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1. Eye problems
According to the Canadian Diabetes Association (CDA), diabetes is the single largest cause of blindness in Canada. People with diabetes are twice as likely as the rest of the population to develop glaucoma, and they also have a higher risk of developing cataracts.
According to Dr. Silverberg, the most worrisome eye problem is diabetic retinopathy, a condition that affects the retina. "There are two types: nonproliferative (or background) diabetic retinopathy, which is very common, and proliferative diabetic retinopathy, which can result in blindness," he says. With nonproliferative diabetic retinopathy, blood can leak from the retina's arteries causing blurred vision. Proliferative diabetic retinopathy is more sinister. Decreased circulation to the retina's blood vessels cuts off the flow of oxygen, leading to substantial vision loss and even blindness.
Proliferative diabetic retinopathy usually occurs in people who don't manage their disease properly. Monitoring blood glucose levels, maintaining healthy blood pressure, and having regular eye exams can make a big difference. "I have patients who have had diabetes for decades and have little to no eye disease because they take care of their diabetes, and have regular eye exams regardless if they're having problems or not," says Dr. Silverberg. Being diligent with diabetes management can save your sight. Once vision is lost, you can't get it back.
2. Nerve damage
Consistently high blood sugar levels can spark nerve damage (diabetic neuropathy) throughout the body. When the hands or feet are affected, ‘pins and needles' or a burning sensation can be the precursor to numbness. "Little sores and blisters that most people would notice go unchecked in diabetes patients because they can't feel them," says Dr. Silverberg. "With diabetes patients, once an infection takes hold, they may not be able to combat it." Delayed treatment can result in gangrene of the afflicted toe or finger, and the digit being amputated.
To combat the risk of nerve damage and the potential for amputation, people with diabetes should manage their glycemic levels, and examine their hands and feet regularly. "If they have trouble trimming their toe nails, or develop corns or calluses, they should seek professional help from a podiatrist," says Dr. Silverberg. Diabetics can also lower their risk of nerve damage by maintaining a healthy weight and blood pressure, and quitting smoking.
3. Kidney disease
Diabetes is the leading cause of kidney disease in Canada. High blood glucose levels can make it difficult for the kidneys' blood vessels to filter impurities. With the blood vessels impaired, high levels of a protein called albumin can collect in the patient's urine. Without treatment, this situation could lead to kidney damage, and failure, and the need for dialysis or a kidney transplant.
To avoid kidney disease, Dr. Silverberg recommends routine tests for albumin in the urine. Testing can flag the need for treatment at an early stage, slowing down the disease's progression. High blood pressure can also contribute to kidney disease so medications such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) may be prescribed to stabilize blood pressure. Routine blood glucose control is also necessary to avoid kidney complications.
4. Cardiovascular disease (CVD)
"Heart attack and stroke are common in patients with diabetes because often they have high blood pressure, high cholesterol, and vascular changes," says Dr. Silverberg. Add in high blood glucose, an inactive lifestyle and excessive weight, and the risk increases. In fact, those with diabetes may develop CVD 10 to 15 years earlier than people without diabetes. When the arteries of the heart become choked with fatty deposits, a heart attack could occur. If these deposits settle in the brain's arteries, there's the potential for stroke.
Lifestyle changes, along with careful monitoring of blood glucose levels, can help lower the risk of CVD. Regular exercise, a healthy diet, weight loss, controlled blood pressure (below 130/80 mm Hg), and medications (ACE inhibitors, ARBs, statins, or Aspirin) are typical recommendations for prevention and treatment. Quitting smoking and reducing stress are also necessary.
5. Digestive problems
Nerve damage from diabetes can affect the muscles of the stomach causing a condition called gastroparesis. Patients with gastroparesis experience problems with their stomach emptying after eating, which can lead to nausea, vomiting, bloating, digestion difficulties, blood sugar fluctuations, and poor nutrition absorption. "This delay in the absorption of food can make it more difficult to match medications such as insulin with the individual's diet, so glycemic control is more problematic," says Dr. Silverberg.
Maintaining your blood glucose at a steady level will help diminish the chances of nerve damage to the stomach, but if gastroparesis has already occurred, your physician will most likely prescribe a medication to improve gastrointestinal mobility.
Find what to do if you've just been diagnosed with type 2 diabetes here.