Diabetes Complications

Diabetes can lead to many complications in the human body. Diabetes will not only affect a person's blood sugar, but it can affect other important body functions and organs. People who have diabetes may be more at risk for developing complications or diseases. It is important to follow recommendations from a physician or other diabetes health specialist to prevent or treat diabetes complications such as diabetic neuropathy, diabetic retinopathy or other vision complications, erectile dysfunction, and hypoglycemia.

Diabetic Neuropathy

Diabetes can also cause extreme nerve damage in the body. Diabetic Neuropathies are a "family of nerve disorders caused by diabetes". Diabetic patients can develop nerve problems in their feet, legs, arms and hands at any point in their life. The nerve damage is most likely due to metabolic factors, such as high blood glucose, nerve injury, neurovascular factors which affect blood vessels carrying oxygen to the nerves, as well as lifestyle factors and genetics. Although the symptoms of diabetic neuropathies start as a minor problem, they can grow to be extremely severe later on in life. Some symptoms include numbness in the body’s extremities, indigestion, diarrhea, erectile dysfunction and overall weakness of the body.

Diabetic neuropathy is broken down into four classifications.

1. Peripheral neuropathy causes the loss of sensation in the body’s extremities. Numbness, loss of balance, and sharp pains can occur most commonly in the legs and feet.

2. Autonomic neuropathy affects the nerves that control the heart, as well as other internal organs such as bladder and bowel functions, digestion, perspiration and can also cause hypoglycemia.

3. Proximal neuropathy is most common in type 2 diabetes patients and affects the lower part of the body, including the thighs, hips and buttocks.

4. Focal neuropathy affects any nerve in the body which can include the eyes, facial muscles, thighs and abdomen. The symptoms include severe pain and aching and are most common in older people.

To avoid diabetic neuropathy, it is recommended that patients keep their blood glucose levels as normal as possible in order to protect the nerves in the body. Most patients who suffer from diabetic neuropathy have foot problems because the foot contains the longest nerve in the body. Doctors suggest that people with diabetes take extra special care of their feet by cleaning them daily, inspecting them constantly for cuts, swelling or other problems, moisturizing and also wearing comfortable shoes that allow the toes to move.

Diabetic Retinopathy and Other Vision Complications

Diabetics can also suffer from eye problems. When blood glucose levels get too high in the body, the nerves in the eye become affected, which can hurt the retinas of the eye. The retina is the lining in the back of the eye that monitors light entering the eye. Behind the retina are tiny blood vessels. When glucose levels and blood pressure gets too high, the blood vessels behind the eye will swell, weaken, and not let enough blood through. When this happens, the body will go new blood vessels, but they are weaker and break easily, leaking blood into the eyes. The blood will block all light from entering the retina, and therefore will cause temporary and/or total darkness. Some patients will need surgery to remove the blood.

To avoid retina problems, patients are suggested to keep their blood pressure as normal as possible. Leaking blood vessels behind they eye can also be cured by a laser treatment which stopped the blood leak and can slow the permanent loss of sight. If the situation is too sever, the doctor will perform surgery to remove the blood and replace it with clean fluid which can improve eyesight. Symptoms of diabetic retina damage include blurry vision, dark or floating spots, or pain and pressure in the eyes. Diabetes can also cause other eye problems including cataracts, which gives patients blurry vision, and glaucoma, which is caused by pressure build up in the eye and will damage the optic nerve, or the main nerve, of the eye.

Erectile Dysfunction

Erectile Dysfunction is the inability for a male to maintain an erection during sexual intercourse. An erection requires a unique set of events which includes impulses from the brain, and responses from muscles and arteries near the corpora cavernosa, which is an important chamber located in the penis. Erectile dysfunction will occur when a male has damage to his nerves or other muscles and tissues in the body. Diabetic patients suffer from tissue damage, and therefore account for 70% of the erectile dysfunction cases. Other factors such as smoking, exercise, common medicines and previous surgery history can also affect the chances of erectile dysfunction. Some men can cure this problem by changing their lifestyle choices and exercising more, or quit smoking; however other patients will require more complicated treatments and should speak to their doctor about alternative options.

