How Does Diabetes Affect Your Body? Diabetes can cause damage to both large and small blood vessels, resulting in complications affecting the kidneys, eyes, nerves, heart, and gums. The DCCT showed that maintaining blood sugar levels as close to normal as possible prevents or slows the development of many of these complications. Kidney Disease Diabetic kidney disease, called diabetic nephropathy, can be a life-threatening complication of IDDM in about 40 percent of people who have had diabetes for 20 or more years. The kidneys are vital to good health because they serve as a filtering system to clean waste products from the blood. Diabetic nephropathy develops when the small blood vessels that filter these wastes are damaged. Sometimes this damage causes the kidneys to stop working. This condition is called kidney failure or end-stage renal disease. People with kidney failure must either have their blood cleaned by a dialysis machine or have a kidney transplant. High blood pressure (hypertension) also increases a person's chance of developing kidney disease. People with diabetes are more likely to develop high blood pressure than people without diabetes. Therefore, keeping blood pressure under control is especially important for someone with IDDM. Your doctor should check your blood pressure at every visit. Blood pressure tests measure how hard your heart is working to pump blood to the organs and vessels in your body. If blood pressure is too high, it can be treated with a doctor's help. Left untreated, bladder and kidney infections can also harm the kidneys. Consult your doctor if symptoms such as painful urination occur. An early sign of kidney disease is albumin or protein in the urine. A doctor should test your urine for protein or albumin once a year. The doctor should also do an annual blood test to evaluate kidney function. More frequent tests may be necessary if findings are not normal. The DCCT proved that intensive therapy can prevent the development and slow the progression of early diabetic kidney disease. Another recent study has shown that a type of medication called an ACE inhibitor can help protect the kidneys from damage. Kevin is a 35-year-old sales representative and has IDDM. He visits his endocrinologist several times a year to have his blood pressure checked and his hemoglobin A1c measured. Once a year, the doctor takes a blood test to measure Kevin's cholesterol level and his kidney function. The doctor also asks Kevin to collect his urine in a container over a 24-hour period to check for protein or albumin in his kidneys. Albumin or protein in the urine is an early sign of diabetic kidney disease. Eye Disease Diabetes can affect the small blood vessels in the back of the eye, a condition called diabetic retinopathy. Retinopathy means disease of the retina, the tissue at the back of the eye that is sensitive to light. Diabetes eventually causes changes in the tiny vessels that supply the retina with blood. These small changes are called background retinopathy. Most people who have had diabetes for a number of years have background retinopathy, which usually does not affect sight. Over time, the blood vessels may rupture or leak fluid. In a minority of patients, most often those with higher blood sugar, retinopathy becomes more severe and new blood vessels may grow on the retina. These vessels may bleed into the clear gel, or vitreous, that fills the eye or detach the retina from its normal position because of bleeding or scar formation. Laser treatment can help restore vision impaired by diabetic retinopathy. If you have had IDDM for 5 years or more, you should see an eye doctor at least once a year for an examination through dilated pupils. An annual exam is the best way to detect and treat eye damage before the condition becomes severe. Laser treatment, as well as surgical procedures performed by eye doctors who specialize in diabetic problems, can often help preserve useful vision even in cases of advanced retinopathy. In the DCCT, intensive management reduced the risk of diabetic eye disease by 76 percent in participants with no eye damage at the beginning of the study. In those with early retinopathy, intensive therapy slowed the progression of eye damage by 50 percent. Joan is a 40-year-old artist. She has had IDDM for 20 years. Every year she visits her ophthalmologist to have her eyes checked for diabetic eye disease. Her doctor dilates Joan's pupils and looks into her eyes carefully to detect any changes that may have occurred since her last visit. They discuss diabetic retinopathy and the importance of yearly check-ups to detect and treat any eye problems that may occur. Although Joan has very mild diabetic changes in her eyes, these changes do not pose a threat to her vision and are not likely to progress if she stays in excellent diabetic control. Nerve Disease Nerve disease caused by diabetes is called diabetic neuropathy. There are three types of nerve disease: peripheral, autonomic, and mononeuropathy. Peripheral neuropathy affects the hands, feet, legs, toes, or fingers. A person's feet, legs, and fingertips may lose feeling, burn, or become painful. To relieve the pain, doctors prescribe pain-killing drugs and sometimes antidepressant drugs. Scientists are studying other substances to help relieve pain associated with diabetic peripheral neuropathy. Because of the loss of