Complications of Diabetes

It is important that you keep your blood sugar under control to avoid complications of diabetes.

Complications of diabetes
Complications of diabetes

Eye problems and retinopathy -one of the complications of diabetes.

Eye problems and retinopathy are complications of diabetes. Diabetes causes eye problems which may lead to blindness. People with diabetes are at higher risk of developing blindness than people without diabetes but most people who have diabetes will only have minor eye problems.

It is important that you have regular eye check-ups to prevent minor problems from becoming major problems. However, if you develop major eye problems, it is important to know that there are treatments that work better if you start them right away.

The retina is the part of the eye that records the images focused on it and converts it into electrical signals which the brain receives and decodes. The macula is the part of the retina specialized for seeing fine detail. 

Glaucoma

People who have diabetes are more likely to get glaucoma than people without diabetes and the longer the person has had diabetes, the more likely they are to get glaucoma. It is also reported that the risk of getting glaucoma increases with age.

Glaucoma is where the optic nerve which connects the eye to the brain becomes damaged. It is caused by fluid build-up in the front part of the eye, which increases pressure inside the eye. This increased pressure, called intraocular pressure, can damage the optic nerve.

The optometrist may diagnose glaucoma by measuring your eye pressure, checking the eye at the optic nerve, and testing the field of your vision. It may also be diagnosed by using non-contact tonometry test (NCT test).

Glaucoma is usually treated with eye drops that relieve pressure in the eye and other treatments e.g eye surgery.

Beta blockers e.g. timolol, betaxolol and levobunolol.

Prostaglandin analogues e.g. travoprost, bimatoprost, latanoprost and tafluprost.

Carbonic anhydrase inhibitors e.g. dorzolamide and brinzolamide 

Other treatments include

Laser treatment (laser iridotomy)

Trabeculectomy surgery.

Diabetes and Cataracts

If you have diabetes mellitus, then you are more likely to develop vision-stealing cataracts compared to those without diabetes. You are also more likely to develop cataracts at a younger age and have them progress faster.

Cataract is an eye condition where the eye’s naturally clear lens becomes cloudy, or opaque. Light doesn’t pass through the lens as it is supposed to and isn’t properly reflected onto the retina and results in vision that is cloudy, blurry or distorted.

Aqueous humour is a thin, clear fluid that made up of 99.9% water and 0.1% of sugars, proteins, vitamins and other nutrients. This fluid supplies nutrients and oxygen to the lens and gives the eye its shape. When your blood glucose levels are uncontrolled, the sugar levels in the aqueous humour and in the lens also rises. High levels of glucose in the lens cause it to swell and affect clarity of vision.

An enzyme in the lens converts glucose to a substance called sorbitol. Sorbitol can accumulate on the lens and affect cells and naturally occurring proteins, which cause the lens to become less clear and opaquer which leads to cataract formation.   

If your cataract is mild, you may need to wear sunglasses more often and use glare-control lenses in your glasses. However, if your cataract is greatly interfering with your vision, you may need to have the lens of the eye removed and maybe a new lens transplanted.

What can you do to prevent cataracts?

Keep your blood glucose well-controlled.

Have your eyes examined regularly by an ophthalmologist?

Keep an eye on your health, and don’t let diabetes steal your vision.

Eye complications of diabetes
Eye complications of diabetes

Retinopathy

Diabetic retinopathy is a general term used to describe all disorders of the retina caused by diabetes and is the most common form of diabetic eye disease. It is the most common diabetic eye disease and the leading cause of irreversible blindness in Nigeria. It usually affects both eyes. It occurs when prolonged high blood glucose levels cause changes in the small blood vessels within the retina. A sustained high sugar glucose levels weaken and damage the small blood vessels within the retina. A damaged blood vessel may become blocked, leak or cause abnormal vessels to grow randomly. The results in swelling of the retina, haemorrhages and exudates.

Diabetic retinopathy can affect all diabetics, especially those who have been diabetic for a significant number of years. If left untreated, it could lead to blindness. The risk of developing diabetic retinopathy increases with age, uncontrolled blood sugar and blood pressure.

