Empowerment: To Prevent Diabetes Complications

Diabetes is a body condition that can harm body organs and tissues exposed to long period of time to high glucose levels. Glucose stays in the blood and can't move into the cells that needed it for body fuel. Excess glucose do more harm giving rise to second diseases or abnormal conditions occurring together with the primary disease- diabetes. These secondary ailments  are  called diabetes complications.

A diabetic must know what these complications are for obvious reasons. He must  empower himself to achieve sufficient information and knowledge of what might happen to his body as result of uncontrolled blood glucose and so that he can self-initiate ways to prevent them. His ignorance about  this possible occurrence of complicating factors will make his management of his  diabetes difficult. 

What is meant by Empowerment? (Sourced from Wikipedia and the (NEC) National Empowerment Center Articles- A Working Definition of Empowerment by Judi Chamberlain, USA).

Empowerment is a term growing in popularity especially in medical programs in the US. For the purpose of this blog, I selected 7 out of 15 character definitions to wit:

1.  having decision-making power
2. having access to information and knowledge
3. Having a range of options from which to make choices (not just yes/no, either/or)
4. a feeling by an individual that he can make a difference (hopeful)
5. capable of  growth and change that is never ending and self-initiated
6. assertiveness or manipulativeness
7. increased ability to manage one's life

Empowerment, in short, is about what you do, not what you say, that gives you a sense of confidence and self-esteem.  It allows you  a positive approach to corrective action as a learning process and gives you that feeling of confidence that you are doing the right thing. An empowered individual can self-evaluate a situation or a minor decision and can determine what went wrong and what to do next time.

The idea of empowerment as a way to manage one's condition as a diabetic was inspired by my diabetologist during my check-up this month. My blood glucose level shot up from  last month's reading of 6.62mmol/L to 10.0mmol/L this month. Like a guilty little girl caught  literally with her hand inside the cookie jar, I demurred, "You know, Doc, my daughters  recently gifted me with a power juicer. I must have exceeded my usual intake of fruits. I couldn't extract enough juice from just one apple or orange so I made double, but adding 2 cucumbers for more juice. I forgot that I used to have few slices of apple or few rinds of orange per serving. I think I'll adjust and see the difference".

As I confessed my "sin", my diabetologist was deep in his thoughts with his eyes locked in mine. Then, suddenly, he blurted out, "Empowerment! I call that empowerment! Given the situation you related, I'm not bothered by the increase in your blood sugar. This is only temporary. You can put it back to near normal if you maintain your regimen about fruits that you singly identified as the cause of your heightened blood sugar".

I've literally put my whole trust in my good doctor the first time I met him. I know he trusts me, too. My diabetes record chart  shows we are on the right track. I then promised in silence that if I innovate, it must not aggravate. He used to say, "Diabetics who simply wait are hard to manage. Participation is crucial. They know how they feel and they direct us on what to do next". That made me proud of myself. I always have something new to tell or ask him during consultations. Upon arriving home, I started this blog. However, my personal opinions are only suggestions . My readers may or may not be obliged  to follow to the letter. Doctors' opinions are still the best.

I'm inspired to make more readings about diabetes and its common complications to share with people with diabetes. "An ounce of prevention is better than a pound of cure". The idea is, if I gain more insights along my topic, I can empower myself with basic information that somehow
can help me identify future problems. This way, I can be of much help to my doctor, at least.

What Are The Common Complications of Diabetes?

Long period of time of  hyperglycemia (heightened blood sugar levels), affects our body organs like the eyes, kidney, liver, lungs, heart, bones, and all the nerves in our body from head to toes.
Secondary ailments in these organs can happen without observed symptoms at early stages. Knowing what will happen because of uncontrolled blood sugar will give us an edge from which decisions are made before they do happen.

by Look into My Eyes @ Flickr

1. Diabetic Retinopathy - is a common complication of diabetes affecting the retina. Retina is the  thin membrane that covers the back of the eye and is sensitive to light. Retinopathy may begin without noticeable change in vision. An ophthalmologist or eye doctor can identify extensive changes during eye examinations. As this condition progresses, symptoms like the following may appear: spot or dark strings (floaters) floating in your vision; blurred vision; fluctuating vision; dark or empty areas in your vision; poor night vision; impaired color vision; total or partial vision loss; pain in the eyes.

There are 2 types of diabetic retinopathy, 1. nonproliferative -  is an early stage caused by bleeding in the retina or due to protein deposits exuding in the retina. As a result, the retina doesn't receive enough oxygen. The fluid in the "wet retina" diminishes vision. 2. proliferative - is the second stage where new abnormal vessels develop in the retina. They often bleed causing visual problem. Small bleeds may clear up on their own, but large bleeds need surgery. Large scars may cause retina to detach.