feeling associated with peripheral neuropathy, feet are especially vulnerable. You should check your feet carefully each day for cuts, bruises, and sores. If you notice anything unusual, see a doctor as soon as possible because foot infections and open sores can be difficult to treat in people with diabetes. Your doctor should check your feet at every visit. At least once a year, the doctor should check your neurological function by testing how well you sense temperature, pinprick, and vibration in your feet and changes of position in your toes. Your doctor may recommend that you see a foot care specialist, called a podiatrist. Another type of nerve disease that may occur after several years of diabetes is called autonomic neuropathy. Autonomic neuropathy affects the internal organs such as the heart, stomach, sexual organs, and urinary tract. It can cause digestive problems and lead to incontinence (a loss of ability to control urine or bowel movements), and sexual impotence. A doctor can help diagnose problems associated with internal organs and may prescribe medication to help relieve pain and other problems associated with autonomic neuropathy. Mononeuropathy is a form of nerve disease that affects specific nerves, most often in the torso, leg, or head. Mononeuropathy may cause pain in the lower back, chest, abdomen, or in the front of one thigh. Sometimes, this nerve disease can cause aching in the eye, an inability to focus the eye, or double vision. Mononeuropathy may also cause facial paralysis, a condition called Bell's palsy, or problems with hearing. Mononeuropathies occur most often in older people and can be quite painful. Usually the symptoms improve in weeks or months without causing long-term damage. Lowering blood sugar levels may help prevent or reduce early neuropathy. DCCT study results showed the risk of significant nerve damage was reduced by 60 percent in persons on intensive treatment. Every time Joe, who is a 45- year-old mail carrier and has IDDM, visits his doctor, he takes off his shoes and socks so his doctor does not forget to check his feet for sores, ulcers, and wounds. The doctor also checks his nerve reflexes and sense of feeling. Joe and his doctor discuss ways to prevent foot and nerve problems. Since Joe has lost some of his ankle reflexes and toe sensation, the doctor also stresses the importance of not smoking, not going barefoot, and keeping blood sugar levels under control. Cardiovascular Disease As with high blood pressure, heart disease is more common in people with diabetes than in people without diabetes. People with diabetes tend to have more fat and cholesterol in their arteries. The arteries are the large blood vessels that keep the heart beating and the blood flowing. When too much fat and cholesterol build up in the arteries, the arteries and heart must work harder. Over time, this extra work can lead to a heart attack. To help avoid heart problems, you should have your blood cholesterol and triglyceride levels checked once a year. Other risk factors that may cause the heart to become overworked include high blood pressure, smoking, age, extra weight, and lack of exercise. People with diabetes are also at greater risk for stroke and other forms of large blood vessel disease. A stroke is the result of damage to the blood vessels that circulate blood in the brain. Blockage of major blood vessels in the feet, legs, or arms is called peripheral vascular disease. Peripheral vascular disease causes poor circulation and can contribute to foot and leg ulcers. DCCT participants were checked regularly for heart disease and related problems, although they were not expected to have many heart-related problems because of their young age. Volunteers in the intensive treatment group had fewer heart attacks and significantly lower risks of developing high blood cholesterol, which causes heart disease. The risk was 35 percent lower in these volunteers, suggesting that intensive treatment can help prevent heart disease. The DCCT volunteers on intensive therapy are being followed closely for the next 10 years to see if their risk of heart disease is reduced. Points to remember To reduce the risk of heart disease: Do not smoke. Eat a diet low in fat and high in fruits and vegetables. Have your blood pressure checked regularly. Have your cholesterol checked regularly. Periodontal (Gum) Disease People with diabetes, especially those with poor control of their blood sugar, are at risk for developing infections of the gum and bone that hold the teeth in place. Like all infections, gum infections can cause blood sugar to rise and make diabetes harder to control. Periodontal disease starts as gingivitis, which causes sore, bleeding gums. If not stopped, gingivitis can lead to serious periodontal disease that can damage the bone that holds the tooth in its socket. Without treatment, teeth may loosen and fall out. Good blood sugar control lowers the risk of gum disease. People with good control have no more gum disease than people without diabetes. Good blood sugar control, daily brushing and flossing, and regular dental check-ups are the best defense against gum problems. Points to remember Take special care of your teeth and gums. Visit your dentist every 6 months. Brush and floss teeth at least twice daily. Practice other dental care guide-lines recommended by the dentist or dental hygienist.