Symptoms may be noticed when the disease becomes advanced. Symptoms include eye pain, eye floaters and spots, sudden changes in vision / blurred vision and double vision. Most people have no symptoms until it is advanced. For this reason, it is advisable that you have your eyes examined regularly by an eye care professional.

There are two major types of diabetic retinopathy: nonproliferative (not growing) and proliferative (growing) referring to the growth of abnormal blood vessels in the retina.

Nonproliferative retinopathy

In nonproliferative retinopathy, the most common form of retinopathy, blood vessels in the retina starts getting damaged. These damaged blood vessels can become blocked and leak. Fluids, proteins and fats leak out of the abnormal blood vessels and can collect in the retina. This results in swelling of the retina and may impair sharp vision. Nonproliferative retinopathy can get worse and go through three stages (mild, moderate, and severe), as more and more blood vessels become blocked.

Diabetic macular oedema

Diabetic macular oedema (DMO) is caused by a diabetic retinopathy. Diabetic retinopathy is caused by continuous damage to the small blood vessels of the retina. When blood vessels get blocked, blood does not drain properly, and it leaks into the retina. If it leaks into the macula, it swells with fluid to cause a condition called macular oedema. While nonproliferative retinopathy does not usually require treatment, macular oedema requires treatment.

Diabetic Maculopathy

Diabetic maculopathy is a condition that can result from retinopathy. Maculopathy is damage to the macula. The macula is the part of the retina specialized for seeing fine detail and provision of central vision. Diabetic macular oedema (DMO) is a common type of damage.

Proliferative retinopathy

For some people, diabetic retinopathy progresses after several years to a more serious type known as proliferative retinopathy. In proliferative retinopathy, the blood vessels become so damaged that they close off. In response to this close off, new structurally unstable blood vessels start to grow in the retina. These weak blood vessels and can easily burst and leak blood into the vitreous. The vitreous is a clear gel between the lens and the retina. Sudden bleeding into this vitreous can block vision quite suddenly, in a condition known as vitreous haemorrhage. The structurally unstable blood vessels can also cause scar tissue to grow. When this scar tissue shrinks, it can distort the retina or pull it out of place, a condition known as retinal detachment.

Treatment of retinopathy

If you have diabetes, it is important that you control your blood glucose levels, high blood pressure, and have regular medical examinations to preventing retinopathy. You should see also see an ophthalmologist (a doctor with specialized education for diagnosis and treatment of eye diseases) for an annual eye examination including pupil dilation for the best possible view of the retina. If retinopathy is detected, early treatment is essential to prevent blindness.

Treatments such as scatter photocoagulation, focal photocoagulation, and vitrectomy.

Injecting medication directly into the eye is a newer type of treatment for retinopathy. The injected medication contains a drug that blocks the activity of vascular endothelial growth factor (VEGF). VEGF is a hormone that promotes the growth of new blood vessels and in the case of retinopathy, it promotes the growth of weak, leaky blood vessels. The injected medication which is Anti-VEGF drugs stops the growth of weak and leaky blood vessels and improve vision in people with retinopathy. Treatments may be repeated every few months or even every month.

Two types of treatment options are available for macular oedema and diabetic maculopathy. These are focal laser therapy which is used to slow down the leakage of fluid and by injection directly into the eye a medication that slows down the growth of new blood vessels and reduce the leakage of fluid into the macula.

Foot problems (Diabetic foot) -one of the complications of diabetes.

Foot problems (Diabetic foot) is one of the complications of diabetes. Diabetes makes you more at risk of developing serious foot problems that can lead to amputation.  You are said to have a serious foot problem when problems to your foot means it needs immediate attention. You should not dismiss even a mild foot problem as your diabetes can mean that the mild problem can become serious. If you have been told that your risk of getting foot problems is high, it means that a minor problem with your feet could quickly become something very serious. Get medical attention immediately if you’re high risk and notice any change or problem with your feet.

If you have diabetes, you are 20 times more likely to have an amputation.

