Expert Advice on Avoiding Complications


Martin J. Abrahamson, MD, is a senior vice president at Joslin Diabetes Center, the medical director of the Joslin Clinic and an associate professor of medicine at Harvard Medical School.

Q: Will diabetes affect my sex life?

A: It can. Men may develop erectile dysfunction, and may also have more frequent urinary tract infections. High blood pressure, high cholesterol, and obesity can increase the likelihood of erectile problems. Woman may experience difficulty having an orgasm, more frequent urinary tract and yeast infections, and vaginal dryness. Viagra and similar drugs for treating erectile dysfunction are safe for people with diabetes to take, and there are other options available if medications don't work. Good blood glucose control can prevent such problems from developing or getting worse. Half of men who have been diagnosed with type 2 diabetes suffer from erectile dysfunction, but that percentage falls to 30% among those whose blood glucose is well-controlled.

Q: What are other complications of diabetes?

A: Diabetes complications are divided into two types: those that affect the large blood vessels, known as macrovascular complications, and those that strike the smaller blood vessels, called microvascular complications. The most important macrovascular complication is cardiovascular disease (heart attacks and strokes), which is the leading killer of people with diabetes. Another macrovascular complication is peripheral vascular disease, where fatty deposits build up in arteries outside of the heart, such as in the legs.Microvascular complications include damage to the retina, the layer of cells lining the back of the eyeball that responds to light. This damage is known as diabetic retinopathy, and can eventually cause blindness. Peripheral neuropathy is damage to the nerves supplying sensation and motor strength to the arms and legs. Neuropathy, or nerve damage, can also affect the autonomic nervous system, which helps regulate heart rate, digestion, and other essential bodily functions. People with diabetes also are at risk of kidney damage—diabetes is the leading cause of end-stage renal disease in the western world.People with diabetes are also at greater risk than the general population of developing glaucoma and cataracts. Due to these complications, diabetes is the leading cause of blindness in the western world, as well as the most common cause of non-traumatic lower limb amputation.

Q: What can I do to reduce my risk of developing these complications?

A: First of all, if you smoke, quit. Smoking cigarettes worsens blood vessel damage due to diabetes. Next, keep your blood glucose levels under tight control, which will sharply reduce your risk of developing these complications. If you are already experiencing complications, good blood glucose control can halt their progression, and may even reverse them. The American Diabetes Association (ADA) recommends that your A1C, a measure of long-term blood glucose control, be less than 7%. Your fasting or pre-meal blood glucose should be between 90 and 130 mg/dl, and should rise to no more than 180 mg/dl after a meal.Controlling your blood pressure and cholesterol will also reduce your risk of both macrovascular and microvascular complications. According to the ADA, people with diabetes should keep their blood pressure below 130/86 mmHg, levels of LDL cholesterol below 100 mg/dL (70 mg/dL if you have a history of heart disease), HDL cholesterol above 40 mg/dL for women and 50 mg/dL for men, and triglycerides below 150 mg/dL. Eating healthy, exercising, and losing weight are helpful for keeping blood glucose, blood pressure, and cholesterol levels in check, although you may need to take medication if lifestyle changes aren't enough. Ask your physician if you should be taking aspirin to help protect your heart and blood vessels.

Q: How often do I need to see a health care professional?

A: Anybody with type 2 diabetes should see a health care professional at least once every three months. Regular medical care is essential for helping you to manage diabetes and also to screen for complications.

Q: Who should be on my health care team?

A: Ideally your team should include a physician, nurse practitioner, and a diabetes educator, who can be a pharmacist, nurse, dietitian, or exercise physiologist. You should also see a podiatrist if you have neuropathy in your feet, and an ophthalmologist for annual eye exams.

Q: My vision is blurry. Does this mean I have diabetic retinopathy?

A: People with diabetes may have blurry vision in the early stages of the disease, due to fluid buildup within the eyes that causes the lens to swell. Blurred vision may also occur during the early days of diabetes treatment but will improve once blood glucose levels are under control. So blurry vision is not necessarily a sign of a more serious problem. But some vision symptoms do require immediate medical attention. Contact your eye doctor if you experience sudden loss of vision, severe pain in the eye, a sense that a curtain is falling over your eyes, if you see black or red floating spots, or if straight lines become blurry or distorted.

Q: What are some signs that I may be developing diabetes-related eye problems?

A: Many complications of diabetes—like retinopathy—don't produce symptoms until they are fairly advanced. That's why it's crucial to be screened for these problems so that if they develop they can be treated early. People should have their eyes checked, including a dilated eye exam, by an ophthalmologist who is experienced in treating people with diabetes once they are diagnosed, and at least once a year thereafter.

