Diabetes is the seventh leading cause of death among Americans. Experts think that many cases of diabetes are not reported as a condition leading to or causing death. But each year, more than 200,000 deaths are reported as being caused by diabetes or its complications.
Complications of diabetes can include eye problems and blindness, heart disease, stroke, neurological problems, amputation, kidney disease, and impotence.
In this segment, Laurie Sandberg, BSN, RN, CDE, discusses the long term complications of diabetes and how with good management and control, you can possibly prevent these complications from occurring.
Selected Podcast
Long Term Complications of Diabetes
Featured Speaker:
Laurie Sandberg, BSN, RN
Laurie S. Sandberg, BSN, RN, CDE, graduated from the University of Maryland School of Nursing with a Bachelor’s of Science degree in nursing. She has over 35 years of nursing experience in a variety of areas including medical/surgical, long term care, intensive care, case management and nursing education. She has provided both inpatient and outpatient diabetes education since 2000. She is a certified diabetes educator and a member of the American Association of Diabetes Educators and the American Diabetes Association. Transcription:
Long Term Complications of Diabetes
Melanie Cole (Host): Long-term complications of diabetes can develop gradually. The longer you have diabetes and the less controlled is your blood sugar, the higher the risk of complications. Eventually, these complications may be disabling or even life-threatening. Here to speak with us today about the long-term complications of diabetes is my guest, Laurie Sandberg. She's a registered nurse and certified diabetes educator with Meritus Health. Welcome to the show. What are some of these long-term complications of diabetes and what does that even mean?
Laurie Sandberg, BSN, RN, CDE (Guest): Long-term complications of diabetes really develop related to uncontrolled diabetes. That is one of the things that we have learned, that by controlling your blood sugar, we can actually prevent most of all of these complications. I do like to make it clear to people that I talk with that if we can control their blood sugar, these long-term complications are not inevitable; they are based on blood sugar control. High blood sugar damages blood vessels and nerves. That's why the complications develop. If we never allow the blood sugar to get high, we don't disturb the blood vessels and nerves. When we think of long-term complications of diabetes, the systems that are related to blood vessels are what are called large blood vessel damage, and when large blood vessels are damaged, the complications associated with that are a heart attack, stroke, and amputation. There are small blood vessels and that damage can lead to blindness and kidney failure. There is nerve damage, which can affect almost any nerve in the body, and there are many different things that can develop.
The first sign of nerve damage tends to be in the feet and hands with something called neuropathy. High blood sugar damages blood vessels and nerves, and that’s what leads to the complications. If we’re talking about the microvascular, the kidney problems that is seen in uncontrolled diabetes, one of the problems is kidney disease related to diabetes doesn’t hurt. You cannot tell that your diabetes is damaging your kidneys. You will not get any effects until the kidney disease is severe. What we try to do is actually for kidneys as well as all of the rest of the complications that can arise is to keep track of them at least yearly to see how your kidneys are this year. We do that with a test called a urine from microalbuminuria. It's basically just a urine test that is done in the lab and it will tell us if your kidneys are starting to be affected by blood sugar. Some other tests that we use to look at the kidneys are something called the creatinine, which is a blood test, and another blood test called a glomerular filtration rate, but the main one we look at that will find kidney problems the soonest is going to be the urine from microalbuminuria. Obviously, to prevent it, you want to control blood sugar, but blood pressure also plays a role here. Many people with diabetes also have high blood pressure, so we want to look at that blood pressure and we want to look at cholesterol control. For the kidney, we’re going to watch your blood sugar, keep that A1C below 7%, that is an individualized goal so just overall for people as it helps protect the kidney, controlling the blood pressure definitely below 140/90, and controlling the cholesterol. Making sure you get that urine microalbumin is key for looking at the kidney and trying to prevent damage.
Melanie: When we’re talking about things like the foot, you mentioned that right at the beginning, so we understand now about the kidney, but when you talk about feet and hands, what is it you'd like people to be on the lookout for and what should they be aware of?
