Diabetes Complications: Management and Prevention

Diabetes Mellitus is a disease that does not always cause symptoms. In some cases, it can take years for people with diabetes to even be diagnosed or feel that anything is wrong. 

This is because changes in blood sugar levels can take time, sometimes even decades, to cause real problems.

Keeping blood sugar in control is not just about seeing a normal lab test; it helps prevent and delay serious problems.

In this article, the short- and long-term complications of diabetes will be explored.

Short-term diabetes complications

When thinking of diabetes problems, most people think of losing limbs or blindness, but these are long-term complications. In the short-term, diabetes can cause several issues. If not quickly treated, these short-term issues can turn into long-term problems. 

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Hypoglycemia

Hypoglycemia, or a dangerous drop in blood sugar, can happen in those taking insulin or certain other diabetes medications. These medications work to treat high blood sugar, but if not used correctly can cause blood sugar to drop too low.

Mild hypoglycemia can cause hunger, nausea, dizziness, and irritability. Severe hypoglycemia can lead to nervous system problems, coma, and even death.

Once a blood sugar under 70mg/dl is noticed, about 15g of a fast-acting sugar such as skim milk or glucose tablets should be consumed quickly to bring blood sugar back into a normal range. 

Diabetic ketoacidosis

If there is no available insulin for the body to use, then there is no way for sugar to get out of the bloodstream and into cells. When this happens, blood sugar can rise very high, and the body will be starving for food.

Unable to get enough food, the body uses fat to make an alternate source of energy known as ketone bodies.

As the number of ketone bodies increases, the blood turns acidic and leads to a life-threatening condition known as diabetic ketoacidosis. This requires emergency care and insulin treatment. Diabetic ketoacidosis is more common in those with type 1 diabetes.

Hyperosmolar Hyperglycemic Non-Ketoic Syndrome

Illness or stress can cause blood sugars to spike. When blood sugars get very high, the body tries to get rid of the sugar by pulling the water of our cells and triggering more frequent urination.

This is known as a hyperosmolar hyperglycemic non-ketoic syndrome.  This syndrome causes extreme thirst, dehydration, and disorientation.

Typically, IV fluids and insulin are required to correct this condition. Unlike diabetic ketoacidosis, there is still some insulin available to prevent a dangerous rise in ketone bodies. This syndrome is more common in type 2 diabetes.

Skin conditions

Diabetes can also affect your skin, with some people experiencing rashes, bacterial infections and scaly patches. This is as the skin is supplied with blood by many small vessels. These vessels can become damaged due to high blood sugar, which impairs their ability to provide the skin with the nourishment it needs to be healthy.

Gum disease

It is now well-established that gum disease is a complication of diabetes. Studies estimate that the risk of gum disease, such as periodontitis is three-fold in people with diabetes.

Periodontal diseases infections of the gum and bone that hold the teeth in place. In advanced stages, they lead to painful chewing problems and even tooth loss.

Long-term diabetes complications

It is entirely normal to have some sugar, or glucose, in the blood. The body works hard to keep glucose within a certain range. However, blood glucose is toxic when it is too high for too long. 

This excess glucose can go on to damage large blood vessels leading to significant organs (macrovascular complications), small blood vessels such as the ones in the eye (microvascular complications). The following long-term complications can develop over the years to decades. 

Gestational diabetes

Gestational diabetes, or GDM, is when a woman develops high blood sugar levels during pregnancy and is diagnosed with diabetes. About 10% of pregnant women end up diagnosed with gestational diabetes each year in the United States.

Unlike type 1 and type 2 diabetes, gestational diabetes often goes away once the pregnancy is over. However, having gestational diabetes does increase the chance of developing type 2 diabetes later in life.

Atherosclerosis

Macrovascular complications typically involve one key process: atherosclerosis. Atherosclerosis is a diabetes complication that occurs when a blockage is formed in a major blood vessel.

This blockage develops due to several factors: elevated glucose causes blood vessels to weaken and become narrower, elevated cholesterol leads to plaque buildup, and high blood pressure stiffens artery walls. Managing macrovascular complications involves excellent control of blood glucose, cholesterol, and blood pressure.

Diabetic heart disease

The leading cause of death in those with diabetes is heart disease. Over time, high blood glucose can cause large blood vessels to weaken and become narrower. This, along with elevated cholesterol and blood pressure, puts those with diabetes at twice the risk of heart disease. 

