Treating Complications of Diabetes

Prevention, early detection and treatment are key to keeping long-term complications of diabetes at bay. Most individuals who are effectively managing their disease and seeing their doctor on a regular basis will not develop the debilitating side effects of diabetes, such as blindness, kidney failure or amputation of a limb. Even patients with the more serious manifestations of diabetes, such as proliferative retinopathy, in which new fragile blood vessels grow on the retina, can be successfully treated with new surgical techniques. Diabetes Center patients are seen at the Seattle Main Clinic.

Diabetic neuropathy

Unfortunately nothing can rejuvenate or replace nerves that have been damaged or have died because of diabetes. The best treatment is keeping your blood glucose under control and exercising to keep muscles toned. Your doctor may also suggest that you take pain relievers such as acetaminophen, aspirin or ibuprofen on a regular schedule throughout the day instead of when the pain is at its worse. In addition, your doctor may recommend other drugs, such as tricyclic medications, which have been found to relieve pain.

Cardiovascular disease

Cardiovascular disease is a serious, long-term complication of diabetes. Uncontrolled blood glucose damage blood vessels throughout the body by making the vascular walls thicker. Additionally, people with diabetes are more prone to high cholesterol levels. Cholesterol, or fat, can block major arteries and lead to heart disease. Patients are treated with the mainstay of diabetes management: controlling blood glucose levels, eating properly, exercising often, and taking diabetes medications if these are indicated for you.

In addition, you will be counseled to stop smoking if you smoke. Nicotine constricts blood vessels, thus compromising an already damaged vascular system. Your doctor may also prescribe cholesterol-lowering drugs to control the amount of fat (lipids) in your blood and blood pressure medication to keep blood pressure within a normal range. (High blood pressure makes the heart work harder and damages the inner walls of arteries where cholesterol can build up.) Your doctor may also refer you to a cardiologist within Virginia Mason for additional treatment.

Diabetic nephropathy (kidney disease)

Uncontrolled high blood glucose, over time, can destroy the delicate filtering system in the kidneys that filters waste products from blood. High blood pressure can also adversely affect the kidneys. If lab tests show that there is some kidney damage, your doctor will use blood pressure medication and possibly diet therapy to help protect your kidneys. ACE inhibitors, for example, are medications that protect against progressive kidney damage and are excellent medications for people with diabetes.

Patients who have lost all function of their kidneys will need dialysis to routinely remove waste products from blood and eventually will need to undergo a kidney transplant. It is important to know that the underlying diabetes, if not controlled, can damage a new kidney. Virginia Mason is participating in a study of islet cell transplantation in which a new kidney and islet cells, which produce insulin, are transplanted into the patient. The new islet cells may then reduce or eliminate the need for insulin.

Diabetic retinopathy (eye disease)

Several surgical procedures are available to help patients with diabetic retinopathy, in which new, weakened blood vessels form along the retina and leak blood into the eye. Laser surgery is used to cauterize blood vessels to keep them from leaking and to destroy or shrink new ones that have formed. If there is a serious hemorrhage, a vitrectomy procedure is used to replace the vitreous fluid in the eye with a salt solution. These procedures are also successful in severe cases of the disease. However, nothing can restore sight once it is lost.

Gastroparesis (diabetic stomach)

Your doctor may prescribe a medication such as metoclopramide to help move food out of the stomach and through the digestive tract.

Bladder neuropathy

You may be prescribed a drug such as Urecholine that helps the bladder empty urine. Your doctor may also prescribe an antibiotic to keep infection under control.

Postural hypotension (low blood pressure upon standing)

If you do not have high blood pressure, your doctor may prescribe a medication that raises blood pressure. In addition, he or she may suggest wearing support stockings to relieve pooling of blood in the lower legs. If you have high blood pressure, your doctor will talk with you about other measures to help relieve this condition.

Diabetic ketoacidosis

Ketoacidosis occurs from a lack of insulin. The body then begins breaking down fat instead of metabolizing sugar properly for energy. Ketoacidosis is a serious medical condition. You must get immediate treatment with insulin and intravenous fluids to avoid lapsing into a coma.