Hypoglycemia

Hypoglycemia occurs when blood sugar levels drop below normal and affect the body’s activities. In healthy individuals, when blood glucose levels begin to fall, the pancreas creates a hormone called glucagon which causes the liver to release glucose, which will in turn raise the body's sugar levels back to normal. In people with diabetes, however, the pancreas’s response to produce glucagon fails, and therefore the body’s normal glucose levels do not reach normal amounts. Some symptoms of hypoglycemia are dizziness, confusion, anxiousness, hunger and perspiration. Hypoglycemia can occur for several reasons, including skipping meals, exercising, alcohol drinking, excessive doses of diabetes medications.

In order to prevent or manage hypoglycemia, doctors recommend that people with diabetes take the correct doses of medicines at the correct times, because some medicines are known to cause hypoglycemia. People should also eat regular meals daily, exercise, and always eat during or before drinking an alcoholic beverage. Because the effects of hypoglycemia can be sudden and unexpected, doctors recommend that you keep quick-sugar foods near you at all times. Some of these foods include candy, honey, regular soda or fruit juice to help raise blood sugar levels at that moment.

Diabetic Neuropathy

Diabetic neuropathy is one of the most common conditions that affects people with diabetes. Learn about the four types of diabetic neuropathy, as well as its causes, symptoms, and treatment.

Diabetic neuropathy refers to the nerve damage caused by diabetes. While there are many contributing risk factors for neuropathy, such as inherited traits and injuries, high blood glucose levels are likely a main cause of this condition. Diabetic neuropathy is still being studied, but it is believed to be affected by low levels of insulin, unusual blood fat levels, and the long-term nature of diabetes.

There are four main classifications of diabetic neuropathy, and each one affects different parts of the body.

1. Peripheral neuropathy affects the legs, feet, and toes, and to a lesser extent, the arms and hands. Peripheral neuropathy causes pain or loss of feeling in the affected areas. Some people with diabetes experience burning or prickling sensations, become very sensitive to touch, or lose balance or coordination. Foot injuries must be given particular attention for people with peripheral neuropathy.

2. Autonomic neuropathy has many varied effects, especially on the heart and blood vessels, the digestive system, the urinary tract, sex organs, sweat glands, and the eyes. Autonomic neuropathy can affect blood pressure, sexual activity, and normal functioning of the bowel and bladder. This condition may also cause people with diabetes to be unable to recognize the symptoms of low blood sugar. Autonomic neuropathy may cause weight loss, a sustained high heart rate, and reduced night vision.

3. Proximal neuropathy affects the thighs, hips, and buttocks. Diabetics may experience pain and a weakening of the legs. Proximal neuropathy is more common in Type 2 diabetes and in older people who have diabetes.

4. Focal neuropathy generally affects the eyes, face, ears, pelvis, lower back, thighs, and abdomen, though any nerve in the body may experience focal neuropathy. This condition causes weakness or pain in muscles due to the weakening of the affected nerve(s). It is most common in older people who have diabetes, but does not cause long-term damage and is self-healing over time.

To prevent diabetic neuropathy, your best course of action is to keep your blood sugar levels under control to prevent nerve damage. In addition, diabetic neuropathy may be treated with many methods:

  • Proper foot care, including daily inspection for injuries.
  • Pain relievers, hypnosis, acupuncture, and other pain-relieving methods.
  • Medication for digestive problems.
  • Eating small, frequent meals that are lower in fat and fiber, or other diet modifications as specified by your doctor.
  • Wearing elastic stockings to improve circulation.
  • Antibiotics to clear up infections and to help regulate digestive problems.
  • Medications to increase sexual function.

Diabetic Retinopathy

Diabetes can have serious effects on your vision. It is the number one cause of legal blindness in the United States.i Both Type 1 and Type 2 diabetes can cause damage to your eyes.

