November is Diabetes Awareness Month, and Gazette decided to play its part in creating awareness of this rather widespread medical condition.
In its first instalment, Gazette explained what diabetes is and the impact it has had on so many, and last week itexplained the importance of a good diet. This week it looks at the health issues many experience after type 1 or type 2 diabetes is diagnosed.
Urological problems and other complications of diabetes
People with diabetes may experience bladder problems, such as overactive bladder, poor control of sphincter muscles that surround the urethra, urine retention and urinary tract infections. These problems occur due to the damage diabetes can cause to blood vessels and nerves.
More than 50% of men and women with diabetes have bladder dysfunction. The current understanding of bladder dysfunction reflects a progressive condition encompassing a broad spectrum of lower urinary tract symptoms, including urinary urgency, frequency, nocturia and incontinence. Previously, the dysfunction has been classically described as diminished bladder sensation, poor contractility, and increased postvoid residual urine, termed bladder cystopathy. However, bladder cystopathy most likely represents end-stage bladder failure, with symptoms of infrequent voiding, difficulty initiating voiding and postvoid fullness, and is relatively uncommon.
A number of clinical studies in men and women with diabetes have reported bladder instability or hypersensitivity as the most frequent finding, ranging from 39–61% of subjects. Diminished bladder contractility or sensation has been found less often, and an acontractile bladder appears to be quite uncommon.
A common problem is impaired sensation in which the bladder becomes “numb” and the patient gets no signal to urinate. Another problem is impaired bladder contractility in which the bladder muscle does not function properly, causing an inability to empty the bladder completely. Other diabetics develop involuntary bladder contractions, or overactive bladder, causing urinary urgency, frequency and incontinence.
When a person has diabetes, wounds can take longer to heal, which can increase the risk of infection and other complications developing, such as amputations. A person who manages their diabetes well can improve the rate at which wounds heal and reduce the chances of developing a severe infection.
Although cuts, grazes, scratches and blisters can occur anywhere on the body, the feet are one of the most common places of injury. A small wound on the foot can quickly develop into a foot ulcer.
Foot ulcers can become serious if left untreated. Between 14% and 24% of people who have diabetes and develop an ulcer will end up having a lower limb amputation.
For this reason, it’s crucial that you do regular self-checks and closely monitor any wounds closely. Catching wounds early is the only way to reduce your risk of complications.
When you have diabetes, a number of factors can affect your body’s ability to heal wounds:
High blood-sugar levels
Your blood-sugar level is the main factor in how quickly your wound will heal.
When your blood sugar level is higher than normal, it:. prevents nutrients and oxygen from energising cells. prevents your immune system from functioning efficiently. increases inflammation in the body’s cells
These effects slow down wound healing.
Peripheral neuropathy can also result from having blood-sugar levels that are consistently higher than normal. Over time damage occurs to the nerves and vessels. This can cause the affected areas to lose sensation.
Neuropathy is particularly common in the hands and feet. When it happens, you may not be able to feel wounds when they occur. This is one major reason why foot wounds tend to be more common in people with diabetes.
People with diabetes are twice as likely to develop peripheral vascular disease, a condition of poor circulation. Peripheral vascular disease causes your blood vessels to narrow, which reduces blood flow to the limbs. The condition also affects red blood cells’ ability to pass through the vessels easily. And a higher-than-normal blood glucose level increases the thickness of blood, affecting the body’s blood flow even more.
Immune system deficiency
Many people who have diabetes also have problems with immune system activation. The number of immune fighter cells sent to heal wounds, and their ability to take action, is often reduced. If your immune system can’t function properly, wound healing is slower and your risk of infection is higher.
If your immune system isn’t functioning at its best, your body may struggle to fight off bacteria that cause infection.
Higher-than-normal blood sugar levels also increase the possibility of infection. This is because bacteria thrive on the extra sugar that’s available in the bloodstream. High blood sugar levels can also prevent immune cells from being able to fight off invading bacteria.
If your infection is untreated and left to spread, it can lead to complications such as gangrene or sepsis.
What can happen if wounds are left untreated
Wounds present a real cause for concern. If they’re not carefully monitored, they can quickly progress into an infection or more serious complication.
The most serious concern is amputation. People with diabetes are 15 times more likely to have amputations as a result of foot wounds or ulcers. Here’s why this happens and what you can do to prevent it.
How is diabetes managed?
With Type 2 diabetes, it’s vital to modify lifestyle, including dietary changes that avoid diabetic-promoting foods and replacement with healthier foods in order to have appropriate sugar control to help prevent diabetic complications. Diabetics should refrain from high glycemic index foods (those that are rapidly absorbed) including sugars and refined white carbohydrates. Instead, diabetics should consume high-fibre vegetables, fresh fruits, and whole-grain products. Regular exercise is equally as important as healthy eating, and the combination of healthy eating, physical activity, and weight loss can often adequately address Type 2 diabetes.
When lifestyle measures cannot be successfully implemented, or do not achieve complete resolution, there are different classes of medications that can be used to manage the diabetes. However, lifestyle modification should always be the initial approach, since lifestyle (in large part) caused the problem and is capable of improving/reversing it. At times, when diet, exercise and drugs are unable to control the diabetes, bariatric (weight loss) surgery may be needed to control and even potentially eliminate the diabetes.
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