Peripheral artery disease (PAD) and peripheral neuropathy are the two main conditions responsible for the increased risk of foot problems in people with diabetes.

Diabetic foot problems include:

Dry skin: This occurs when skin doesn’t retain enough moisture.

Blisters: This is a small pocket of fluid that can form on the upper layers of the skin.

Bunions: These are bony lumps that form on the side of the feet

Corns:  These are hardened or thick areas of skin that can be painful when pressed. They are usually smaller than calluses and have a hard centre surrounded by inflamed skin. Corns can be found on the top and sides of your toes and even between your toes.

Calluses: These are hardened or thick areas of skin that are rarely painful. They are usually found on the soles of your feet, especially under the heels. They are usually bigger than corns and vary in size and shape.

Hammer toes and mallet toes: A hammer toe has a bend in the middle joint of your toe, while mallet toe bends the toe joint closest to the nail.

Fungal nail infections:  This occurs when fungi attack the toenails, or the skin under the nail, called the nail bed. Fungi can get into your nails through small cuts in the skin around your nail or through the opening between your nail and nail bed.

Athlete’s foot:  Athlete’s foot is a fungal foot infection that occurs when fungi grow and multiply on the skin. The fungi grow in dark, warm and moist environments, e.g. between toes or bottom of the foot. It can make the skin on your foot to have a rash and become sore, red and itchy.

Ingrown toenails: This is where the nail grows into the toe. It can be very painful.

Charcot foot: It is a problem that can affect the foot of people who have diabetic neuropathy. The bones of the foot become weakened and can fracture or dislocate with minor forces like standing or walking. This may go unnoticed because of diabetic neuropathy and not treated.  If this remains untreated, the arch can collapse, and the foot takes on a convex shape giving it a rocker bottom appearance which makes it difficult to walk on. This serious and potentially limb-threatening foot condition can lead to severe disability, deformity, and even amputation. Treatment includes immobilizing the foot in a plaster cast or sometimes surgery.

Foot ulcers: These are long-lasting sores on the feet that may develop just on the skin’s surface or into more serious wounds that can lead to amputation.

Gout: This is a form of arthritis which can be intensely painful and swollen. it’s caused by having small sodium urate crystals in and around your joints.

Plantar fasciitis: This is heel pain that is caused when the plantar fascia (band of tissue in the foot) is damaged and thickens.

Plantar warts: These are warts that affect the bottom of the feet usually the heel or other weight-bearing areas of your feet. Plantar warts are caused by the human papillomavirus virus (HPV) which gets into your body through cuts or breaks on the bottom of your feet.

These problems are not specifically experienced by diabetic patients, but it may occur more often in diabetics due to the nerve and vascular damage caused by diabetes.

Treatment is different depending on the exact type of foot problem. Surgery or even amputation may be required for some cases.

diabetic foot ulcers can cause foot gangrene
diabetic foot ulcers can cause foot gangrene

Some other serious problems that may occur include cellulitis (an infection of the tissues beneath the skin), sepsis (the infection spreads to the bloodstream) and osteomyelitis (infection of the bone).

Signs and Symptoms of a serious foot problem

You should examine your feet every day so that you can notice any changes when it occurs.  If you notice any changes, take the weight off your foot and see your doctor about it straight away. It’s important to try and sort any foot problems before it gets any worse. It is important to let your doctor know about any changes no matter how small because a serious foot problem can lead to amputation very quickly.

Symptoms include

swollen feet

tingling sensation or pins and needles

shiny, smooth skin on your feet

pain in the feet

Burning sensation

a dull ache

hair loss on your legs and feet

loss of feeling in your feet or legs

your feet don’t sweat

wounds or sores that don’t heal

cramp in your calves when resting or walking.

Numbness

Dry and cracked skin

Firm spots on the feet

Warts and fungus

Symptoms that will prompt you to see your doctor urgently:

Changes in toenails

changes in the colour of your foot

Changes in shape of the foot

warm or hot feet

Cold feet

blisters and cuts that you can see but don’t feel

foul smell coming from an open wound.