Retinopathy – Diabetes is the leading cause of new blindness in 20-74 year old Americans.  Most cases are preventable.  About 40-45% of Americans with diabetes have some form of diabetic retinopathy, which simply means damage to the retina caused by diabetes. In this condition, blood vessels to the eyes are damaged, causing vision impairment or loss. Retinopathy can occur when the blood vessels that supply the retina with nourishment are blocked. The retina sends out signals to the body to grow new blood vessels to replace the blocked ones, which is called proliferative diabetic retinopathy. The blood vessels grow along the retina and the surface of the eye, and are quite fragile. They may leak blood into the eye, which can cause blurred vision or even blindness.

Macular Edema – Macular edema can be another form of diabetic retinopathy. When fluid leaks into the center of the eye, the macula, it can swell. This causes blurred or distorted central vision, since the macula helps us see straight ahead.

Cataracts – Cataracts are the clouding of the clear tissue at the front of the eye. People with diabetes have twice the risk of developing cataracts.ii

Glaucoma – Glaucoma is a condition in which fluid builds up in the eye, causing the pressure to increase. This high pressure can damage the optic nerve, causing headaches and loss of vision.

Preventing Damage

There are many things can you do to guard against the effects of diabetes on your eyes. The most important is to have an annual dilated eye examination. Many stages of eye damage, such as diabetic retinopathy, do not have symptoms, so this eye examination is crucial. An eye exam should test your visual acuity using a vision chart. Your eye doctor should also inspect your retina and optic nerve for damage, such as leaking blood vessels or any swelling (macular edema). People with proliferative diabetic retinopathy can reduce their risk of blindness by 95% if they receive treatment and proper follow-up care in a timely manner.iii

Monitoring your blood sugar is another good preventative measure in caring for your eyes. Both the rate and the progression of eye damage can be slowed when your blood glucose levels are under control. Quitting smoking and controlling your blood pressure are two additional health measures than can lower the risk of damage to your eyes.

i http://www.eyesod.com/articles/diabetes_reeves.htm
ii Vision Complications at dLife
iii http://www.nei.nih.gov/health/diabetic/retinopathy.asp#2c

Erectile Dysfunction

Erectile dysfunction, sometimes called "impotence," is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word "impotence" may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range from 15 million to 30 million, depending on the definition used. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. The increase happened gradually, presumably as treatments such as vacuum devices and injectable drugs became more widely available and discussing erectile function became accepted. Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS data on new drugs show an estimated 2.6 million mentions of Viagra at physician office visits in 1999, and one-third of those mentions occurred during visits for a diagnosis other than ED.

In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED. But it is not an inevitable part of aging.

ED is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED. Urologists, who specialize in problems of the urinary tract, have traditionally treated ED; however, urologists accounted for only 25 percent of Viagra mentions in 1999.

How does an erection occur?

The penis contains two chambers called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.

Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

What causes erectile dysfunction (ED)?

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases—such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease—account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.

Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of ED.

Also, surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

In addition, many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)—can produce ED as a side effect.

Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

How is ED diagnosed?

Patient History

Medical and sexual histories help define the degree and nature of ED. A medical history can disclose diseases that lead to ED, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm.

Using certain prescription or illegal drugs can suggest a chemical cause, since drug effects account for 25 percent of ED cases. Cutting back on or substituting certain medications can often alleviate the problem.

Physical Examination

A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touching, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems, which would mean that the endocrine system is involved. The examiner might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem—for example, a penis that bends or curves when erect could be the result of Peyronie's disease.

Laboratory Tests

Several laboratory tests can help diagnose ED. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of free testosterone in the blood can yield information about problems with the endocrine system and is indicated especially in patients with decreased sexual desire.

Other Tests

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.

Psychosocial Examination

A psychosocial examination, using an interview and a questionnaire, reveals psychological factors. A man's sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.

How is ED treated?

Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.

Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.

Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

Psychotherapy

Experts often treat psychologically based ED using techniques that decrease the anxiety associated with intercourse. The patient's partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated.

Drug Therapy

Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested for safety and effectiveness.

Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body's ability to use the drug. Levitra is also available in a 2.5 mg dose.

