Complications of Diabetes—Microvascular

Contributed by: Paul Hampton, Pharm.D. Candidate

UMKC School of Pharmacy

Text Box: Diabetes affects over 20 million people each year. These effects are many and complicated with some of the more severe ranging from amputation and blindness to a loss of feeling in the hands and feet. The importance of keeping your blood sugar under control is important in preventing these effects. Blood sugar levels directly effect the rate at which these adverse effects happen. The higher your blood sugar the faster the adverse events happens. Since 1987 the death rate due to diabetes has increased by 47%, with 224,092 deaths attributed to diabetes in 2002. You are at risk for Diabetes Type II if: · Age 45 or older · Have a family member with diabetes · Are overweight · Don’t exercise regularly · Have high cholesterol · Have high blood pressure The effects can be grouped into two major categories, micro-vascular and macro-vascular. The microvascular complications of diabetes, or the ones that affect the small vessels of the body, affect the eyes, kidneys, teeth and gums, nervous system, and the circulatory system of the extremities. Macrovascular complications include heart disease, liver and kidney dysfunction. Diabetes can cause blindness, Diabetic Retinopathy, causes 12,000 to 24,000 cases of blindness every year, the highest rate of new blindness in people 20 to 74 years old. Experts believe that keeping blood glucose levels as close to normal as possible can decrease this by up to 76%, this was outlined in The New England Journal of Medicine, September 30, 2003. The damage is caused by the blood vessels in the eyes being plugged by the glucose molecules which are bigger than the other molecules in the blood. This plugging causes pooling of fluid in the eyes which leads to blindness. Diabetes can also cause damage to the kidneys, Diabetic Nephrology. Diabetic Ne

Text Box: phrology is the leading cause of kidney failure, 44% of all cases in 2002. In 2002, 44,400 people were beginning treatment for End Stage Renal Disease. The experts again believe that tight blood sugar control can reduce damage to kidneys from 35% to 56%. This was also reported in The New England Journal of Medicine, September 30, 2003. This damage is also due to plugging, plugging of the glomeruli, this is the filter for the blood. Sixty to seventy percent of patients with diabetes have some form of moderate to serious nervous system damage. This damage results in loss of sensation or pain in the hands and feet. It can also result in slowed digestion and Carpal Tunnel Syndrome. Thirty percent of diabetic patients over 40 years old have a loss of feeling in their feet; this nerve damage is the single biggest reason for lower leg amputations. In 2002 approximately 82,000 lower leg amputations were done due to non-injury diabetic nerve damage. Uncontrolled diabetics are also at an increased risk for gum disease. Adult diabetics are twice as likely to have gum disease as those people without diabetes. Diabetic patients should brush their teeth twice daily and floss at least once daily. Men with diabetes have two times the likelihood of experiencing erectile dysfunction. Patients should discuss this with their physician and whether medications are needed and available. Prevention of these problems can be avoided by a few key monitoring parameters. First off, keeping the blood sugar levels as close to normal as possible is the most important. Fasting blood sugar should be between 70mg/dl to 120mg/dl. Post-prandial or 2 hours after a meal, should be less than 160mg/dl, and HgbA1C below 6.5%. Blood pressure should also be controlled as much as possible. Diabetic patients should have a blood pressure less than 130/80mm Hg. Every 10mm Hg decreases diabetic complications by up to 12%. Lipid control is also important. Total cholesterol should be below 200mg/dl,

Text Box: LDL should be less than 100mg/dl, triglycerides below 150mg/dl and the good cholesterol, HDL, should be higher than 40mg/dl. With all of this information here are the times you should be tested: · HgbA1C should be tested every 3 months unless under 6.5%, then every year. · Blood pressure should be tested every visit to the clinic. · Lipids should be tested every 3 to 6 months unless under control, then every year. · Microalbuminuria, which is a marker for kidney disease should be tested yearly. · Diabetics should see their dentist every 6 months to make sure teeth and gums stay healthy. · Ophthalmologists are the eye doctor of choice and should be seen yearly. · Diabetics should also check their own feet daily for sore and cuts and have their feet checked by their physician at every clinic visit. So, when your health is important to you and you have diabetes, be diligent and get tested when you’re scheduled to. It is also important to control your blood sugar; this is the single most important thing to control. The others are important but the lack of blood sugar control is the most damaging. For more information talk with your pharmacist, physician or visit www.diabetes.org or www.ada.org.