How to prevent foot problems

You can reduce the chances of developing a foot problem by

Checking your feet for signs of problems every day-very important

Not walking barefooted

Wearing shoes that are not tight as tight shoes can cause blisters

Keeping your feet clean

Keeping your feet moisturised

Diabetes, Heart attack and Stroke are complications of diabetes.

Diabetes, Heart attack and Stroke are complications of diabetes. Persistent high blood sugar levels can damage arteries around the body and cause them to become hard and stiff. When this damage occurs, the arteries slowly become narrowed from a build-up of fat, cholesterol and other substances that together are called plaque. This process is known as atherosclerosis. This can then block blood flow to the heart or brain.

A heart attack is when one of the coronary arteries becomes totally blocked due to an accumulation of plaque or a blood clot. This starves the heart muscle of vital oxygen and nutrients and, if not treated, will begin to die. The damage or death of part of the heart muscle is what is referred to as a heart attack or myocardial infarction.

Symptoms of Heart attack

This varies from one person to another, but the most common signs of a heart attack are:

Sudden pain or discomfort in your chest that doesn’t go away.

This pain may spread to your arms, neck, jaw, back or stomach.

Feeling light-headed, sick, sweaty, or short of breath.

It’s possible to have a heart attack without experiencing ‘classic’ chest pain. This is common in people who have diabetes as the condition can cause nerve damage which may affect how you feel pain.

Warning signs of a heart attack
Warning signs of a heart attack

Ischemic stroke

When clots block the blood flow to the brain, that part of the brain is no longer getting the oxygen it needs, so it starts to die within minutes. Your brain controls your movement and thoughts, so a stroke can affect your ability to think, move and function. It can also affect language, vision, memory and may even cause paralysis or death.

Haemorrhagic strokes

This type of stroke is less common than ischemic stroke but tend to be more serious and deadlier.  They are caused by bleeding from ruptured blood vessel either in or around the brain subarachnoid haemorrhage (SAH) on the surface of the brain or deep within the brain intracerebral haemorrhage (ICH). Diabetes damages arteries and makes them more likely to tear or burst.

Transient ischemic attack (TIA) or mini strokes

This is caused by a temporary clot which may dissolves or gets dislodged on its own. Most people will fully recover from TIAs, but they are a warning that a full-blown stroke may be eminent.

 Signs and symptoms of stroke?

The signs and symptoms of stroke usually come on suddenly, without warning. Call for emergency if you notice any of the following symptoms.

Dizziness

Numbness or weakness on one side of the body

Problems walking

Problem speaking

Problem understanding speech

Visual disturbances

Nausea, maybe with vomiting

Headache

Diabetes and Kidney disease (diabetic nephropathy) -one of the complications of diabetes.

Diabetes and Kidney disease (diabetic nephropathy) is another complication of diabetes. Diabetic nephropathy is a kidney disease that occurs in people who have diabetes. Diabetic nephropathy can affect people with either type 1 or type 2 diabetes. Kidney disease is when your kidneys are not working as well as they should. Your kidneys are a pair of regulatory organs found on either side of your back. Their main function is to filter your blood to remove unwanted waste products and excess fluid from the body. The nephrons are part of the kidney that filter your blood. These nephrons receive its blood supply through a dense network of blood vessels and a high volume of blood flow through them. Kidneys also produce aldosterone which helps in regulating blood pressure. When your kidneys are damaged, your kidneys fail to give the right signal to produce this hormone which means blood pressure is not regulated.

Diabetic nephropathy
Diabetic nephropathy

While it is well known that kidney disease in diabetics is associated with higher blood glucose levels, the mechanism by which high blood glucose levels cause damage to the kidneys is poorly understood. Diabetic nephropathy is directly influenced by high blood pressure, and in patients with high blood pressure acceleration through the stages of diabetic nephropathy may be quicker.

Kidney problems are a particular risk for people with diabetes because diabetes affects the arteries in the body and the kidney filters blood from arteries. It is estimated that around 40 percent of people with diabetes develop nephropathy. However, with good blood glucose and blood pressure control, it is possible to prevent or delay kidney disease.

