DIABETES

In Your Life and As You Age

Preventing Diabetes Complications

Diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes, their support network, and their health care providers can reduce the occurrence of these and other diabetes complications by

  1.   Controlling the levels of blood glucose

  2.   Controlling blood pressure

  3.   Controlling blood lipids

  4.   Managing and receiving preventive care in a timely manner.

Glucose Control

Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes.

In general, every percentage point drop in A1C blood test results—for example, from 8 to 7 percent—can reduce the risk of microvascular complications—eye, kidney, and nerve diseases—by 40 percent.





Blood Pressure Control











Control of Blood Lipids

When lipids get out of control, it can lead to coronary heart disease, stroke, and poor circulation that can lead to amputation, among other things.  The only real way to know your lipid level is to ask a doctor or healthcare provider for a test.  This is especially important if you are middle aged, smoke or have a family history of high blood pressure or high blood sugar.

If you are at high risk of having too many lipids in your blood, you can help yourself in several ways:

  1.   Quit smoking

  2.   If you drink, drink only in moderation

  3.   Eliminate hydrogenated fats from your diet

  4.   Reduce your saturated fat intake

  5.   Increase the amount of vegetables and high-fiber foods you eat

  6.   Limit your meat intake to no more than 6 ounces a day

  7.   Use canola, olive and peanut oils when you cook

  8.   Exercise regularly  (at least 4 or 5 times a week; daily is even better)

If these methods do not work to lower your blood lipids to acceptable levels, talk to your doctor about medications that can help lower them.

Improved control of LDL cholesterol can help reduce cardiovascular complications by 20 to 50 percent.
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  Heart Disease and Stroke

•In 2004, heart disease was noted on 68 percent of diabetes-related death certificates among people ages 65 years or older.

•In 2004, stroke was noted on 16 percent of diabetes-related death certificates among people ages 65 years or older.

•Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes.

•The risk for stroke is two to four times higher among people with diabetes.
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Complications Due To Diabetes in the United States

Risk of Death Due to Diabetes, United States, 2006

•Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006. This ranking is based on the 72,507 death certificates in 2006 in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 233,619 deaths in 2005, the latest year for which data on contributing causes of death are available.

•Diabetes is likely to be underreported as a cause of death. Studies have found that only about 35 to 40 percent of decedents with diabetes had it listed anywhere on the death certificate, and only about 10 to 15 percent had it listed as the underlying cause of death.

  High Blood Pressure

•In 2003 to 2004, 75 percent of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or used prescription medications for hypertension.

If your blood sugar levels remain consistently high during pregnancy, the excess sugar can increase your child's future risk of obesity and type 2 diabetes.

  1. Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with Type 1 Diabetes can cause major birth defects in 5 to 10 percent of pregnancies, and spontaneous abortions in 15 to 20 percent of pregnancies.


  2. Poorly controlled diabetes during the second and third trimester of pregnancy can result in excessively large babies, posing a risk to both mother and child.

   Dental Disease

•Periodontal disease, also known as gum, disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.

   Blindness

Diabetes is the leading cause of new cases of blindness among adults ages 20 to 74 years.  Diabetic eye disease may include:

  1.   Diabetic retinopathy: damage to the blood vessels in the retina. Diabetic retinopathy causes about 12,000 to 24,000 new cases of  blindness each year.


  1.   Cataract: clouding of the eye's lens. Cataracts develop at an earlier age in people with diabetes.


  1.   Glaucoma: increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.


Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.
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Kidney Disease

There is a rising incidence and predominance of kidney failure - with poor outcomes and spiraling costs.  There is an even higher occurance of earlier stages of chronic kidney disease (CKD).

•    Diabetes is the leading cause of kidney failure; it accounted for more than 44 % of new cases in 2005.


•    In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.


•    In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.
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  Diabetic Nervous System Disease

Diabetic Nervous System Disease may include symptoms such as pain, tingling, or numbness - loss of feeling - in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.

About 60 to 70 percent of people with diabetes have some form of neuropathy.

People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years.

Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose (also called blood sugar)as well as those with high levels of blood fat and blood pressure and those who are overweight.

•About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, erectile dysfunction, or other nerve problems.


•Almost 30 percent of people with diabetes ages 40 years or older have impaired sensation in the feet; for example, at least one area that lacks feeling.


•Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.
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   Diabetes-Related Amputations

•More than 60 percent of non-traumatic lower-limb amputations occur in people with diabetes.

•In 2004, about 71,000 non-traumatic lower-limb amputations were performed in people with diabetes.

  Other Complications Due To Diabetes

•Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar, or nonketotic, coma.


•People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.


•People with diabetes ages 60 years or older are two to three times more likely to report an inability to walk a quarter of a mile, climb stairs, do housework, or use a mobility aid compared with people without diabetes in the same age group.
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•Overall, the risk for death among people with diabetes is about twice that of people without diabetes of similar age.

Prevalence of multiple risk factors for heart disease and stroke among adults over 18, by state and/or territory. (source:Behavioral Risk Factor Surveillance System, 2003).

U.S. Heart Disease and Stroke Statistics

•People who don’t control their diabetes (A1C greater than 9%) are nearly three times more likely to have severe periodontitis than those without diabetes.

•  Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more.

When the kidneys are damaged, they can’t remove waste from the blood as well as they should. This is called chronic kidney disease (CKD) Almost 20 million people in the U.S. suffer from this disease.

Diabetes is one of the 7 most common causes of chronic kidney disease (CKD)

The photo (left) is an example of a diabetes-related amputation and diabetic foot ulcers.

DIABETES FACTS & FIGURES


In the U.S. alone, about 20 million people have diabetes; that is about 1 in every 15 people.  For people over 20, the diabetes rate is about 1 in every 10 people; and more than 1 in every 5 adults over age 60 is diabetic.   More than 6 million of the people who have diabetes (more than 30%) don’t even know they have it!


Diabetes continues to get more common in every age group of Americans,  and men and women have an equal chance of getting diabetes.


Between 90% and 95% of diabetes cases are Type 2 Diabetes.

Since 1988, the average age of diagnosis of Type 2 Diabetes has dropped from 52 years to 46 years.  Over the last 20 years, diabetes in children and young adults has become much more prevalent. 
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A CLOSER LOOK AT DIABETES STATISTICS

TOTAL COST (2007):          $176 Billion   

Direct Medical Costs:        $116 Billion

Average medical expenditures among people with diagnosed diabetes were 2.3 times higher than in people without diagnosed diabetes.

Indirect Costs:                    $ 58 Billion Indirect costs include disability, work loss, premature mortality.
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Diabetic Nervous System Disease is more common in people who have problems controlling their blood sugar, those with high levels of blood fat and/or high blood pressure and those who are overweight.

It's important to manage gestational diabetes for both your sake and your baby's.  Protect your child's health; do as much as you can to manage gestational diabetes during your pregnancy.

Preventive Care Practices for Eyes, Feet, and Kidneys

•Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent.


•Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent.


•Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 to 70 percent. Treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are more effective in reducing the decline in kidney function than other blood pressure lowering drugs.


•In addition to lowering blood pressure, ARBs reduce proteinuria, a risk factor for developing kidney disease, by 35 percent—similar to the reduction achieved by ACE inhibitors.
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In people with Type 1 Diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease

Blood pressure control reduces the risk of cardiovascular disease (heart disease or stroke) among people with diabetes by 33 to 50 percent, and the risk of microvascular complications (eye, kidney and nerve diseases) is reduced by 12 percent or more.

In general, for every 10 mm Hg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by about 12 percent.

More vegetables, high-fiber foods and regular exercise can help you get high blood lipid levels under control.

Patients with diabetes should be examined at least once a year for diabetic eye diseases. If diabetic disease is present in the eye more frequent visits are necessary.

Regular cardio, stretching and strength training are very important.

Extension mirrors and mirrored scales (like this one from Insight) are helpful tools  that can help with daily diabetic foot care.

Complications During Pregnancy (Gestational Diabetes)

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Diabetes Facts

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