Peripheral artery disease

The blood vessels that run through the legs are known as peripheral arteries, and these are especially susceptible to damage from high blood glucose. 

Stroke

Although glucose is the preferred energy source of the brain, too much can lead to an interruption in blood flow to the brain or a stroke. Similar to cardiovascular disease, high cholesterol and blood pressure also increases the risk for stroke. 

Diabetic retinopathy

Diabetic retinopathy is defined as an eye disease that causes loss of vision and blindness in people with diabetes. The vessels leading to the eyes become damaged when glucose is chronically high. This can lead to glaucoma (damaged optic nerve), cataracts (clouding of the eye), and eventually blindness. In the developed world, the most common cause of blindness is diabetes.

Diabetic nephropathy 

The kidneys, a pair of organs important in regulating fluid balance and filtering the blood, are also vulnerable to high blood sugars. When the kidneys become damaged, they lose their ability to remove toxins from the blood.

These toxins build up in the bloodstream, which is how medical providers monitor for signs of kidney damage. Over time, this can lead to complete kidney failure, which will require dialysis.

Diabetic peripheral neuropathy

Just like blood vessels, the body is lined with nerves. Damage to nerves by high blood glucose can cause a number of problems.

When nerves are impaired, you can suffer a wound and not know it is there. This happens most often in the nerves affecting the feet.

A foot wound that is not healing well and not noticed will lead to an infection that may require amputation. Nerve damage can also lead to neuropathic pain, often described as a tingling or burning sensation. 

Diabetic autonomic neuropathy

Automatic neuropathy is damage to nerves that carry out involuntary functions, like digestion, breathing, blood flow, and bladder.

This can lead to several symptoms such as slowed digestion, constipation, problems with urination. Poor blood flow is also a common cause of sexual dysfunction such as erectile dysfunction.

More serious autonomic nerve problems include dangerous changes in heart rate and an inability to feel when blood glucose is too low.

Alzheimer’s disease

Type 3 diabetes is a term that is sometimes used to describe Alzheimer’s disease, and there is growing evidence about how this most common cause of dementia is linked with diabetes.

The type of insulin resistance that occurs in Alzheimer’s, and is a key feature of the disease, happens specifically in the brain. De la Monte and Wands reported in their research that when neurons in the blood-brain barrier become unable to respond to insulin, or the insulin is deficient, this leads to the cognitive decline seen in Alzheimer’s.

While it may seem that the researchers have identified clear justifications for why Alzheimer’s disease is type 3 diabetes, there are several other possible mechanisms.

One 2014 review study highlighted the metabolic links between Alzheimer’s disease and type 2 diabetes and identified that these may also lead to an increased risk of this specific type of marked a decline in cognitive function. 

How to prevent complications of diabetes

The old saying “an ounce of prevention is worth a pound of cure” definitely holds true when speaking about diabetes.

The truth is, diabetes complications are often incurable, and the management involves slowing the rate of disease progression. Preventing these complications in the first place is the only way to treat them completely. 

  • Diet: For people with diabetes, it is essential to limit sugars and fats found in junk foods. A poor diet, high in fat, sugar, and processed foods will contribute to weight gain. And this can result in high blood sugar levels. Continuous spikes in blood sugar, which go unmanaged, can result in many diabetic health complications over time and if type 2 diabetes goes untreated.

  • Regular exercise: A sedentary lifestyle is one of the risk factors for developing type 2 diabetes. Exercise can help improve insulin resistance, which is a precursor to type 2 diabetes.  The American Diabetes Association recommends that people with diabetes take part in at least 150 minutes of physical activity per week, including both aerobic and resistance exercises.

  • Weight loss: Being overweight is one of the greatest risk factors for type 2 diabetes. In fact, research shows that losing 5-10 percent of your body weight can lower your risk of developing diabetes by 58 percent. One study of more than 1,000 people with prediabetes found that for every kilogram (2.2 lbs) of weight participants lost, their risk of diabetes reduced by 16%, up to a maximum reduction of 96%.