Laurie: Mainly with the feet and hands, neuropathy develops because of damage to the nerve. It’s blood sugar that can damage the nerve, but when we’re looking at the feet, what happens is they tend to lose something called protective sensation. There are nerves in the feet that tell you ‘there's something hurting you here, there's a little stone in your shoe, or you're not standing right on your foot.’ It tells you how your feet are. Pain is usually what tells us that. You start losing a little bit of that protective pain sensation, not the severe pain but the protective pain. You might leave the stone in your shoe a little bit longer, you might not notice that your feet that are close to the fire are actually hotter than what they feel to you and you could get burned, so you lost sensation to your feet. There's a little monofilament test that your physician should do. You should have at least an annual foot exam that includes a monofilament to check the sensation in your feet, but when you look at your feet, you just want to look at if there's anything new. Is there an open area? Is there a big callous? Is there a corn? Is there some rubbing? Is there an open area? If you have any of those, you should see your physician.
Some people will go directly to their primary physician, other people have a podiatrist or a foot doctor, who will look at them, but every day you want to look at your feet. Is there a red area? Is there an opening? Are my toenails growing thick? Do I have a corn? Is a bunion starting to develop? It might not hurt. Sometimes, corns hurt, but if you have neuropathy of diabetes, they don’t hurt. Often, people do not seek treatment until something hurts. When you have diabetes, you can't do that. When you see something, even if it doesn’t hurt, you need to see your practitioner right away, either your primary doctor or your foot doctor.
Melanie: Before we get onto other ones, do you want people to keep track of these things, to write in a journal so that when they do go to their primary care or their podiatrist or diabetes educator, that they can read off these things and keep track of things like bunions or a wound that isn't healing? Do you want them to journal? How do you want them to keep track?
Laurie: I don't know that you'd have to journal per se and write it down. Just be aware of what your foot looked like before. ‘This is a change, I didn't have this red area before, this corn is new, this callous has gotten bigger.' I would let my doctor journal it. When you see something different, you go in and then your physician will work with you as to what specific change might be needed to be seen on a more frequent basis. If you have one of these problems, if it's severe, he'll say come back in four weeks or come back in six weeks and they'll keep an eye on it. When you have lost sensation to your feet often, if it's severe, your podiatrist will ask you to come in every three months perhaps. If it's not quite as severe, your podiatrist might say every six months. If you're not having any problems with your feet, your podiatrist will say yearly. I would let the podiatrist work with you on that as to what's the best return rate, but anytime you see anything different in your feet, it needs to be looked by someone.
Melanie: What about the skin? What should we be looking for there?
Laurie: The skin they find in people with diabetes tends to be thinner, so it's more likely to break down. We want to take good care of our skin, so we don't want it to get too dry and we don't want it to get too moist. Often, where the dry skin happens is on the feet at the heels at the ball of the foot, and sometimes elbows. You'll want to put lotion on those areas. You want to keep them soft. You want to prevent them from cracking. You want to wear sunscreen. You want to prevent sunburns. You want to avoid scratching an insect bite or anything that would cause an open area to the skin. If you have an open area to the skin, that is something that you would follow up with your primary doctor for. Take good care of your skin, keep it hydrated, apply lotion, avoid sunburns, avoid scratching, avoid anything that's going to open up that skin because it is more pliable. It is more likely to break down than other people. A show that rubs, you're going to get a blister more quickly than someone who doesn't have diabetes, so you just want to keep track of what's going on with your skin.
Melanie: Such important points. One thing people hear about in the media and from diabetes educators is about eye problems with diabetes. Speak about those before we wrap up.
Laurie: Eye problems are another microvascular along with the kidneys. These are the two that for type 2 diabetes, it has been proven that by controlling the A1C and keeping it below 7%, we can prevent complications in the kidneys by 34% and in the eye by 21%. Eye damage, you don’t know that you're getting eye damage. If you wait until you’ve got a problem with your vision, that has progressed rather far. A yearly eye exam is what's needed. It needs to be a dilated eye exam because what we’re looking at with a diabetic eye is what the blood vessels look like in the back of the eye, remembering the high blood sugar affects blood vessels. A dilated eye exam by a provider who does that can look at those blood vessels to see if they have been damaged in any way. If they have been, there are treatments; there are injections that sometimes can help prevent further eye damage.
There's laser treatment, which is different than the Lasix, but a laser treatment can prevent further complications or the eye from becoming further damaged, but number one is going to be controlling that blood sugar. Make sure a yearly dilated eye exam, a yearly kidney exam with that urine from microalbumin, a yearly foot exam and then the heart for possible heart attack and stroke and amputation. We want to control blood sugar, but also control cholesterol and control blood pressure. All three of those things tie in not just the blood sugar but also blood pressure and cholesterol and lead to the macrovascular heart disease, stroke, and amputation. The microvascular is kidneys and eyes; yearly eye exam and kidney exam. The foot exam, a yearly foot exam, but a daily foot exam by the person with diabetes, and preventing all of it by keeping the A1C below 7%.
