Diabetes: Why Does It Need to Be Controlled?

What is diabetes?

Approximately 11.3 percent of the US population has diabetes, and 38.0 percent of the US population has prediabetes, health disorders that include Type I, Type II, and gestational diabetes.  Diabetes can be controlled with lifestyle, such as diet and exercise, or a variety of medications. Uncontrolled diabetes is seen frequently in inpatient and outpatient settings, so this basic knowledge may be useful in educating patients.

Among the primary concerns, a prolonged elevated blood sugar can have an effect on the blood vessels, so it is important to keep these numbers under control.  Vasculature is often destroyed by high cholesterol.  People who have diabetes do not have the high LDL that we typically worry about in patients with high cholesterol, but they have specific characteristics of altered cholesterol that can still affect the blood vessels. These changes lead to inflammation, increased programmed cell death, and further accumulation of plaque inside the blood vessels, possibly causing perforation or blockages in the blood vessels, which may prevent oxygen from being delivered to the necessary destinations. Depending on where these issues occur, this can cause the following conditions:

Blindness

Diabetes can cause retinopathy, a disease of the retina in the eye that may lead to blindness.  Laser and steroid injections may assist in blood vessel growth and retention.  Management of diabetes going forward is imperative.

Stroke

Diabetes can cause damage to the blood vessels in the brain, which can lead to a stroke.  Timely management of a stroke is key.  The sooner the patient presents to a hospital, the sooner a thrombolytic (clot-busting medication) can be given, or the patient can be taken to surgery.

Heart Attack

Diabetes can cause blockages in the blood vessels that bring oxygen to the heart, which can lead to a myocardial infarction (heart attack).  Timely management of a heart attack is also necessary.  As with a stroke, the patient can be given a thrombolytic or taken to the Cath Lab for a stent to open the blood vessel.

Kidney Failure

Diabetes can damage the blood vessels that bring oxygen to the kidneys.  Ultimately when the kidneys fail, dialysis is necessary to filter the blood and rid toxins from the body.  If the kidneys fail very quickly, dialysis is sometimes temporary, but in the case of diabetes, they are typically undergoing long-term destruction.  In this case, the patient is typically on dialysis for the remainder of their life.

Vascular Occlusion or Osteomyelitis (bone infection)

These are put together because they ultimately both result in amputation.

• Diabetes can lead to peripheral vascular disease, resulting in damage to the veins and arteries in the extremities (particularly lower legs and feet).
• Unfortunately, this is often combined with neuropathy (numbness) and a higher risk of infection.  Thus, wounds that occur often go untreated and do not heal as quickly, and are more likely to become severe infections.  This may eventually lead to amputation if the infection spreads to the bone.
• Diabetes may also lead to blockages in the arteries that bring blood to the legs.  When this happens, a vascular surgeon may be able to place a stent, but if this fails or is not an option, amputation may be required.

Many of these diagnoses are not only caused by diabetes, but are often made worse by factors such as high cholesterol and smoking.  However, when blood sugars remain uncontrolled for too long, they can independently lead to many of these diagnoses.

Luckily, even with a diagnosis of diabetes, patients can control their blood sugars when they work diligently with their healthcare providers.  Diet and exercise changes are typically the first-line methods to control blood sugar, but, as mentioned earlier, there are also many medications available to help.

References/Resources

Vascular complications of diabetes: mechanisms of injury and protective factors: National Library of Medicine

National Diabetes Statistics Report: CDC

Put the Brakes on Diabetes Complications: CDC

Treatment - Diabetic retinopathy: NHS services (UK)

Guidelines for Early Management of Acute Ischemic Stroke: Key Points: American College of Cardiology

ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction:Executive Summary: American Heart Association