Type 2 Diabetes is a common condition often diagnosed during a routine yearly physical exam at your primary care physician's office. Initially symptoms of diabetes can be overlooked because they can be subtle, although some people reported symptoms prior to be diagnosed.
Symptoms associated with high blood sugar levels include:
Increased Urination (Polyuria)
Increased Thirst (Polydipsia)
Increased Hunger (Polyphagia)
Weight changes
Visual Changes
Tingling/Numbness to hands and feed (Paraesthesia)
Changes in Energy
Changes in Skin
Infections with delayed healing
Once diagnosed, patients can choose to make lifestyle modifications to help improve their diabetes by changing their diet, activity, and stressors to optimize their health. This change can help reverse type 2 diabetes.
Physicians often give patients 3 months to make this change prior to initiating medications to help control blood sugar levels. Remember that not all patients associate symptoms to their elevated glucose, but the goal to maintain adequate blood sugar is to prevent the diseases associated with diabetes.
Please remember that these complications are preventable with optimized lifestyle changes and evidence based screening methods to help keep you healthy.
Complications Associated with Diabetes
Diabetes is often defined as a chronic condition under the umbrella Metabolic Syndrome. Sustained high sugar levels in patients can lead to oxidative stress and inflammation, along with excessive free fatty acid (secondary to long term over secretion of insulin and liver saturation of the stored sugar, glycogen) which over time leads to insulin resistance.
This high sugar environment eventually plays a role in damaging blood vessels leading to the complications associated with diabetes. When managing diabetes overtime, your physician focuses on preventing both small blood vessel and large blood vessel diseases. Both become affected when diabetes is not well controlled overtime.
Microvascular Complications
High blood sugar over time can affect small blood vessels which typically affect the eyes (Retinopathy), kidney (Nephropathy) and our nerves (Neuropathy).
Lowering your A1C to <7 is associated with reduction of microvascular complications of diabetes. This means, tighter blood sugar control prevents the occurrence of these associated diseases.
Aggressive sugar management should be done under physician supervision to prevent low blood sugar levels associated with diabetes management.
Diabetic Retinopathy : The diabetic eye disease
This microvascular complication of diabetes may be the most common associated disease and although initially asymptomatic, it is one of the leading causes of blindness.
Diabetic Retinopathy is the medical term to diagnose disease of the eyes associated with diabetes. It is initially asymptomatic but overtime can lead to blurry vision or blindness.
The rate of eye disease depends on both the duration of diabetes, and severity of disease. Other risk factors are associated with development of diabetic eye disease which include high blood pressure, elevated cholesterol, kidney disease and pregnancy.
Diabetic Retinopathy is divided into two categories
Nonproliferative retinopathy
Proliferative Retinopathy
Your Family Doctor, will screen for this condition with an in office eye exam and referral to an ophthalmologist or optometrist for a dilated, comprehensive eye exam.
Screening Recommendations:
Type 1 Diabetes: Dilated, comprehensive eye exam by a specialist within 5 years of onset of diabetes followed by an annual dilated eye exam.
Type 2 Diabetes: Dilated, comprehensive eye examination by a specialist at the time of diagnosis followed by an annual dilated eye exam. If initially normal, can have comprehensive eye exams every 2 years or per your physicians discretion.
Diabetic Nephropathy : The diabetic kidney disease
The kidney damage associated with diabetes is the leading cause of kidney failure.
This condition is defined by persistent protein spillage in the urine secondary to damage within the kidney's filtration system. Overtime, diabetic kidney damage is associated with decrease in function eventually leading to end stage kidney failure
The earliest sign of diabetic kidney disease is high blood pressure, overtime this is associated with protein found within the urine (microalbuminuria). As the kidney disease worsens, it is associated with generalized swelling, potential abnormal heart rhythms, and other symptoms associated with kidney failure
Screening Recommendations:
Patients with diabetes should be screened for high blood pressure at every doctors visit.
Type 1 Diabetes: Screen starting after 5 years of diagnosis, and every year for protein spillage in the urine (microalbuminuria) and with calculation of kidney function (GFR estimate).
Type 2 Diabetes: Screen every year for microalbuminuria and estimated GFR.
Diabetic Neuropathy : The diabetic nerve disease
The cause of diabetic nerve disease is complex and an environment of sustained high blood sugar levels causes damage to our nerves.
Symptoms of nerve damage associated with diabetes depends on the type of neuropathy experienced. Most commonly people present with symptoms of sensory changes of their hands and legs causing a tingling sensation called paraesthesia. further nerve damage is associated with changes in reflexes and loss of touch sensation.
Diabetic nerve damage places diabetic patients at an increase risk of injury and infection due to loss of sensation and is associated with loss of limbs if not properly managed and prevented.
Up to 50% of diabetic nerve damage is asymptomatic
Screening Recommendations:
Patients who smoke should be counseled to quit in order to reduce their risk of nerve damage.
Type 1 Diabetes: Screening at the time of diagnosis and annually thereafter with physical examination including sensory monofilament test, on-off vibration testing with tuning fork, or superficial pain sensation testing (Pinprick).
Type 2 Diabetes: Screening at the time of diagnosis and annually thereafter with physical examination including sensory monofilament test, on-off vibration testing with tuning fork, or superficial pain sensation testing (Pinprick).
Macrovascular Complications
Long standing diabetes increases the process of atherosclerosis, which is defined as disease of the arteries characterized by deposition of plaque (fatty material) on the inner walls of the blood vessel.
The main large vessels damaged by diabetes include the coronary arteries (heart), peripheral arteries (legs), and cerebrovasculature (brain).
The fatty material that line the inside of these large blood vessels increase the risk of having a heart attack (myocardial infarction), stroke (cerebrovascular accident), peripheral vascular disease (leg pain/claudication), and gangrene (increased risk of infection due to poor wound healing and adequate treatment).
Macrovascular complications are the major cause of early death associated with diabetes and can be prevented with optimal sugar control and if necessary medications to help prevent disease occurrence.
Screening Recommendations:
Blood pressure: Diabetic patients should be screened for high blood pressure at the time of diagnosis and each subsequent office visit.
Cholesterol: In general all adults age 40 years or older should be screened for lipid disorders. Diabetics should be screened at the time of diagnosis. Other conditions can cause a doctor to screen for this condition earlier if indicated.
High risk behavior: Smoking cessation, excessive alcohol usage and drug abuse should be discussed at each preventative visit to discuss the importance of abstinence.
Lifestyle Modifications: Diet, exercise/physical activity, weight reduction, and medication/supplements review should be done at every preventative visit.
Diabetic patients should be taught on self assessment of their feet frequently, looking between the toe webs for signs of infection or skin changes.
Prevention is better than treatment
As you can see, diabetes is not an easy disease to manage from a physician stand point because it is associated with so many additional disease states, but if you focus on optimizing your lifestyle, then things become a lot easier.
Type 2 diabetes is associated with metabolic syndrome, which is cluster of conditions including insulin resistance, and/or abdominal obesity, hypertension, and high cholesterol. This condition is reversible with lifestyle changes.
Optimizing someones lifestyle is our goal as a preventative care doctor. At every visit, it is important to discuss ways to improve the way we live, in order to improve our outcomes.
Managing diabetes is best when you have a support system, a healthy environment, evidence based medicine. This leaves you in the drivers seat with all the essentials needed to control this disease.
We are always here to help at Florida Advanced Medicine.