Melanie: Thank you so much. It’s really great information and so well said. You're listening to Your Health Matters with Meritus Health. For more information, please visit meritushealth.com. That’s meritushealth.com. I'm Melanie Cole. Thanks so much for listening.
Long Term Complications of Diabetes
Melanie Cole (Host): Long-term complications of diabetes can develop gradually. The longer you have diabetes and the less controlled is your blood sugar, the higher the risk of complications. Eventually, these complications may be disabling or even life-threatening. Here to speak with us today about the long-term complications of diabetes is my guest, Laurie Sandberg. She's a registered nurse and certified diabetes educator with Meritus Health. Welcome to the show. What are some of these long-term complications of diabetes and what does that even mean?
Laurie Sandberg, BSN, RN, CDE (Guest): Long-term complications of diabetes really develop related to uncontrolled diabetes. That is one of the things that we have learned, that by controlling your blood sugar, we can actually prevent most of all of these complications. I do like to make it clear to people that I talk with that if we can control their blood sugar, these long-term complications are not inevitable; they are based on blood sugar control. High blood sugar damages blood vessels and nerves. That's why the complications develop. If we never allow the blood sugar to get high, we don't disturb the blood vessels and nerves. When we think of long-term complications of diabetes, the systems that are related to blood vessels are what are called large blood vessel damage, and when large blood vessels are damaged, the complications associated with that are a heart attack, stroke, and amputation. There are small blood vessels and that damage can lead to blindness and kidney failure. There is nerve damage, which can affect almost any nerve in the body, and there are many different things that can develop.
The first sign of nerve damage tends to be in the feet and hands with something called neuropathy. High blood sugar damages blood vessels and nerves, and that’s what leads to the complications. If we’re talking about the microvascular, the kidney problems that is seen in uncontrolled diabetes, one of the problems is kidney disease related to diabetes doesn’t hurt. You cannot tell that your diabetes is damaging your kidneys. You will not get any effects until the kidney disease is severe. What we try to do is actually for kidneys as well as all of the rest of the complications that can arise is to keep track of them at least yearly to see how your kidneys are this year. We do that with a test called a urine from microalbuminuria. It's basically just a urine test that is done in the lab and it will tell us if your kidneys are starting to be affected by blood sugar. Some other tests that we use to look at the kidneys are something called the creatinine, which is a blood test, and another blood test called a glomerular filtration rate, but the main one we look at that will find kidney problems the soonest is going to be the urine from microalbuminuria. Obviously, to prevent it, you want to control blood sugar, but blood pressure also plays a role here. Many people with diabetes also have high blood pressure, so we want to look at that blood pressure and we want to look at cholesterol control. For the kidney, we’re going to watch your blood sugar, keep that A1C below 7%, that is an individualized goal so just overall for people as it helps protect the kidney, controlling the blood pressure definitely below 140/90, and controlling the cholesterol. Making sure you get that urine microalbumin is key for looking at the kidney and trying to prevent damage.
Melanie: When we’re talking about things like the foot, you mentioned that right at the beginning, so we understand now about the kidney, but when you talk about feet and hands, what is it you'd like people to be on the lookout for and what should they be aware of?
Laurie: Mainly with the feet and hands, neuropathy develops because of damage to the nerve. It’s blood sugar that can damage the nerve, but when we’re looking at the feet, what happens is they tend to lose something called protective sensation. There are nerves in the feet that tell you ‘there's something hurting you here, there's a little stone in your shoe, or you're not standing right on your foot.’ It tells you how your feet are. Pain is usually what tells us that. You start losing a little bit of that protective pain sensation, not the severe pain but the protective pain. You might leave the stone in your shoe a little bit longer, you might not notice that your feet that are close to the fire are actually hotter than what they feel to you and you could get burned, so you lost sensation to your feet. There's a little monofilament test that your physician should do. You should have at least an annual foot exam that includes a monofilament to check the sensation in your feet, but when you look at your feet, you just want to look at if there's anything new. Is there an open area? Is there a big callous? Is there a corn? Is there some rubbing? Is there an open area? If you have any of those, you should see your physician.
