Monday, December 6, 2010


Wow, haven't had a Diabetic Monday post in a I thought it was time. Recently, I've been seeing a lot of patients with complications related to their diabetes.  There are tons of complications related to diabetes, but I'm only going to focus on the top four~kidney damage; eye damage; heart damage; nerve damage.  These can be prevented if you treat diabetes, manage blood pressure, and manage cholesterol.

Nephropathy (Kidney Damage)~

Let's start with the kidneys.  Are you aware that diabetes is the leading cause of kidney failure leading to dialysis in the United States?  We only have two kidneys.  If one fails, one can do the work of two, but without a functioning kidney, the body doesn't have a way to filter out unwanted toxins that build up in the blood stream, or get rid of fluid to help keep your body's intake and output in balance. 

 Screening for diabetic nephropathy consists of having your urine tested for microalbumin on a yearly basis. Microalbumin is the name for microscopic proteins that are found in the urine when the kidneys are damaged by poorly controlled diabetes, and can be detected by a simple urine test. Testing for blood urea nitrogen (BUN), creatinine, and an estimated glomerular filtration rate (eGFR) are blood tests that evaluate kidney function, and should be done on a routine basis.


My older sister has diabetes.  Although, she has been in such denial about it over the last couple of years, that she doesn't take care of herself at all.  She eats whatever~mostly processed foods with high fat, sugar, and salt content.  What is her biggest complaint?  How much pain she has in her feet.  "Like pins and needles."  Well, this is due to diabetic neuropathy.

 Diabetic peripheral neuropathy most commonly occurs in the feet. Since the nerves that travel from your brain to your feet and vice versa are the longest nerves in your body, they are the nerves mostly likely to be damaged by poorly controlled diabetes. The best way to screen for diabetic nerve damage is having your feet examined on a regular basis. Take your shoes and socks off when you visit your primary care provider so your feet can be thoroughly examined. You should have a specific test called monofilament testing which evaluates your feet for normal touch sensation.


Did you know that diabetes is the leading cause of blindness in America?  I didn't.  Not until I was looking up facts for this blog.  With good control of glucoses, good blood pressure control, and yearly screening, this could be prevented. Screening for retinopathy is done by having a yearly eye exam that includes dilating your eyes with eye drops and looking in the back of your eyes. What the eye doctor is examining are the small blood vessels in the retina (the back of your eyes) that can be damaged from poorly controlled diabetes. My eye doctor does this with my yearly check up.  There is also this really cool test that she does that maps the retina and it is as simple as taking a picture of it when I look into this machine without blinking for a moment. 


I saved the best for last.  As a cardiovascular intensive care nurse, I see patients when heart disease has affected the patient beyond simple treatment with medications.  I can't reiterate this enough:  The most common complication of diabetes and the leading cause of death in people with diabetes is heart disease or hardening of the arteries.

 Screening for heart disease is done differently than screening for kidney, eye, and nerve damage in that we do not specifically screen the heart. Instead, it is recommended that we screen for and treat the risks factors for heart disease. It would be impractical, expensive, and unreliable; for example, to perform a stress test designed to diagnose heart disease on all people with diabetes. Instead,  we screen and try to educate people for the six major risk factors for heart disease:

1. Diabetes

2. High blood pressure

3. High cholesterol

4. Smoking  (BAD! BAD! BAD! DO NOT SMOKE!!)

5. Family history (having an aunt, uncle, parent, child or sibling with premature or early heart disease, which includes heart attacks, angioplasty, stent placements or coronary artery bypass grafting before the age of 60)

6. Age (men greater than age 45 and women greater than age 55).


First--NO SMOKING!!!  That is an easy one.  Just think about this.  There is some statistic out there.  Don't quote me on it, because I'm being lazy and don't want to stop to search at the moment.  But it goes something like this:  For every FIVE YEARS---yes!  FIVE YEARS that you have quit smoking, you get about a year of  lung viability back. 

So, smoking aside, diet and exercise can help you control blood sugars; manage cholesterol, weight, and blood pressure.  Start with simple life style changes.  Increase your daily activity.  Take the stairs instead of the elevator.  Do that "accidental exercise"--meaning, don't park close to an entrance of the store. Park just far enough from the door to give yourself a nice stretch when going in and out. 

Next, cut out processed foods and foods that are high in fat, sugar, and salt. This is a lot harder because labels are sometimes misleading.  I know Dr. Oz has a few key words he has you look for on labels and if they are within the first couple of ingredients listed, AVOID them.  Check his website  He also has a lot of great recipes that are easy to make and great tasting, too!  I love to watch his tv show because he gives a lot of people great health information that is easy to understand and follow.  He gives people hope.  Everyone should have hope in their lives!  Don't forget to increase your servings of fresh fruits and vegetables.  And, people shouldn't drink carbonated beverages like Coke, Pepsi, Mountain Dew, Dr. Pepper.  Even if they are "diet" sodas.  Instead, drink water, tea, coffee, and fresh juices.  One soda once in a while is a nice treat, but daily adds on the pounds and increases your caloric intake.

Well, I think I've droned on enough for one day.   Happy Monday, everyone!



Dee Ann W said...

Hi Kathleen, I'm glad you will be discussing this topic. I've had a crash course on diabetes because of my son and the problem he had earlier this year and sometime could you discuss the difference between a Type I and Type II diabetic? Anyway, my friend's mother (75 yrs old) is in denial about her sugar levels. They are high and she has nephropathy in her feet and has had blood pooling in her eyes which is causing blindness. She is Type II. It is preventable and she has had surgery on each eye in the last couple weeks. Her sight has been restored however, due to her negligence it may only be a one or two year fix. Prevention is key. I now follow American Diabetes FB for the sake of my son. It is a devastating disease and one of the most expensive. Thanks for talking about this and allowing me to share.

Unknown said...

Hi Dee Ann! Glad I was able to give you some information. Maybe next Monday I will discuss the differences between type I and II. I'm sure I've gone over it before...there are 17 other diabetic Monday facts on this blog somewhere...But it never hurts to reiterate. Take care,

Dee Ann W said...

Hi Kathleen, I do have a question. "Why is it that the elderly are in denial about their sugar levels and severity of being a diabetic?" I ask since you've seen the worse cases when their symptoms bring them into the hospital.

Unknown said...

I'm not sure it is "old people" in general. Personally, I think its a personality thing. Some people have a really difficult time accepting a diagnosis of any kind, not just being told, "you have diabetes". Imagine being told, "you have cancer" "your heart muscle is dead, even bypass surgery won't help you" "Your kidneys no longer work. You will need to be on dialysis for the rest of your life". How would you cope with that? It's not easy to hear or to understand. Every person has their own way of dealing with stuff. For some, it is easier not to believe it because they just can't handle it.