Symptoms of kidney disease

The following symptoms may usually be noticed around stage four of kidney disease

Swelling of the ankles, feet, lower legs or hands caused by water retention

Darker urine, due to blood in the urine

Shortness of breath,

Tiredness as a result of a lack of oxygen in the blood

Nausea or vomiting

Metallic taste

Stages of Kidney disease

Diabetic nephropathy is divided into five stages of deterioration, with the final one being end stage renal disease (ESRD). It usually takes over 20 years to reach stage 5. The stages of kidney disease are determined by the extent of kidney damage and the glomerular filtration rate, or GFR. The GFR tells your doctor how well your kidneys are working. A low GFR indicates kidney problems. To help stop kidney disease from deteriorating to later stages if you have diabetes, you should be checked for kidney complications at least once a year.

Stage 1: Kidney damage present but normal or high kidney function; GFR above 90.

Stage 2: Kidney damage with mild decrease in kidney function; GFR between 60 and 89.

Stage 3a: Mild to moderate decrease in kidney function; GFR between 40 and 59.

Stage 3b: Mild to moderate decrease in kidney function; GFR between 30 and 44.

Stage 4: Severely decreased in kidney function; GFR between 15 and 29.

Stage 5: Kidney failure; GFR less than 15.

stages of kidney disease
stages of kidney disease

Prevention of diabetic nephropathy

You can delay or prevent the development of diabetic nephropathy by

 good control of blood glucose levels

good control of blood pressure.

Attending your annual kidney check-up to pick any problems early so that your doctor can take actions to limit progression of kidney disease.

Reducing your HbA1c level. Research shows that reducing your HbA1c by 1% reduces the risk of microvascular complications, such as diabetic nephropathy.

Treatment of diabetic nephropathy

Treatment depends on the stage of the disease, your age, overall health, and past medical history, Personal tolerance for specific medications, procedures, or therapies, opinion and preference. It is easier to treat kidney disease in its early stage i.e. when only small but abnormal amounts of protein appear in the urine (microalbuminuria). You will be advised to follow a healthy diet, exercise regularly, avoid alcohol and tobacco and control blood glucose and pressure.

Your doctor may prescribe medications called angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) because they have been proven to help protect kidney function and further damage plus lowering of blood pressure.

If you have end stage renal disease (ESRD) which is when tests show that your urine contains larger amounts of protein (macroalbuminuria), or if you have kidney failure, you may require regular blood-cleansing treatments (dialysis) or a kidney transplant when your kidneys no longer work well enough to meet the needs of daily life.

Diabetes and Nerve damage (diabetic neuropathy) – one of the complications of diabetes.

Diabetic neuropathy (nerve damage) is one of the complications of diabetes. Nerves carry messages from the brain to other parts of the body as a result, any damage to the nerves would cause problems to the different parts of the body. Neuropathy is one of the long-term complications of diabetes and can be caused by both type 1 and type 2 diabetes. The longer you have had diabetes, the greater your risk of developing neuropathies.

Diabetic neuropathy
Diabetic neuropathy

Diabetes causes neuropathy because high blood glucose levels damage the small blood vessels which supply the nerves thus prevents essential nutrients from reaching the nerves. The nerve fibres can become damaged if it does not get nutrients. Damaged nerves cannot effectively carry messages between the brain and other parts of the body. This could impair your ability to feel heat, cold, or pain in your feet, legs, or hands.

There are three different types of neuropathy: sensory, autonomic and motor. Different types of neuropathy cause different symptoms.

The term peripheral neuropathy sometimes be used, this simply refers to nerve damage affecting any nerves outside of the brain or spinal cord.

Sensory neuropathy

Sensory neuropathy is when the nerves which detect touch and temperature are damaged. It commonly affects the nerves in the feet and the legs but may also affect the arms and hands.

