A diabetes diagnosis can be frightening for many people. Like any disease, the uncertainty of one’s health going forward can weigh heavily on anyone’s mind. Although there are a few understood variables that come with a diabetes diagnosis, such as regularly checking your blood glucose level, watching carbohydrate intake, exercising daily and getting regular checkups, there are a few health outliers you may not know can go hand in hand with the disease.
We spoke to Karen Bruner, a registered nurse and certified diabetes educator at Texas Health Alliance, to identify the top five health conditions about which people with diabetes should be aware of.
Neuropathy is one of the most commonly known diabetes-related health issues, and about half of all people with diabetes will have some form of nerve damage. Although neuropathy is well known, Bruner says a common misconception is that it will be easy to tell when you’re losing sensation.
“When a patient has early neuropathy, they may only lose slight protective sensation, which may not be realized without a test,” she says. “This is a slight loss but is important to diagnose as it can keep people from realizing if they have a small cut or if the bath water is too hot, etc.”
Loss of sensation can only be checked by a physician or podiatrist, but daily foot checks at home should always include a visual inspection to ensure there are no cuts or openings in the skin, no spots that are red or discolored and checking to see whether there are any spots that are more hot or cold to the touch than the surrounding area.
Bruner says that the first signs of nerve damage are numbness and tingling in the fingers and/or toes. With early diagnosis and improved blood sugar control, these symptoms can subside. Once symptoms have progressed to pain, it’s unlikely that symptoms can be reversed but they can be managed with physical therapy and medication.
The most effective way to decrease the risk of nerve damage is to keep blood sugar levels under control and visiting a podiatrist at least every year — more often if recommended by your physician — for a full exam and nerve check.
According to the Centers for Disease Control and Prevention (CDC), 10.3 percent of adults in the Dallas–Fort Worth metroplex have diabetes. Moreover, stroke is the third leading cause of death for Texans. People with diabetes have an increased risk of having a stroke due to the damage uncontrolled glucose levels causes to veins and arteries.
A stroke happens when the blood supply to part of your brain is suddenly stopped or briefly interrupted. Most strokes happen because a clot blocks a blood vessel in the brain or neck.
“When blood sugar control is poor, the sugar can increase the buildup of plaque in blood vessels causing them to become narrow and hardened,” Bruner explains. “This can lead to a clot causing a stroke. Smoking, high cholesterol and high blood pressure increase this risk even further.”
Having diabetes raises your risk for a stroke, but your risk is even greater if:
- You are over the age of 55
- You are African American
- You’ve already had a stroke or transient ischemic attack (TIA)
- You have a family history of stroke, TIAs or heart disease
- You have heart disease
- You have high blood pressure
- You’re overweight
- You have high LDL (bad) cholesterol and low HDL (good) cholesterol levels
- You are not physically active
- You smoke
Although you cannot change some of these risk factors, you can lower your chances of having a stroke by keeping your blood glucose, blood pressure and cholesterol low. This can be achieved by following healthy eating and exercise habits, and staying on top of your medication, if recommended by your physician. If you smoke, the best thing you can do is quit, since smoking also increases your risk of having a stroke.
High glucose levels can make the kidneys filter too much blood, placing too much stress and demand on the millions of tiny blood vessels inside the kidneys that act as filters. When the kidneys lose their ability to remove waste products from the blood, this results in kidney disease.
Not everyone with diabetes will develop kidney disease, but some factors that influence the development of kidney disease include:
- A history of uncontrolled glucose levels
- A history of uncontrolled high blood pressure
Unfortunately, kidney disease often does not produce any symptoms until almost all kidney function is gone. While the symptoms of kidney disease do not often follow a certain order, the first symptom is often fluid buildup or edema. Patients often report feeling heavy or puffy or that their clothes, shoes, rings or watches suddenly feel too tight.
“Because kidney disease is typically symptomless, patients should remind their doctor to add a test called microalbumin to their regular bloodwork,” Bruner suggests. “As for prevention, keeping an eagle eye on blood sugar control is best.”
Elevated blood sugar puts a strain on the very small blood vessels in the eyes, causing them to bulge or bleed. This complication is called retinopathy and there are two major types: nonproliferative and proliferative. People with type one diabetes are more likely to develop nonproliferative retinopathy while people with type two diabetes are more likely to develop proliferative retinopathy.
Nonproliferative is the most common form of retinopathy and moves through stages of mild, moderate and severe as more blood vessels become blocked. Nonproliferative progresses into proliferative, in which the blood vessels are so damaged they close off, causing vision loss.
While glaucoma and cataracts can develop in anyone, people with diabetes — especially those with poorly controlled glucose levels — tend to develop these eye complications earlier and have a harder time being treated.
Much like nerve damage, Bruner says retinopathy is not always evident to the patient.
“If it has progressed to the point of bleeding, the patient might see larger ‘floaters’ come across their field of vision which is actually blood from the bleeding vessels,” she explains. “Most patients don’t realize they have damage unless they are being seen annually for a retinal exam by an ophthalmologist who can evaluate the vessels to be sure there are no bulges or bleeds.”
The longer you have had diabetes, the more likely you are to develop retinopathy, but annual screenings can pick up on early signs before they progress.
Gastroparesis is a disorder in which the stomach takes too long to empty its contents, causing blood sugar levels to spike once food that has been delayed hits the small intestine all at once. Since matching up medication with food consumption and absorption are necessary for good blood sugar control, the condition can make controlling blood sugar difficult.
In addition, food that stays too long in the stomach can cause problems like bacterial overgrowth or it can even harden into solid masses called bezoars that may cause a blockage in the stomach or small intestine.
Symptoms of gastroparesis include:
- Vomiting of undigested food
- An early feeling of fullness when eating
- Weight loss
- Abdominal bleeding
- Erratic blood glucose levels
- Lack of appetite
- Gastroesophageal reflux
- Spasms of the stomach wall
These symptoms may be mild or severe, depending on the person.
“Gastroparesis is a chronic condition; therefore, treatments are aimed at managing and controlling symptoms,” Bruner says. “There are medications and treatments available but many times complete relief is not achieved.”
Although these complications can be severe, Bruner says many can be prevented or delayed by keeping blood sugar levels in control. Working with your health care team and incorporating friends and family members who can help keep you accountable can not only improve your health but your outlook on your disease.
Texas Health has 10 outpatient diabetes education centers that are recognized by the American Diabetes Association. Certified Diabetes Educators at each center tailor the program to suit each and every patient, whether they are newly diagnosed and need complete education or simply need a refresher course.
“Our teams offer group classes along with individual education,” Bruner says. “When a patient partners with their physician and a diabetes educator, they increase their likelihood of achieving good control and maintaining it.”