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Bad Things Can Happen April 3, 2006

Posted by becoming in Becoming Healthy.

A friend who visited yesterday, after listening to me go on and on about my desire/intent to become insulin independent, asked what would happen if I just stopped taking insulin. I did not supply him with a particularly good answer.

So I did some research. Before I share the results, let me try to provide a little perspective.

The current consensus is that the formula for diabetic complications is:

Diabetes + Time = Complications.

What this means is there is a much higher potential of a diabetic becoming diagnosed with one or more complications over time. Still, the evidence to date shows that excellent control of blood sugar and the maintenance of an active lifestyle go a very long way in preventing and/or slowing down the onset of diabetic complications.

It's estimated that more than 15 million Americans have Type 2 diabetes, but as many as one third of those who do – more than five million – don't know it, and therefore aren't treating it. The consequences of untreated diabetes are bad things.

Studies have shown that up to 60% of adults with diabetes have high blood pressure and nearly all have one or more lipid abnormalities, such as increased triglycerides, low HDL cholesterol, or elevated LDL cholesterol. If you have diabetes, you’re much more likely to have: coronary artery disease; vascular disease, such as atherosclerosis (hardening of the arteries) or peripheral arterial disease (PAD); a heart attack; and/or a stroke.

Diabetes can cause kidney disease (nephropathy). High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak. Useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria. When kidney disease is diagnosed early, (during microalbuminuria), several treatments may keep kidney disease from getting worse. Having larger amounts is called macroalbuminuria. When kidney disease is caught later (during macroalbuminuria), end-stage renal disease, or ESRD, usually follows. In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).

The longer a person has diabetes, the higher their chances of developing diabetic eye disease (retinopathy). If left untreated, diabetic retinopathy can lead to blindness. Prolonged periods of high blood sugar levels cause damage to the small blood vessels in the retina at the back of the eye. These blood vessels initially become leaky, and then may become blocked off. This causes hemorrhages (spots of blood) and exudates (proteins) from the blood vessels on to the retina. It may also cause swelling, known as oedema of the retina. People with diabetes are 40% more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more common glaucoma is. People with diabetes are 60% more likely to develop cataracts.

About half of all people with diabetes have some form of nerve damage. It is more common in those who have had the disease for a number of years. Nerve damage from diabetes is called diabeticneuropathy. There are various types of nerve damage. One is sensorimotor neuropathy, or peripheral neuropathy. This can cause tingling, pain, numbness, or weakness in your feet and hands. Another is called autonomic neuropathy. This type can lead to: digestive problems (nausea, vomiting, diarrhea, or constipation), problems with how well your bladder works, problems having sex, dizziness or faintness, loss of the typical warning signs of a heart attack, etc. People with diabetes can also have what is called focal neuropathy . In this kind of nerve damage, a nerve or a group of nerves is affected, causing sudden weakness or pain. It can lead to double vision, a paralysis on one side of the face called Bell's palsy, or pain in the front of the thigh or other parts of the body.

People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications. Foot problems most often happen when there is nerve damage which results in loss of feeling in your feet. Poor blood flow or changes in the shape of your feet or toes may also cause problems. Diabetes can cause changes in the skin of your feet. At times your feet may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your feet no longer work. Poor circulation can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation.

Diabetes can affect every part of the body, including the skin. As many as one third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Some of these problems are skin conditions anyone can have, but people with diabetes get more easily. These include bacterial infections, fungal infections, and itching. Other skin problems happen mostly or only to people with diabetes. These include diabeticdermopathy, necrobiosis lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis. Yuck.

Studies show that people with diabetes have a greater risk of depression than people without diabetes. There are no easy answers about why this is true. The stress of daily diabetes management can build. You may feel alone or set apart from your friends and family because of all this extra work. If you face diabetes complications such as nerve damage, or if you are having trouble keeping your blood sugar levels where you'd like, you may feel like you're losing control of your diabetes. Even tension between you and your doctor may make you feel frustrated and sad. Depression can get you into a vicious cycle. If you are depressed and have no energy, chances are you will find such tasks as regular blood sugar testing too much. If you feel so anxious that you can't think straight, it will be hard to keep up with a good diet. Of course, this will affect your blood sugar levels.

Still, diabetic complications can be at the very least lessened for a longer time period by paying serious attention to lifestyle. A diabetic who eats right, keeps his blood sugar in control and within accepted limits, exercises and gets proper rest can expect to have a quality of life that is much higher in terms of the pain and suffering that diabetic complications brings into the lives of diabetics who do nothing to change their lifestyle.

What begins to occur in the diabetic who starts to develop complications because of uncontrolled blood sugars over time is a life filled with the possibility of becoming an invalid, either blind, an amputee, or suffering renal failure or a heart attack.

This paints a rather grim picture if lifestyle changes are not adhered to. Research has shown that the diabetic that keeps their blood sugar within acceptable limits and follows a healthy, diabetic lifestyle that has been shown to be effective against diabetic complications stands a much better chance of not developing many of the complications their less than dedicated counterparts do.

That is what I intend to do. I have to.



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