  • Blood glucose control: At the center of all, the above complications are blood glucose control. Blood glucose that is too high is the catalyst that leads to all the complications of diabetes. When fasting, a normal blood glucose level is 80-130 mg/dl (4.4-7.2 mmol/L). After meals, the goal is <180 mg/dl (<10 mmol/L). Of course, other factors such as blood pressure and cholesterol are also important.

How can changes in diet prevent diabetes complications?

Diabetes is a condition that is tightly linked to diet because food directly impacts blood glucose control. Even small changes in eating habits can have a large impact on diabetes control.

In addition, making diet changes is the most effective way to control weight, and losing extra weight can indirectly improve blood glucose by helping the body use its insulin more effectively.

Understand carbohydrates

Carbohydrates, or carbs, are a fancy term for sugars and starches. Carb containing foods include starchy vegetables, grains, fruit, milk, yogurt, and sweets. Carbs are important to understand in diabetes because this nutrient directly breaks down into blood glucose.

It is not that carbs are evil; in fact, several sources of carbs such as sweet potatoes, berries, and oatmeal have health benefits. However, control of the number of carbs is important to maintain blood glucose control and prevent high blood sugar levels.

Portion control

When creating a meal, think more about the overall composition and portions of the foods and less about the specific foods themselves.

For example, it is easy to get caught up in a notion that white bread and hot dogs are “bad foods” while apples and fish are “good foods,” but this line of thinking often misses the bigger picture.

If portion sizes are in check, having a hot dog every once in a while can be just fine. On the other hand, if you have too many apples, you can easily turn a portion of good food into a bad diet habit.

The Plate Method

The plate method is a simple way to visualize healthy eating. On a standard 9” plate, aim for half of the plate to come from non-starchy vegetables. Non-starchy vegetables are any vegetable that cannot be ground up into a paste, such as broccoli, tomatoes, carrots, and spinach.

These foods contain almost no carbs, are full of nutrients, fill up the stomach, and do not contribute to weight gain.

Starchy foods should be a quarter of the plate and whole-grain options chosen more often. Protein foods, which include meats, fish, poultry, eggs, and tofu, can be placed in the final quarter of the plate.

Protein foods do not contain carbs, but too much can contribute to weight gain. The type of protein foods is also crucial to controlling cholesterol. Choosing leaner types of proteins such as eggs, poultry, fish, and lean cuts of meat more often will reduce plaque-forming cholesterol.

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For more information on the best diet for diabetes, click here.

Avoiding common diet traps

The following are common issues when trying to keep your diet in check:

  • Beverages: choose only sugar-free beverages such as tea or seltzer water when possible. Juices, sodas, and sports drinks can wreak havoc on blood glucose control.

  • Restaurants: know before you go, look up the nutrition information online to make better choices. Try to take half of the meal home, and skip the bread.

  • Alcohol: the recommendation is no more than 2 drinks a day for men and 1 drink a day for women. Be mindful that alcohol can lead to weight gain. Alcohol can make blood glucose drop too low if enjoyed without food, but can also increase blood glucose if mixed with sugary drinks.

Keeping blood glucose under control by exercise

Being physically active allows the body to soak up more blood glucose and bring it into the cells where it is used for energy.

The goal with exercise is aiming for 30 minutes of moderate-intensity activity on most days of the week. Moderate intensity is when you can talk, but not sing.

Exercise does not have to mean going to the gym, simply moving in any way counts. This includes taking the stairs instead of the elevator, sitting less, taking walks, dancing, and even gardening. Some exercise is always better than none.

Best supplements for preventing diabetes complications

Many people are curious about taking dietary supplements to manage their diabetes. In addition to lifestyle changes and any necessary medical treatment, certain supplements can be effective as part of a diabetes treatment regimen. 

With so many supplements on the market, it can be confusing to choose the one right for you. In many cases, the research on supplements is mixed or inconclusive, which makes choosing the right supplements difficult. 

Remember that when talking about preventing and diabetes related complciations, the most important factor in controlling blood glucose. The following supplements have research supporting their effectiveness in this aim.

Alpha Lipoic Acid 

Alpha-Lipoic acid is a naturally occurring compound produced by the human body. In supplement form, it has been shown to reduce insulin resistance and fasting blood glucose in type 2 diabetes. Alpha-Lipoic acid has also been shown to help with the symptoms of diabetic neuropathy specifically.

