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PREVENTION OF LONG TERM COMPLICATIONS

Everyone with Diabetes is at risk of developing long term complications (5 to 10 years from onset). However, the people most at risk are:

• those who have had diabetes for many years,
• those whose diabetes is poorly controlled (high blood sugars),
• people with diabetes who have high blood pressure particularly if they also have kidney damage.

The best way to prevent the development of long term complications is to maintain excellent control of blood sugars from the onset of diabetes.

Diabetes and Eyes
The most significant eye problems are:

• cataracts (clouding of the lens in the eye)
• diabetic retinopathy (swelling and bleeding of small blood vessels within the retina of the eye)

Good control of blood sugars, may prevent or slow the development of eye complications. It is recommended that you have regular eye examinations by an eye specialist (ophthalmologist) who is qualified to diagnose and treat retinopathy and cataracts.

Diabetes and Cardiovascular problems
What is meant by cardiovascular problems?

• Ischaemic heart disease leading to heart attacks
• cerebrovascular disease leading to strokes
• peripheral vascular disease leading to poor circulation to legs and feet, progressing to gangrene and lower limb amputations.
• The above problems are caused by the narrowing and blockage of large arteries due to fat deposits under the inner lining of the arterial walls.

Risk factors for large artery disease (macrovascular disease) include:

• smoking
• high blood pressure
• high blood lipids
• the ability of the blood to clot
• the body's ability to dissolve any clots formed
• obesity
• lack of exercise
• family history

The following preventative strategies are recommended to reduce the risk of developing long term complications:

• stop smoking
• aim for blood sugars between 4 - 8 mmol/L
• have your blood pressure checked regularly and treated if needed
• keep your blood lipids within normal range and treated if needed
• reduce body weight to acceptable levels
• take up some suitable aerobic exercises (walking, cycling, swimming)
• eat a diet low in fat and high in complex carbohydrates and fibre
• minimise alcohol intake.

Diabetes and Kidneys
The function of the kidneys is to filter toxic wastes from your blood stream and pass them out of the body in the urine.

High blood sugars can affect the filtering system of the kidneys. Over a period of time the filters become leaky. Water and waste products are not removed as efficiently from the blood. At the same time protein leaks out into the urine. This protein shows up with simple urine testing. This is called nephropathy.

Kidney complications can be prevented by:

• keeping good control of the diabetes
• keeping blood pressure normal
• following a healthy diet
• having urine and blood tests as ordered by your doctor, to test for protein and waste products. This will help your doctor detect problems with kidney function at the early stages.

Diabetes and Complications affecting the lower limbs.
The complications which affect the lower limbs of people with diabetes are:

Peripheral Vascular Disease and Neuropathy.
Peripheral Vascular Disease: occurs when the blood vessels in the lower limbs become thickened and narrowed causing reduced circulation. It can be caused by; deposits of blood fats, blood clots, smoking, high blood pressure and consistently high blood sugar levels.
This reduced blood circulation can mean that healing is impaired and if there is a blockage in the vessel gangrene can occur.

• You may experience cramping and pain in your legs which can limit the distance you are able to walk.
• Injuries e.g. cuts, scratches, blisters may become infected or may not heal as quickly as in the past. Wounds that do not heal can lead to ulceration, gangrene and amputation.

Neuropathy: caused by damage to the nerves which results in reduced sensation / feeling in the feet. This is thought to be caused by high blood sugar levels over a long time. The small blood vessels become thickened by deposits of glucose- protein which narrows the vessel and obstructs blood flow. This leads to damage to the nerves and/or the nerve sheath.
The effect of Neuropathy may include:

• Impaired sensation/ feeling in the feet.
• Tingling, burning feeling or shooting pains in the feet.
• Reduced temperature and vibration sensation in the feet.
• Change in the shape of your feet and the way you walk.
• Muscular weakness.
• Dry and cracked skin.
• Corns and callous.
• Increased risk of infection, for example, tinea.

In a healthy foot, the blood supply keeps the foot healthy and the nerves warn you of any injury e.g. a stone in your shoe. However if you have vascular disease or neuropathy you may not be aware of any damage to your feet. And if you are unaware of any damage you will not treat it promptly and because of poor circulation the wound may not heal. This is generally what has happened if a person ends up with gangrene and then amputation.

How can you prevent foot problems?

• Protect your feet from injury.
• Check your feet morning and night and after any exercise.
• Treat any injury immediately, and
• Contact your Podiatrist or doctor if the injury is not healing.
• Maintain good blood sugar levels.
• Exercise regularly.
• Yearly Assessment by a Podiatrist.

Diabetes and Smoking
Smoking adds to the risk of developing long term complications.
Smoking:

• Constricts blood vessels resulting in poor circulation,
• Increases blood pressure,
• Decreases fitness which reduces your ability to exercise.

Discuss ways of stopping smoking with your Doctor.

KEY POINTS

• Visit an Ophthalmologist annually.
• Keep Blood Pressure and blood lipids within the normal range.
• Exercise sensibly.
• Look after your feet and visit your Podiatrist as required.
• Seek help to stop smoking.