiovascular disease (CAD) is the most common cause of death in Type 2 diabetics.  CAD also increases dramatically in diabetics with any of the other risk factors described earlier.  Diabetics with CAD have more blood vessels with blockages than those without diabetes, and those blockages are more complicated, calcified and hard.
Heart attacks occur more frequently in diabetics and the size of the heart attack tends to be larger. Because diabetes effects the nerves, it is possible a diabetic would not feel the discomfort of angina (a warning sign of decreased blood flow to the heart) as intensely.  In fact, the incidence of silent heart attacks (a heart attack without pain) is higher.

Additionally, a type of fat in the blood stream, triglycerides, tend to run high.  High triglycerides are suspected in the role of plaque build up in the arteries.  Diabetes also facilitates blockages of the arteries of the legs (peripheral vascular disease) and neck (carotid artery) which increases risk of stroke. Diabetics are at increased risk of a small vessel disease.  This, in particular, affects the eyes (diabetes is the leading cause of blindness), and kidneys.  The nerves are also commonly affected by diabetes by unknown means, probably circulation.

The information may sound like the outlook for diabetics is quite bleak -- but there is good news! The good news is it has been shown that Type 2 diabetics under very strict control of their blood sugar levels have less of a substance circulating in their system which is known to cause the formation of clots.  These clots when lodges in a narrowed blood vessel can cause heart attacks and stroke.  Data also shows that diabetics who keep their blood sugars under control in general have less severe complications of diabetes.

In order to keep diabetes under tight control, it is essential the patient follow their physician and dietitians guidelines without fail.  The treatment of diabetes focuses on three areas:  Diet exercise, and medication.  Diet therapy centers on weight reduction in overweight individuals, a low-fat diet (less than 20% of total calories) and a diet consistent with timing and caloric intake.  Many physicians will recommend a diet low in sugar, starch, and alcohol as a first step.  Beneficial effects of exercise for diabetics includes wight control, increased HDL (good) cholesterol, and lower blood sugar levels.  Medication therapy is started with anti-diabetic agents in pill form.  If necessary, insulin will be prescribed and is injected into the fatty layer of tissue on a daily basis.  Diabetics are usually instructed on how to take periodic test of blood and urine at home.

Kidney

Kidney complications. Diabetes is a major cause of kidney failure. As with the eye the site of the damage is in the small blood vessels where filtering of impurities takes place. An early sign of damage taking place is the presence of a protein called albumin in the urine. Initially the quantities may be very small so a special test to look for microalbuminuria is done at the laboratory. We now know that strict control of blood pressure in diabetics goes a long way towards preventing this going on to destroy kidney function.

Nerve Damage

Sensory nerves. Loss of sensation again tends to involve the feet. This can allow foreign bodies to cause damage to the feet quite painlessly and the wounds thus caused, because the circulation is also invariably poor, can be very resistant to attempts to heal them. Diabetics must NEVER BE BAREFOOT and ALWAYS CHECK SHOES AND SOCKS FOR FOREIGN BODIES.

Autonomic nerves. These nerves control such things as blood pressure and male potency. If they are damaged by diabetes then the blood pressure may fall on standing - this is checked at your annual clinic visit. Impotence is quite common among diabetics but there are new and effective treatments available now.

Sexual Dysfunction

Sexual problems (sexual dysfunction) are common among people with diabetes, particularly in older men who have had diabetes for years. Men with type 1 diabetes have a greater risk of sexual dysfunction than men with type 2 diabetes. In addition, many medical experts believe that women with diabetes experience sexual difficulties as a result of complications from the disease. One way diabetes can interfere with the sexual function is through neuropathy, which means damaged nerves. Damaged nerves can't send messages properly, including the messages the brain sends to the penis to get an erection. In addition, diabetes may be associated with vascular disease, meaning less blood may flow into the sex organs.

People who experience sexual difficulties can lead more enjoyable, fulfilling sexual lives by learning about common causes and symptoms of sexual difficulties, treatment options, and how to talk it over with a doctor or mate. If you wonder if some of the problems you are experiencing may be symptoms of sexual dysfunction, visit your doctor or healthcare professional, who may suggest treatments or refer you to another doctor.