I was diagnosed in June 2009 with a  ruptured macroaneurism shown by a hyper-pigmented lesion along the inferotemporal vascular arcade in my right eye after an eye examination called Flourescein Angiogram. The blood clot was from a small vein. I  complained of feeling sudden bursts of fluid in both eyes and felt like my eyes were sprayed with foreign bodies that caused pain making it difficult for me to focus my vision. It was only minor. And my eyes were found to be healthy, with no retinopathy. I can relax for the next 3 years, according to the ophthalmologist. Had I not been honest with my problem, I would not have been diagnosed on time. The treatment? I was told to have my blood glucose controlled to a healthy level. Of course proper  eye care was also recommended. Today, I no longer feel the  discomfort my earlier unattended eyes gave me.

Laser can only stop the progression of discomfort in the eye caused by bleeding or proteinuria (leaking protein). It can't reverse the damage already done in the eyes. However, it can slow down further damage by careful control of diabetes, reduction of high blood pressure and regular eye examinations.

2. Diabetic Neuropathy - is another common complication of diabetes affecting the nerves caused by poor blood circulation due to uncontrolled blood sugar. Neuropathies are of 4 types according to the parts of the body with nerve damage. 1. autonomic neuropathy- affects tthe heart and blood vessels, digestive system, urinary tract, sex organs, sweat glands, eyes, and lungs. 2. peripheral neuropathy- affects the feet, legs, arms, and hands. 3. proximal neuropathy- affects the highs, hips, buttocks, and legs. 4. focal neuropathy- affects the eyes, facial muscles, ears, pelvis and lower back, chest, thighs, legs, and feet.

Diabetic neuropathies are disorders associated with diabetes mellitus. It affects all peripheral nerves, pain fibers, motor nerves, and autonomic nerves. All organs and systems in the body can be affected since all are innervated.

Neuropathic symptoms vary depending on the nerve(s) affected. They usually develop over the years. Symptoms may include the following:

Digestive tract
  1.  nausea and vomiting
  2. difficulty in swallowing
  3. constipation
  4. diarrhea
  5. stomach belching, bloating, abdominal pain
  6. stomach paralysis- stomach takes too long to empty its content

Legs and Arms
  1. muscular cramps
  2. loss of sense of warm or cold
  3. numbness (if the nerves are severely damaged, the patient may not be aware of blisters or      minor wounds that can be infected)
  4.deep pain, most commonly in feet and legs
  5. weakness
  6. tingling or burning sensation or electric pain

Other Symptoms
  1. urinary incontinence (loss of bladder control)
  2. fasciculation (muscle contraction)
  3. dysesthesia (decreased or loss of sensation to a body part)
  4. impotence
  5. erectile dysfunction
  6. vision changes
  7. muscle weakness
  8. facial, mouth, and eyelid drooping
  9. dizziness
10.speech impairment
11.excessive sweating

12. rapid heart rate
13. orthostatic hypotension (lightheadedness when standing up of sitting down)

The goals of treating diabetic neuropathies are to prevent further nerve damages from getting worse. The first treatment is  a tight control of blood sugar to bring it down to normal range. Others may include meal planning, physical activity, oral medicine and insulin shots.  Medication may be used to reduce the symptoms. I used pregabalin (Lyrica- approved by the US Food and Drug Association) for my peripheral neuropathy pain and later switched to a milder gabapentin (Neurontin). Scientists continue to discover new treatments to help patients to slow, prevent, or even reverse nerve damage.

3. Diabetic Nephropathy- also known as Kimmelstiel-Wilson Syndrome, is one long term complication of diabetes of a progressive  kidney  disease caused by angiopathy of capillaries in the kidney glomeruli due to long standing diabetes mellitus. .

This complication  shows no symptoms in early stage. The earliest detectable  change in kidney function is the presence of more serum albumin(plasma protein) than normal in the urine(albuminaria) through medical tests.  As it progresses, it can be detected by ordinary urinalysis techniques. The presence of retinopathy also confirms kidney damage in progress. Long term renal failure or excretion of high amount of protein in the urine result to symptoms to develop in the later stage.

Nephropathic symptoms  may show as the following:

by .A.A. Andrea Allen @Flickr

   1. edema- swelling usually around the eyes in the morning and later, general body swelling such as in the feet
   2. proteinura- foamy appearance or excessive frothing of urine
   3. unintentional weight (from fluid retention)
   4. anorexia- poor appetite
   5. nausea and vomiting
   6. malaise- general ill feeling
   7. fatigue
   8. headache
   9. frequent hiccups
  10. generalized itching

Again, the first goal of treating nephropathy is to slow progression of kidney damage and to control related complications. Once proteinuria is established, ACE inhibitor drugs are the main treatment to reduce proteinura levels. Close monitoring of blood glucose levels, modified intake of protein, modified diet, control of lipids, and high blood pressure, physical activity, and maintaining a healthy weight are guides to address kidney damage if found in progress or even if one is not there yet as symptoms may not manifest in early stage.

Patients with diabetic nephropathy should avoid drugs with iodine content, and inhibitors like ibuprofen, naproxen or COX-2 like celecoxid because they may injure the weakened kidney. Once the end-stage develops, dialysis is necessary. A kidney transplantation or a combined kidney-pancreas transplant in type 1 diabetics with kidney damage in progress must be considered.

