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Complications of diabetes occur from damage to blood vessels.  The type of complication depends upon the location of the damaged vessels. Prolonged elevation of blood glucose (sugar) damages arteries. Other risks for artery damage are high blood pressure and elevated blood fats (cholesterol, etc).

damaged artery
If small arteries are damaged, complications occur in the eyes, kidneys or/and small nerves.  If the damage is in the large arteries, complications occur as coronary disease, stroke or/and decreased circulation in the legs.


Arteries are the body's vital plumbing system constantly taking a supply of fuel and other vital materials to the working units (cells). They are elastic, recoiling from every heart beat, propelling blood to vital tissues. They are not only elastic pipes to convey blood but are living organs with several functioning layers. The layers are involved in opening up or constricting as the need for blood flow changes, increasing or decreasing movement of materials from blood to tissues as well as other functions. The inner (endothelial) layer is perhaps the most functional, having to do with blood pressure, blood clotting, the passage of infection fighting and inflammatory cells where needed, to name a few.

When damage occurs in small blood vessels in the eye, it can lead to bleeding at the back oretinopathyf the eye with laser treatment to prevent blindness.

When in the small vessels of the kidney, it can lead to kidney failure and the need for (renal) dialysis.dialysis

 

 

 


 A patient receiving dialysis

Diabetic neuropathy


When in the small vessels of the kidney, it can lead to kidney failure and the need for (renal) dialysis.
The term “Diabetic Neuropathy” simply means nerve damage from diabetes. In medical circles it is called “Diabetic Peripheral Neuropathy”, or “ Polyneuropathy of Diabetes”. It usually occurs in people who have had (poorly controlled) diabetes for a long time.  Diabetes sometimes goes undetected for many years. By the time the diabetes is diagnosed, diabetic neuropathy may already be present. The cause is poorly understood but is related to damage to the small blood vessels that supply nerves. Diabetic neuropathy typically occurs in the legs and feet but may occur in other nerves. When severe and long standing, it can cause a loss of balance and muscle weakness.

The main ingredient in diabetic neuropathy is pain, pain, pain. It may appear as numbness, burning, cramping, gnawing, splitting, throbbing, jabbing, cramping, tender, aching, etc.  When long standing, the pain may go away only to be replaced by a complete or partial loss of sensation.

Loss of sensation is particularly dangerous because it can lead to undetected injury, infection and amputation.  We have known a patient to be severely bitten upon standing in a bed of red ants with no sensation of the bites which became infected and resulted in amputation.

Treatment
If you don’t have it, don’t get it!! Diabetic neuropathy is directly related to prolonged high blood sugar. Control of diabetes and other blood vessel risk factors can prevent problems. If diabetes is controlled early in the course of diabetic neuropathy the symptoms generally go away completely. In our experience it takes about 12 weeks of control.
Follow your Diabetes Team’s advice about diet and exercise.
Control blood sugar as best you can. Strive for A1c less than 6.5% (if OK with your doctor).
Control blood pressure and blood fats (Cholesterol, Triglycerides, HDL,LDL).
MEDICINES
Pain, as bad as it is, will not likely kill you. There are many people in the graveyard from medicines!
Avoid narcotics, they relieve pain but also reduce pain threshold making one need more pain medicine.
Acetaminophen (Tylenol®)  is a good pain reliever. If a person has no liver problems the maximum dose is about 4gm (4000mg). Use acetaminephen safely! Click here to see FDA recommendations.
Gabapentin (Neurontin®). This prescription drug is approved by the FDA for seizure control and some nerve pain. It is sometimes used to suppress the pain of diabetic neuropathy. It has many side effects including sleepiness.
Duloxetine (Cymbalta®) is a prescription drug approved by the FDA for the treatment of diabetic neuropathy. We find it more effective than Gabapentin.  It is an antidepressant that has many side effects.  Duloxetine has been associated with liver damage, low blood pressure, abnormal bleeding and seizures among others.
Pregabalin (Lyrica®) is another prescription drug approved by the FDA for diabetic neuropathy.  We find it the most effective of prescription products for the pain of neuropathy.  As with all drugs, there are potential side effects. These include: dizziness, sleepiness, dry mouth, swelling, blurred vision, weight gain and difficulty with concentration/attention.

 Reference for medication information:Goodman & Gilman's Manual of Pharmacology and Therapeutics © 2007

Updated: September 16, 2013

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