The warning signs of ketoacidosis include the following:

  • Nausea and vomiting
  • Profound weakness
  • Hyperventilation
  • Thirst or a very dry mouth
  • Frequent urination
  • High blood-sugar levels
  • High ketone levels in urine
  • Dry or flushed skin
  • Fruity odor on breath


If you experience any of these warning signs, call your doctor immediately or go to the nearest hospital emergency room.

Hyperosmolar coma

This condition occurs primarily in people with type 2 diabetes. It is caused from a reduced level of insulin and increased insulin resistance that cause blood glucose to rise dangerously high. Hyperosmolar coma is considered a medical emergency. You must get treatment immediately with small amounts of insulin and large amounts of intravenous fluids.

The warning signs for hypersomolar coma are the following:

  • Very high blood sugar levels
  • Frequent urination along with large quantities of urine
  • Dehydration
  • Weakness
  • Confusion

If you experience any of these warning signs, call your doctor immediately or go to the nearest hospital emergency room.

Hypoglycemia (low blood sugar)

Hypoglycemia occurs after taking too much insulin or sulfonureas or because of not ingesting enough calories or from participating in more strenuous-than-normal exercise. The condition can affect people with type 1 or type 2 diabetes. It is treated by immediately ingesting sugar – a piece of candy or fruit juice. You must eat or drink a substance with sugar immediately to raise your blood glucose level. Rarely, the blood sugar might drop so low that it causes unconsciousness.

Some patients with diabetes do not get the warning signs of hypoglycemia and therefore do not ingest emergency sugar. This situation is dangerous and increases the chance of very low blood sugars and loss of consciousness.

The warning signs associated with hypoglycemia are:

  • Shakiness
  • Dizziness
  • Sweating
  • Rapid heart beat
  • Hunger
  • Headache
  • Pale-looking skin
  • Sudden behavior changes or moodiness
  • Jerky movements
  • Confusion
  • Tingling sensations around the mouth

If you experience any of these warning signs, ingest sugar immediately, such as 5-6 pieces of hard candy, ½ cup of fruit juice or three glucose tablets, to raise your blood sugar level. (Glucose tablets can be purchased at a drug store.) You should retest your blood sugar level 15-20 minutes after eating or drinking the sugar substance. If your levels are still low, repeat the treatment.

Your doctor may also prescribe Glucagon, which is injected like insulin. Glucagon raises blood sugar levels. If you carry Glucagon with you, you should inform your family, friends and co-workers about how and when to use it.

Impotence

New drugs, such as sildenafil (Viagra®), and others being tested in clinical trials, are available to help men with impotence. However the use of these drugs in men with diabetes has to be weighed carefully against other factors such as the presence of cardiovascular disease. If you have impotence, your doctor will counsel you about drugs or devices (surgically implanted prosthesis, vacuum devices, etc.) that may be an option for you.

Foot ulcers

The nerves that go to the feet can be damaged by years of high blood glucose levels. Lack of sensation in the foot makes a foot injury more likely. If blood flow is also reduced, healing is more difficult. In severe cases, sores may never heal, leading to gangrene and amputation.

A foot ulcer can begin with a callus or corn that becomes thick over time and breaks down, leaving an open sore. Untreated, the wound can become infected and enlarged. The infection may also travel deeper into your foot. Always see your doctor if you have cracked skin or an open sore on your foot.

Treatment will depend on the ulcer itself. You may have an x-ray taken of your foot to determine if there is an infection in the bone or if a foreign body has lodged in the tissue. Your doctor will then clean out the infection and remove any dead tissue. If the wound is deep, this may require surgery in the hospital. You may also be prescribed antibiotics.

During treatment for an ulcer, you will need to keep off of your foot. You may also need to wear special insoles or shoes to allow healing to take place.

You will need to pay special attention to keeping your blood sugars under control and adhering to a nutritional meal plan. Doing so allows your body to fight infection effectively.

If your wound does not heal properly and if you have poor circulation, you may be referred to a vascular specialist within Virginia Mason for additional treatment.

Charcot joint

Your doctor may suggest that you not put weight on your foot until the fractures heal and may place your foot in a cast for several weeks to aid the healing process. In more severe cases, surgery may be recommended to help restore the foot to its proper shape.