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Long-term complications

By April 28, 2015 - 2:43am


Can someone with diabetes controlled only by diet suffer from diabetic complications?

Complications may occur with any type of diabetes. The cause of diabetic complications is not completely understood. Unquestionably the main cause of long-term complications is poor blood glucose control over a number of years but this is not the whole story and some people with prolonged poor control do not run into any problems. Presumably people like this are protected in some way - possibly by genetic factors. The duration of diabetes (the length of time for which you have had it, whether diagnosed or not) is also important: complications are rare in the first few years and occur more commonly after many years. The longer the duration, the higher the risk.

People treated with diet alone are usually diagnosed in middle or later life. At the time of diagnosis, the disease may have been present for a long time, often many years, without the person being aware of it, and therefore without any attempt being made to control it. Thus it is not surprising that complications can occur in some people even when they are treated with diet alone. Good control in these people is clearly just as important as in people who have treatment with tablets or who have Type 1 diabetes.

What are the complications and what should I keep a lookout for to ensure that they are picked up as soon as possible?

The complications specific to diabetes are known as diabetic retinopathy, neuropathy and nephropathy.

Retinopathy means damage to the retina at the back of the eye.
Neuropathy means damage to the nerves. This can affect nerves supplying any part of the body but is generally referred to as either ‘peripheral’ when affecting nerves supplying muscles and skin, or as ‘autonomic’ when affecting nerves supplying organs such as the bladder, the bowel and the heart.
Nephropathy is damage affecting the kidneys, which in the first instance makes them more leaky, so that albumin (protein) appears in the urine. At a later stage it may affect the function of the kidneys and in severe cases lead to kidney failure.

The best way of detecting complications early is to visit your doctor or clinic for regular review. You should have a check once a year, either at your doctor’s surgery or at the hospital clinic so that complications can be detected at an early stage. Most areas now offer annual retinal photography to screen for diabetic eye changes. It is important to make use of this service.

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Prevention is, however, clearly better than treatment and, if you can control your diabetes well you will be less likely to suffer these complications.

I am very worried that I might develop complications after some years of having diabetes. Is it possible to avoid complications in later life? If so, how?

We believe that all people could avoid complications if they were able to control their diabetes from the day that they were diagnosed. There are now many cases on record of people who have had Type 1 diabetes for 50 years or more and are completely free from any signs of complications. Things are a bit different for Type 2 diabetes, which may be present for many years without causing any symptoms. Some people may be unfortunate enough to develop a complication, such as a foot ulcer, before diabetes itself is diagnosed.

The best advice we can give you on how to avoid complications is to take the control of your blood glucose and diabetes seriously from the outset and to attend regularly for review and supervision by somebody experienced in the management of people with diabetes. Focus on learning how to look after yourself in such a way that you can achieve and maintain a normal HbA1c level. If you can do that and keep your HbA1c normal, you can look forward to a life free from the risk of diabetic complications.

To what extent are the complications of diabetes genetically determined?

This is a very difficult question to answer. Most specialists believe that there is a hereditary factor which predisposes some people to develop certain complications and makes others relatively immune from them. So far, scientific evidence for this is not very strong but there is a lot of work in progress in this field at the moment.

I have recently been told I have Type 2 diabetes and have read that this may reduce my life span. Is this true?

Any effect diabetes may have on life span depends on the age at which diabetes is diagnosed. The older you are at diagnosis, the closer your expected life span is to someone who does not have diabetes. The biggest threat to people with Type 2 diabetes is the increased risk of heart attack and stroke. Fortunately, great strides have been made over the last few years in reducing these risks and most people with Type 2 diabetes find that their doctor advises them to take a cholesterol-lowering tablet called a statin, along with a very low dose of aspirin. A number of studies have shown that by taking these tablets the risk of heart attack and stroke is reduced by about 25%. If you have high blood pressure, it is very important to take treatment to bring this down and some people need a combination of three or four drugs to achieve the target blood pressure of less than 140/80. It may come as a shock to find that once you have diabetes you suddenly need to take a large number of tablets - you may need tablets for your diabetes as well - but there is no doubt that by controlling your blood glucose, blood pressure and cholesterol you can increase your life expectancy. Cigarette smoking greatly increases the risk of heart attack and stroke for people with diabetes and if you are a smoker you should do your best to stop.

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