These information I gathered in my readings, explains why I'm admonished by my diabetologist in the use of celecoxid ( I use Celebrex for pain lately, and now I try to tolerate pain  in my extremities when it comes and hope to wean myself from pain relievers). My regular urinalysis test no longer manifests the presence of albumin and sugar in my urine.  I take it religiously to  maintain a tight blood glucose control so that  I can  prevent this complication. As I'm taking Vitamin B complex for my peripheral neuropathy, this again will be brought up by me in my next consultation due to this new information- that excessive high-dose Vitamin B therapy can cause rapid decline of kidney function and higher rate of heart attack. This is what I call empowerment in progress.

4. Nonalcoholic Steatohepatitis(NASH)- This is another complication of diabetes due to insulin resistance. Poorly uncontrolled blood sugar increases risk of nonalcoholic fatty acid which can lead to scarring of the liver(nonalcoholic cirrhosis). In simple fattynliver condition, there is an accumulation of fat within the liver., which may progress to eithr cirrhosis or liver cancer. High levels of cholesterol, obesity and some cholesterol-lowering drugs may cause liver damage, too.

In early stages, NASH victims feel fatigue, malaise, dull ache in the upper right abdomen. Advanced stages manifest symptoms like, lack of appetite, unexplaine4d weight loss, nausea, weakness, fatigue, small red spider veins under the skin or easy bruising of skin, jaundice, bleeding in the esophagus or in the intestines, loss of interest in sex, fluid in the abdominal cavity, swelling of feet and legs, and itching on hands and feet and eventually in the entire body.

Our best defense against liver disease is a tight control of sugar levels, maintaining healthy weight, reducing high cholesterol, and blood pressure control, weight loss and exercise programs, low cholesterol diet, aerobics of at least 30 minutes 3X a week, use of statins or lipids.

Other Symptoms When Involuntary Functions of the Body Are Affected by Diabetes

1. Digestion- Autonomic nerves affecting the gastrointestinal system control the way involuntary organs contract and relax in order to move food along.  When the nerves in the stomach are damaged, stomach paralysis (gastroparesis) occur.  A wide range of symptoms  begin to manifest,  like  poor digestion of protein and glutien leading to bloating, belching, and abdominal pain; delayed gastric emptying disorder in which stomach takes too long to empty its content;  heartburn; alternating constipation and diarrhea and occasional fecal incontinence; feeling that food is stuck in the stomach which causes nausea and vomitting. In severe cases,  where the patient's esophagus  has problems to contract and relax, he  is fed by inserting a feeding tube into the small intestine  bypassing the stomach.

2. Constipation- Anyone who has bowel movement less than 3X a week and passes hard stools is said to be constipated.  Weakened bowel muscle contraction caused by increased blood sugar make food and waste move slowly causing constipation. This autonomic nerve disorder may also be the side effect of some prescribed drugs like Metformin.

3. Diarrhea - Passage of loose and frequent stools with a sense or urgency. Often causes are consumption of sugar free foods, Metformin, inadequate breakdown of fructose, lactose, and sorbitol in the small intestine. 2 episodes of diarrhea requires you to replace your body fluids with warm water with added pinch of salt in a quart of water. This provides the sodium your body needs. 1/2 teaspoon of table salt provides the potassium your body requires. Sodium and potassium help your large intestine absorb the fluids. We all know that our body needs 8-12 glasses or 2-3 litters of fluid on well days and more on sick days.

4. Dehydration-Diabetes can result from lack of water in the brain. In dehydration, the brain summons fluid, sugar, and salt. If there's less water, sugar level rises. So lack of water may be a genetic cause of diabetes. Wrong amount of insulin in your circulation may also cause dehydration. First symptoms of dehydration is sudden loss of vision due to dehydrated lens of the eye or sudden loss of consciousness  when brain is dehydrated. Proper hydration requires 2 quarts of water spread out daily. 1-2 glasses of water in an empty stomach is good start. Add 1 quarter teaspoon salt to one cup of water.

5.Urinary Incontinence- Due to bladder nerve damage, the body attempts to eliminate excess sugars through the urine causing large amount of urine to be produced. This may result to mild leaking of urine to uncontrollable wetting. Increased thirst is a common symptom of diabetes that results in drinking more fluids and causing frequent and/or urgent need to urinate. Increased blood sugar also cause irritation of the bladder. This condition can be treated with tight control of sugar, and pelvic muscle exercises for better bladder control, less frequent and/or urgent need to urinate, and proper emptying of the bladder.

There are a lot more of secondary ailments to the main ailment of diabetes now on the rise. A good look at these medical conditions will teach us one crucial lesson- to control our blood glucose to its normal range and be spared from such diseases and  discomforts. Many  resources like the Wikipedia and the NEC offer  great information  about diabetes and its common complications for free. Empowerment is necessary because not everything that a diabetic may want to know about his condition- diabetes- can be taught by one's doctor even in his lifetime. We need to self-educate, self evaluate, but no to self-medicate. Our doctors know best.