A a large multicenter trial, the NATHAN-1 cohort, that used subjective and neurophysiological measures to assess the use of 600 mg/day of oral ALA in 460 patients with Diabetic Peripheral Neuropathy over 4 years. That study found significant improvements in the subjective scores of neuropathy. The authors of the study noted that ALA led to “clinically meaningful improvement and prevention of progression of neuropathic impairments and was well tolerated.”

Cinnamon

Cassia cinnamon, the type used in supplements, has demonstrated improvements in blood glucose in some studies. Studies are somewhat mixed on exactly how effective cinnamon is, but the supplement is generally well tolerated and safe.  Cinnamon in spice form can also be added to foods such as oatmeal and fruit to provide a sweet flavor without extra calories.

A randomized, double-blind placebo-controlled trial of cinnamon supplementation on people diagnosed with metabolic syndrome was carried out for 16 weeks (2). 

All the participants were encouraged to follow a healthy diet and exercise regularly. Half the participants were received 6 grams of cinnamon extract, and the rest were given 6 grams of a placebo. 

There was a reduction in HbA1c and fasting blood sugar in the cinnamon group compared to placebo by week 16. 

Berberine

A chemical found in certain plants, Berberine, has been used for diabetes treatment for hundreds of years. Several clinical trials support the use of berberine supplement to lower blood glucose. Some research has also found a cholesterol-lowering effect with berberine, which is important to prevent diabetes heart disease. 

Bitter Melon 

Researchers have found that bitter melon can have a hypoglycemic effect and help to lower blood sugar levels. 

A 10-week study with 95 patients found that consumption of bitter melon significantly reduced blood glucose levels. Scientists have found that one of the ways bitter melon works is by decreasing the intestines’ uptake of glucose.

Multiple studies have shown that bitter melon can inhibit intestinal absorption of glucose, suppress key glucogenic enzymes, and decrease hepatic gluconeogenesis.

Gynostemma 

One study tested the effects of gynostemma and found that steady-state plasma glucose responses markedly decreased after the treatment, indicating improved insulin sensitivity.

Another study found that patients who took gynostemma had their fasting plasma glucose levels decreased. This study shows a prompt improvement in glycemia and insulin sensitivity. Thereby providing a basis for a novel, effective, and safe approach using Gynostemma to treat type 2 diabetic patients.

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Conclusion

Diabetes is a progressive condition, that if left untreated, can lead to a number of severe complications. Preventing and treating these diabetic complications primarily involves controlling blood glucose levels, blood pressure, and cholesterol. Diabetes control can be achieved through a combination of diet, exercise, medical treatment, and dietary supplements.

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Sources

  1. Autonomic Neuropathy. (2018, February 01). Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/autonomic-neuropathy
  2. Berberine diabetes information. (n.d.). Retrieved from https://diabetesaction.org/article-berberine
  3. Diabetic hyperosmolar syndrome. (2018, May 03). Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetic-hyperosmolar-syndrome/symptoms-causes/syc-20371501
  4. Diabetic hyperosmolar syndrome. (2018, May 03). Retrieved from https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hyperosmolar-hyperglycemic-state-hhs
  5. Diabetes Self-Management. (2019). What Is a Normal Blood Sugar Level? – Diabetes Self-Management. [online] Available at: https://www.diabetesselfmanagement.com/blog/what-is-a-normal-blood-sugar-level/ [Accessed 19 Jun. 2019].
  6. Fowler, M. J. (2011). Microvascular and Macrovascular Complications of Diabetes. Clinical Diabetes,29(3), 116-122. doi:10.2337/diaclin.29.3.116
  7. Hyperosmolar Hyperglycemic State (HHS) – Endocrine and Metabolic Disorders. (n.d.). Retrieved from https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hyperosmolar-hyperglycemic-state-hhs
  8. Mospan, C. M. (2018, October 16). The Role of Supplements in Diabetes Management. Retrieved from https://www.uspharmacist.com/article/the-role-of-supplements-in-diabetes-management
  9. NATURAL MEDICINES, Diabetes. (n.d.). Retrieved from https://naturalmedicines.therapeuticresearch.com/. [Accessed 3 July. 2019]
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Michael Fornaris

Michael is a registered dietitian and diabetes educator currently working in outpatient nutrition counseling for a large hospital system. He specializes in weight management, diabetes control, prediabetes, and metabolic syndrome.

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