Q: Can these eye problems be treated if I do develop them?

A: Diabetic retinopathy cannot be cured, but laser surgery can help stop it from progressing. And the earlier it is treated, the better your chance of preserving your vision. Anemia, kidney disease, abdominal obesity, and high cholesterol are all associated with the development and progression of diabetic retinopathy, so controlling these risk factors can help prevent the disease or slow its progress.Medication and, if necessary, surgery can help control the increase in pressure within the eye that causes glaucoma, while cataracts can be treated by removal of the clouded lens and implantation of a new, artificial lens.

Q: What can I do to keep my kidneys healthy?

A: Controlling your blood pressure is essential for keeping your kidneys working properly. You should also have a urine test for microalbuminuria at least once a year; this will determine if your kidneys are releasing too much protein, an early sign of kidney damage as well as a risk factor for heart attack and stroke. It's also crucial to have an annual blood test for the protein creatinine; levels of this protein rise if your kidneys aren't filtering urine properly. But creatinine level alone isn't an accurate indicator of kidney function; it must be used along with a mathematical formula that includes other information to provide an accurate gauge of your kidney's filtering capacity. While kidney specialists will use this formula, most commonly the MDRD equation, not all physicians do.

Q: What are the symptoms of peripheral neuropathy? Can it be treated?

A: Symptoms of peripheral or sensory neuropathy can include burning, pain, and numbness in the hands or feet. Again, tight blood glucose control can also help prevent neuropathy or control its progression. Neuropathy can be quite painful. Your doctor may recommend over-the-counter pain relievers such as aspirin, Tylenol, or ibuprofen. If these medications are not enough, your doctor may suggest taking antidepressants, which can help ease pain from neuropathy, although they take several weeks to work. Pregabalin and Cymbalta are medications specifically approved by the FDA for the treatment of painful neuropathy. Topical treatment with capsaicin cream or a pain relieving ointment such as Bengay can also be helpful. Finally, non-drug options such as biofeedback and acupuncture are useful for some people.

Q: How can I protect my feet?

A: You should check your feet every day, without fail, for any sores or signs of infection. Make sure your feet are clean, and dry them carefully after you wash them. File your toenails, don't cut them. See a podiatrist regularly if you do have neuropathy. Be sure to wear shoes that fit properly and don't pinch or rub your feet, and don't go barefoot.

Q: I have gastroparesis. How can I eat to manage it, and are there medications available to help treat it? Can it be cured?

A: In gastroparesis, the muscles that normally propel food through the stomach no longer work properly, due to damage to the autonomic nervous system. This makes it difficult for the stomach to empty normally, and can lead to nausea and vomiting. It also makes it extremely difficult to control blood glucose levels. People generally go through phases in which the condition worsens, then improves, and while gastroparesis can be managed, it can't be cured. Eating smaller meals, avoiding difficult-to-digest foods, and raising the head of your bed can be helpful. Unfortunately, there are no effective medications to treat gastroparesis at this time.

Q: Am I at greater risk of depression because I have diabetes? Can I take an antidepressant medication?

A: People with diabetes, like individuals with any chronic illness, are at an increased risk for depression. Symptoms of depression include losing interest or pleasure in things you normally enjoy, feeling hopeless and helpless, sleeping too much or having difficulty sleeping, feeling fatigued, and having difficulty thinking and concentrating. If you think you may be depressed, consult a health care professional to determine if therapy or medication or both would be most helpful to you. Medications for depression are not contraindicated for people with diabetes.

Q: Can I exercise after having laser therapy for retinopathy?

A: Certain exercises, such as lifting weights with the upper body, will increase pressure within the eye and should be avoided as you are recovering from this surgery. Talk with your surgeon about what you can and can't do, and get clearance from your physician before you begin any workout plan.

Q: Do I need to take special care of my teeth and gums?

A: Yes. Poorly controlled diabetes can increase the risk of periodontal disease, while periodontal disease can worsen blood glucose control. It's essential for you to floss and brush as recommended, and have dental checkups at least every six months. If you do develop periodontal disease, it should be treated aggressively.

Q: Do I need to get a flu shot? What happens if I do come down with the flu?

A: Yes, you do. If you do come down with the flu, you need to check your blood sugar frequently and stay hydrated. If you take insulin, it may be necessary for you to take larger doses to keep your blood glucose under control. Develop a sick day plan with your health care professional to make sure you'll be prepared for the flu and other bugs.