Symptoms can include:

Tingling feeling like “pins and needles”

Numbness

Reduced ability to feel pain

Reduced ability to detect changes in temperature

Loss of coordination – when you lose your joint position sense

Burning sensation

Shooting pains (sharp stabbing pain) – these may be worse at nighttime.

The major danger with having sensory neuropathy when you have diabetes is that you will typically have difficulty sensing the causes of pain and heat. This can make you not to notice any injury you have sustained from sharps objects in shoes, walking around barefoot, from badly fitting shoes and burns. The feet are particularly vulnerable to damage going unnoticed in people with neuropathy because they are not easily seen compared to the hands. If this minor injury is not treated, it may develop into infection or ulcers.

Charcot foot: It is a problem that can affect the foot of people who have diabetic neuropathy. The bones of the foot become weakened and can fracture or dislocate with minor forces like standing or walking. This may go unnoticed because of diabetic neuropathy and not treated.  If this remains untreated, the arch can collapse, and the foot takes on a convex shape giving it a rocker bottom appearance which makes it difficult to walk on. This serious and potentially limb-threatening foot condition can lead to severe disability, deformity, and even amputation. Treatment includes immobilizing the foot in a plaster cast and sometimes surgery.

Treatment of sensory neuropathy

Mild to moderate pain can be treated with Paracetamol or Ibuprofen.

Duloxetine is effective for painful neuropathy.

Amitriptyline or Nortriptyline can be used if Duloxetine is not effective.

Gabapentin can also be used if all the above drugs are inadequate.

Carbamazepine can also be used for neuropathic pain.

skin creams e.g. Capsaicin cream, patches, or sprays, such as lidocaine

Tramadol, morphine and oxycodone may also be used under specialist supervision.

Autonomic neuropathy

Autonomic neuropathy is when the nerves that control your internal organs become damaged and leads to problems with your heart rate and blood pressure, bladder, digestive system, sex organs, and sweat glands. The damage can also lead to hypoglycaemia unawareness.

Symptoms of autonomic neuropathy

The symptoms of autonomic neuropathy depend on which of your body’s functions are affected.

Heart rate and blood pressure

Damage to the nerves that control your heart rate and blood pressure may cause your heart rate to remain high even at rest and this can also result in lower blood pressure, such that you feel dizzy or faint when you stand up after lying or sitting (known as postural hypotension). You may have a rapid or irregular heartbeat. Nerve damage can also make it difficult for you to feel chest pain when you are having a heart attack. Your doctor may prescribe you with water tablets to help reduce the effects of postural hypotension.

Bladder

Damage to the nerves that control your bladder may lead to bladder incontinence and infections. When the nerves to your bladder is damaged, it may be harder for you to know you need to urinate which means you may hold urine for too long and cause you to get bladder infections. You may also leak urine or not be able to hold urine as you should. When you cannot hold urine or leak urine, you are said to have bladder incontinence. Your doctor may prescribe you antibiotics to help treat bacterial infections or recommend catheterization if you have urinary incontinence.

Digestive system

Damage to the nerves that control the digestive system can cause you to have symptoms which include; difficulty swallowing, bloating, fullness, nausea, constipation, diarrhoea, faecal incontinence vomiting. Autonomic neuropathy may also cause you to have gastroparesis which is a disorder that means when food can’t move through the digestive system efficiently.

Sex organs

Autonomic neuropathy can also lead to sexual dysfunction.

In men, damage to nerves in the sex organs may affect their ability to have an erection which is when the penis can’t get firm during sexual intercourse. This is known as erectile dysfunction. Men also may have problems with It may also affect the ability to ejaculation.

In women, damage to the nerves in the sex organs can prevent the vagina from getting wet during sexual intercourse. It may also cause the woman to have less feeling around her vagina and may trouble reaching orgasm.

Sweat glands

Damage to the nerves that control your sweat glands may make you to sweat more at night or while eating (gustatory). Sweating helps the body control temperature and helps keep skin hydrated. Your sweat glands may not work at all, or some parts of your body may sweat while other parts are dry. If your sweat glands are affected by nerve damage and do not work properly, your body may not be able to control its temperature, and this could lead to dry or cracked skin on the feet. Foot creams may be prescribed to help rehydrate the feet.

