| Diabetes |
| How Does Diabetes Affect My Body? |
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By
Amy Adams, MS
Reviewed
By Jeremy Walston, MD
Last
Updated September 20, 2000
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People with Type 1 or Type 2 diabetes are at a much higher risk than the general population for damage to the eyes, kidney, nerves, and blood vessels. Because of these serious risk factors, the American Diabetes Association recommends regular screening for early signs of damage. Many of these side effects can be delayed or avoided altogether through careful blood sugar control. In addition, a recent study has found that lowering blood sugar levels also lowers treatment costs for people with Type 2 diabetes.(For
news about addition risks associated with high blood
sugar levels, see Related News below.)
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How does Blood Sugar Cause Damage?
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In
people with diabetes, sugar (glucose) accumulates in
the blood to very high levels. The excess glucose can
attach to proteins
in the blood vessels and alter their normal structure
and function. One effect of this is that the vessels
become thicker and less elastic, making it hard for
blood to squeeze through.
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Measuring
Long-Term Blood Sugar Levels
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Doctors
can measure how much sugar has bound to proteins
over a three to four month period using a glycated
hemoglobin test. This test measures the amount
of sugar that is attached to hemoglobin —
a protein in red blood cells. Hemoglobin circulates
in the blood for about three months, so by looking
at the amount of sugars that have attached to
hemoglobin, doctors have a good indication of
how much sugar has bound to other proteins. This
is an indication of your overall blood sugar control
for that period of time. If the hemoglobin carries
a lot of glucose, then there's a good chance that
proteins in blood vessels have suffered some damage
as well. On the other hand, hemoglobin without
much bound sugar means that you had good blood
sugar control and have a lower risk of tissue
damage. Individuals with diabetes should have
their hemoglobin screened several times a year
to make sure their treatment plan is working. |
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Eye
Damage
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Diabetic
eye disease starts when blood vessels in the back of
the eye (the retina) balloon out into pouches. Although
this stage — called nonproliferative retinopathy
— generally does not affect vision, it can progress
to a more serious form called proliferative retinopathy.
This occurs when damaged blood vessels close off and
new, weaker vessels take their place. These new vessels
can leak blood, which blocks vision. They can also cause
scar tissue to grow and distort the retina.
Because
the retina can be irreversibly damaged before you notice
any change in vision, and because retinopathy can be
effectively treated with lasers to minimize vision loss,
the American Diabetes Association recommends screening
for retinopathy yearly.
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Kidney
Disease
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Kidney
disease starts when the blood vessels in the kidney
become leaky. These leaky vessels allow protein from
the blood to be excreted with urine. (It's this protein
that doctors detect when they test for kidney function.)
Eventually, some vessels collapse and place more pressure
on those that remain. Under this increased load, the
remaining blood vessels are also damaged and the kidney
may fail. If the disease progresses to this point, a
person may have to go on dialysis — where a machine
performs the role of the kidney — or receive a
kidney transplant.
Because
of the serious consequences of kidney disease, the American
Diabetes Association recommends screening for protein
in the urine every year starting at the time of diagnosis,
or five years after the diagnosis in Type 1 diabetics.
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Heart
and Blood Vessel Disease
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High blood sugar damages blood vessels
and can lead to blockage. In the heart, this blockage
can cause heart attacks. In fact, people with diabetes
have two to four times the risk of developing heart
disease or stroke than the general population. Blocked
vessels in the legs can cause pain and can also impair
circulation. With poor circulation, small cuts or infections
are less likely to heal. Eventually, 0.6 percent of
all diabetics have lower limb amputations because of
damage to the feet or lower legs.
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Nerve
Disease
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In
diabetes, the nerves that become damaged are the ones
that allow you to sense temperature, pressure, texture,
or pain on your skin. In most people with diabetes,
nerve disease (neuropathy) effects the feet and lower
legs, causing numbness or tingling. The real problem
arises when numbness allows injuries to the foot to
go unnoticed. For this reason, the American Diabetes
Association recommends that all people with diabetes
have a thorough foot exam every year.
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References
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American Diabetes Associtation (1999). Clinical Practice
Recommendations 1999. Diabetes Care (Suppl. 1),
22, S1-S114.
National Institute to Diabetes and Digestion and Kidney
Diseases (1999). Diabetes Statistics. Bethesda, MD:
National Institute of Health. Publication No. 99-3892.
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