Diabetes Part 2 - Not So Sweet!

     In the last blog of the 3 "highs" series, we discussed about how diet and exercise can prevent insulin resistance and type 2 diabetes. Here, we will talk about why it is so important to control this disease. 

What are the effects of hyperglycemia?

    Let's think about what sugar water can do to hair. It can make the hair so stiff that it can stand straight up against gravity! Similarly, high glucose level in our blood stream contributes to the hardening of the blood vessel walls leading to vascular disease. When the larger blood vessels such as arteries are affected, it is called macrovascular disease. Damage to organs secondary to disease of the smaller vessels are called microvascular disease. The macrovascular complications of diabetes, especially cardiovascular diseases (heart attack), are the main causes of death for patients with diabetes. Microvascular diseases from diabetes, which are much more common, are the effect of persistent hyperglycemia on the small vessels of the eyes, kidneys and nerves. Keeping the glucose near normal level can prevent most of the microvascular complications of diabetes.

• Macrovasular complications (large vessels): 
• Brain: Stroke or Cerebrovascular Disease (CVD)
• Heart - Heart attack or Coronary Artery Disease (CAD)
• Other arteries - Peripheral Arterial Disease (PAD)

• Microvascular complications (small vessels):
• Eye- Retinopathy which may eventually lead to blindness
• Kidneys - Nephropathy, leaking of protein from the kidneys, one of the main reason for hemodialysis
• Nervous system 
• Dementia  
• Peripheral neuropathy - the tingling and painful sensations of the fingers and toes
• Gastroparesis - the slowing of the movement and emptying of the stomach resulting in food and liquid staying in the stomach for longer than normal

    Macrovascular complications from diabetes are compounded by other factors such as hypertension, hypercholesterolemia, obesity and smoking which are often present in diabetic patients. Usually, once someone is diagnosed with diabetes, cholesterol and blood pressure medications are needed as well to reduce the risks of the macrovascular complications. Lifestyle changes such as weight loss and smoking cessation also play a very important role in reducing these devastating complications. 

    Microvascular complications have been shown by 2 landmark studies, UKPDS (United Kingdom Prospective Diabetes Study) and DCCT (The Diabetic Control and Complications Trial), to be markedly reduced by tight control of diabetes. Keeping the glucose level near normal can prevent blindness, kidney damages and the nerve damages. Conversely, every 1% increase in Hemoglobin A1c (HbA1c),  for example from 6.5% to 7.5%, the risks for microvascular complications double! (Remember, the unit for HbA1c is expressed in %).

How to achieve tight control?

    The treatment for type 2 diabetes has changed a lot over the last 20 years, particularly in the last 5 years. The guidelines and algorhithms are updated very frequently as well because of continuous new knowledge, findings and understandings of the disease process. With the new classes of medications, the disease can be controlled so much better that we are seeing a lot less of the diabetic complications such as amputation of toes and legs! Besides lowering the blood glucose level, these new medications on their own, protect the kidneys and heart as well. 

    In addition to taking medications, regular visits to your primary care physician or endocrinologist, once a diagnosis of diabetes is made, one should immediately:

• STOP smoking
• Diet - Consultation with a dietitian is highly recommended. My cousin, Charmain Dietitian,also has a whole blog on what to eat, so do visit and learn about it! 
• Avoid concentrated sweets and refined carbohydrates
• Reduce total caloric intake, best less than 1800kcal/day. Avoid liquid calories; drink water!
• Eat more protein and vegetables
• Exercise regularly
• Get a Pneumococcal vaccine, because the immune system is also affected by diabetes
• Check glucose regularly. Now, there are continuous glucose monitoring device that do not require finger stick such as the Freestyle Libre made by Abbott

Patients with diabetes should make sure they do the following regularly:

• Get Flu vaccine every year
• See an eye doctor annually
• A special urine test called microalbumin at least once a year 
• See a podiatrist regularly or check your feet for wounds and sensory loss
• Most of all, follow up with your doctor or endocrinologist regularly!

    I hope this blog clarifies some of the complications of type 2 diabetes, most of which can be prevented by keeping the glucose level near normal. With all the different classes of diabetic medications and better understanding of the disease process, it is possible to control type 2 diabetes!