Ability to feel symptoms of hypoglycaemia

Autonomic neuropathy can make you unable to feel the symptoms of low blood glucose. This is known as hypoglycaemia unawareness. Symptoms of low blood glucose include feeling nervous, confused, hungry, dizzy and irritable. When you have nerve damage, you may not feel these symptoms which means you may not take steps to treat your low blood glucose. This could cause you to develop severe hypoglycaemia.

Motor neuropathy

Motor neuropathy occurs when the nerves which control muscle movement becomes damaged. It commonly affects the nerves in the feet and the legs but may also affect the arms and hands.

Symptoms of motor neuropathy

Muscle weakness which could cause falls

Loss of ability to coordinate movements

Muscle twitching

Muscle paralysis

Muscle cramps

Muscle wasting which is where muscle tissue is lost due to lack of activity

Complications of motor neuropathy

Muscle weakness in the foot and loss of the body’s ability to coordinate movement can lead to unbalanced pressure being put on the ankle when you walk which may cause sprain if it continues for a long time. If you have neuropathy, you may not notice that you are walking differently or that you have sprained your foot because neuropathy can cause reduced ability to pain. If more pressure is put to the foot, from continued walking, a condition known as Charcot foot can occur.

Steps you can take to avoid neuropathy

Maintain blood glucose levels

Get your feet checked at least once a year.

Inform you doctor if you notice any signs or symptoms of neuropathy.

Protect your feet from injury if you’ve lost sensation in your feet.

Diabetes, Gum disease and other mouth problems

Gum disease is also known as periodontal disease is a disease that affects the gums and bones supporting the teeth. It is a very common disease that can affect a lot of people. If you have diabetes, you are more likely to experience gum disease if you have uncontrolled blood sugar levels for a long period of time. Gum disease is a lesser-known complication of diabetes. If left untreated, it could lead to tooth loss. Gum disease is preventable and if detected early, can be easily treated.

Gum disease is one of the complications of diabetes that is not well known

Gum disease and diabetes

When there is too much sugar in your blood, the sugar in your saliva is also increased and that creates the perfect breeding ground for bacteria. These bacteria produce acid which attacks your tooth enamel and damages your gums.

High blood sugar levels can damage the blood vessels in your gums. Damage to blood vessels in the gum causes a reduction in oxygen supply to the gum and makes the gums and bones more likely to get infected.

Gum disease and diabetes are linked in both directions which means gum disease can negatively affect blood sugar levels the same way blood sugar levels can negatively affect gum disease. Severe gum disease and infection can in turn increase your blood sugar levels, which can increase your chances of suffering from other common long-term complications of diabetes.

It is recommended that you undergo a comprehensive dental check-up after a diagnosis of diabetes.

Causes of gum disease

Genes

Stress

Tobacco Use

Diabetes

Dental plaque (main cause of gum disease)

Plaque is a soft, sticky film that builds up on your teeth and contains millions of bacteria, food particles and saliva. Plaque deposits need to be removed from your teeth regularly (every 12 hours) through brushing and flossing to prevent the plaque hardening into tartar. The bacteria in plaque cause tooth decay and gum disease.

 Symptoms of gum disease

Bleeding while brushing

Swollen and red and painful gums

Bad breath

Shrinking (receding) gums

Gaps appearing between the teeth

Loose teeth

Pus around the gumline (abscesses)

Risk factors for gum disease

The risk of developing gum disease is increased or existing becoming worse by

Uncontrolled blood sugar

Poor plaque removal

Tobacco use

Stress

Medications – e.g some medications used to treat high blood pressure

Conditions that affects the immune system – e.g HIV

The stages of gum disease

Gum disease is classified based on the severity of its development. There are three main stages of gum disease:

Gingivitis

Periodontitis (Mild)

Advanced Periodontitis (Severe)

stages of gum disease
stages of gum disease

Treatment of Gum disease

Control blood glucose levels

Quitting smoking

brush your teeth twice a day

floss your teeth daily

You may use antiseptic mouthwash to help reduce bacteria and plaque build-up but do not use it to substitute effective tooth cleaning. It can mask more serious damage.