Some people will go directly to their primary physician, other people have a podiatrist or a foot doctor, who will look at them, but every day you want to look at your feet. Is there a red area? Is there an opening? Are my toenails growing thick? Do I have a corn? Is a bunion starting to develop? It might not hurt. Sometimes, corns hurt, but if you have neuropathy of diabetes, they don’t hurt. Often, people do not seek treatment until something hurts. When you have diabetes, you can't do that. When you see something, even if it doesn’t hurt, you need to see your practitioner right away, either your primary doctor or your foot doctor.
Melanie: Before we get onto other ones, do you want people to keep track of these things, to write in a journal so that when they do go to their primary care or their podiatrist or diabetes educator, that they can read off these things and keep track of things like bunions or a wound that isn't healing? Do you want them to journal? How do you want them to keep track?
Laurie: I don't know that you'd have to journal per se and write it down. Just be aware of what your foot looked like before. ‘This is a change, I didn't have this red area before, this corn is new, this callous has gotten bigger.' I would let my doctor journal it. When you see something different, you go in and then your physician will work with you as to what specific change might be needed to be seen on a more frequent basis. If you have one of these problems, if it's severe, he'll say come back in four weeks or come back in six weeks and they'll keep an eye on it. When you have lost sensation to your feet often, if it's severe, your podiatrist will ask you to come in every three months perhaps. If it's not quite as severe, your podiatrist might say every six months. If you're not having any problems with your feet, your podiatrist will say yearly. I would let the podiatrist work with you on that as to what's the best return rate, but anytime you see anything different in your feet, it needs to be looked by someone.
Melanie: What about the skin? What should we be looking for there?
Laurie: The skin they find in people with diabetes tends to be thinner, so it's more likely to break down. We want to take good care of our skin, so we don't want it to get too dry and we don't want it to get too moist. Often, where the dry skin happens is on the feet at the heels at the ball of the foot, and sometimes elbows. You'll want to put lotion on those areas. You want to keep them soft. You want to prevent them from cracking. You want to wear sunscreen. You want to prevent sunburns. You want to avoid scratching an insect bite or anything that would cause an open area to the skin. If you have an open area to the skin, that is something that you would follow up with your primary doctor for. Take good care of your skin, keep it hydrated, apply lotion, avoid sunburns, avoid scratching, avoid anything that's going to open up that skin because it is more pliable. It is more likely to break down than other people. A show that rubs, you're going to get a blister more quickly than someone who doesn't have diabetes, so you just want to keep track of what's going on with your skin.
Melanie: Such important points. One thing people hear about in the media and from diabetes educators is about eye problems with diabetes. Speak about those before we wrap up.
Laurie: Eye problems are another microvascular along with the kidneys. These are the two that for type 2 diabetes, it has been proven that by controlling the A1C and keeping it below 7%, we can prevent complications in the kidneys by 34% and in the eye by 21%. Eye damage, you don’t know that you're getting eye damage. If you wait until you’ve got a problem with your vision, that has progressed rather far. A yearly eye exam is what's needed. It needs to be a dilated eye exam because what we’re looking at with a diabetic eye is what the blood vessels look like in the back of the eye, remembering the high blood sugar affects blood vessels. A dilated eye exam by a provider who does that can look at those blood vessels to see if they have been damaged in any way. If they have been, there are treatments; there are injections that sometimes can help prevent further eye damage.
There's laser treatment, which is different than the Lasix, but a laser treatment can prevent further complications or the eye from becoming further damaged, but number one is going to be controlling that blood sugar. Make sure a yearly dilated eye exam, a yearly kidney exam with that urine from microalbumin, a yearly foot exam and then the heart for possible heart attack and stroke and amputation. We want to control blood sugar, but also control cholesterol and control blood pressure. All three of those things tie in not just the blood sugar but also blood pressure and cholesterol and lead to the macrovascular heart disease, stroke, and amputation. The microvascular is kidneys and eyes; yearly eye exam and kidney exam. The foot exam, a yearly foot exam, but a daily foot exam by the person with diabetes, and preventing all of it by keeping the A1C below 7%.
Melanie: Thank you so much. It’s really great information and so well said. You're listening to Your Health Matters with Meritus Health. For more information, please visit meritushealth.com. That’s meritushealth.com. I'm Melanie Cole. Thanks so much for listening.