Visit your dentist for scaling to remove tartar (calcified plaque) if required.

If your teeth and gums do not improve after deep scaling with your dentist, you may be referred to a periodontist, or gum disease specialist.

You may be prescribed antibiotics and/or painkillers to treat acute necrotising ulcerative gingivitis.

You may require surgery if you have severe periodontitis to remove or replace gum tissue.

Diabetes and Cancer

Diabetes carries an increased risk of cancer

When you have diabetes, you have an increased risk of getting cancer. Studies have shown that diabetes can increase your risk of developing some forms of cancer. When you have cancer, it can be more difficult controlling you blood sugar.

Cancer is when cells in a specific part of the body grow and reproduce in an uncontrolled way. The cancerous cells can grow into nearby tissue and destroy surrounding healthy tissue and organs. Cancer sometimes spread from one part of the body to other areas. This process is known as metastasis.

The link between diabetes and cancer has not been completely defined but one theory that exists is that high levels of circulating insulin can promote the growth of tumours. People who have type 2 diabetes have insulin resistance which causes the body to produce more insulin than normal.

The symptoms of cancer depend on which part of the body the cancer affects. Cancer can be treated with surgery to remove the growth, radiotherapy or chemotherapy.

Sometimes, chemotherapy which are medication used to treat cancer and high dose glucocorticoids or steroids, can exacerbate diabetes and make it more difficult to achieve good diabetes control. The side effect of several chemotherapies is nausea and vomiting. This nausea and vomiting can cause additional control difficulties in people with diabetes.

Cancer and type 2 diabetes

When you have type 2 diabetes, you have double the risk of getting pancreatic cancer, endometrial (womb) cancer and liver cancer.

When you have type 2 diabetes, you have an increased risk of getting blood cancers (non-Hodgkin’s lymphoma), bladder cancer, breast cancer and colorectal cancer.

Prostate cancer seems to be lower if you have type 2 diabetes.

Cancer and type 1 diabetes

When you have type 2 diabetes, you have an increased risk of getting stomach cancer and cervical cancer

Diabetes and Sexual problems -one of the complications of diabetes.

Erectile dysfunction

If you have diabetes, you are more at risk of sexual dysfunction which means problems with sexual intercourse. It happens because of high blood sugar levels, high blood pressure and blood fats (cholesterol). High sugar levels overtime can damage your blood vessels and nerves, including the ones that supply your penis. This can limit the volume of blood flowing to your sexual organs and cause you to lose some sensation. The result of this is difficulty/inability to get aroused.

Erectile dysfunction (ED) is a common problem that affects men who have diabetes. This is when you cannot get or keep an erection during sexual intercourse. It is sometimes referred to as impotence. There are several reasons why this could happen. Some of the reasons include reduced blood flow damaged blood vessels and damaged nerves (neuropathy). Some medications can also cause ED.

For an erection to happen, men need to have healthy blood vessels, nerves, male hormones and a desire to have sex. In men, damage to nerves or blood vessels in the sex organs may affect their ability to have an erection despite a desire to have sex and normal male hormones.

You can treat ED with pills like Viagra and Cialis, but talk to your doctor before taking these, as they can cause heart problems.

Diabetes and Sexual problems in women

If you have diabetes, you are more at risk of sexual dysfunction which means problems with sexual intercourse. Diabetes and female sexual dysfunction (FSD) seem to get less talked about than male sexual dysfunction even though research has shown that the prevalence in women could be as problematic for women as it is for men.

High sugar levels overtime can damage your nerves, including the ones that supply your vagina. This can limit the volume of blood flowing to your sexual organs and cause you to lose some sensation. The result of this is difficulty/inability to get aroused.  This nerve damage can also cause vaginal dryness which can lead to painful sexual intercourse. Some medications can also cause this.

Lubricants can help with vaginal dryness and you can buy this from the chemist.

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