None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. Your doctor may need to adjust your ED prescription. Taking a PDE inhibitor and an alpha-blocker at the same time (within 4 hours) can cause a sudden drop in blood pressure.

Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs—including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone—are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances.

Vacuum Devices

Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body.

One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after erection is attained and during intercourse.

Surgery

Surgery usually has one of three goals:

  1. to implant a device that can cause the penis to become erect
  2. to reconstruct arteries to increase flow of blood to the penis
  3. to block off veins that allow blood to leak from the penile tissues

Implanted devices, known as prostheses, can restore erection in many men with ED. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of technological advances.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid. Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.

Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is almost never successful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure—intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection. However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.

Hope through Research

Advances in suppositories, injectable medications, implants, and vacuum devices have expanded the options for men seeking treatment for ED. These advances have also helped increase the number of men seeking treatment. Gene therapy for ED is now being tested in several centers and may offer a long-lasting therapeutic approach for ED.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsors programs aimed at understanding the causes of erectile dysfunction and finding treatments to reverse its effects. NIDDK's Division of Kidney, Urologic, and Hematologic Diseases supported the researchers who developed Viagra and continue to support basic research into the mechanisms of erection and the diseases that impair normal function at the cellular and molecular levels, including diabetes and high blood pressure.

Points to Remember

  • Erectile dysfunction (ED) is the repeated inability to get or keep an erection firm enough for sexual intercourse.
  • ED affects 15 to 30 million American men.
  • ED usually has a physical cause.
  • ED is treatable at all ages.
  • Treatments include psychotherapy, drug therapy, vacuum devices, and surgery.

Heart Disease

Did you know that according to the American Diabetes Association, around two-thirds of people with diabetes die from heart disease or stroke? That's why it's so important to lower the risk factors for these conditions as much as possible.

The American Heart Association recognizes that there are many factors we can’t control when it comes to the risk of heart disease: getting older, heredity and race, and even gender.i However, there are many things we can do to protect the health of our heart.

Quitting smoking is one of the most important measures people can take, since smokers have 2-4 times the risk than nonsmokers of developing heart disease. Adding physical activity not only keeps the heart in shape, but also benefits blood pressure, cholesterol, and blood sugar levels. Losing weight and excess body fat is another effective way to guard against heart disease and stroke. Excess abdominal fat is a particular risk factor for heart disease, so keeping the waist to 35" or under for women and 40" or under for men is widely recommended. Along with losing weight, lowering blood cholesterol levels and keeping blood sugar levels under control are important for preventing heart problems.

For people with diabetes, striking a balance between lowering blood sugar levels and controlling heart-risk factors (such as high blood pressure and cholesterol) may be more important than previously thought. A recent study of 10,000 people with Type 2 diabetes who also had a high risk of heart disease was sponsored in part by the National Heart, Lung, and Blood Institute. The scientists leading this study found that for these patients, lowering the blood sugar levels too much actually led to an increase in the death-rate.ii Reducing patients' blood sugar levels closer to normal raised their risk of death over patients whose blood sugar levels were slightly above what was previously considered to be optimal.

These results go against decades of research that recommends bringing blood sugar levels down to near-normal levels as much as possible. For now, the authors of study are unable to pinpoint why these results occurred, so further research is ongoing. Doctors still agree, however, that the overall effect of lowering blood sugar produces greater benefits than not. Speak with your doctor for more information on how diabetes, heart disease, and stroke are related, and for the best treatment options for you.

i http://www.americanheart.org/presenter.jhtml?identifier=4726
ii http://www.boston.com/news/health/articles/2008/02/11/diabetes_study_upends_another_long_held_belief/

Kidney Disease

People with diabetes have a high risk of developing kidney problems. In fact, diabetes is the number one cause of Chronic Kidney Disease (CKD) in the United States. Yet according to Dr. Joseph Coresh, MD, PhD, less than 10% of people with kidney disease are even aware that they have a problem.i

The kidneys are crucial for maintaining a healthy body. They filter both toxins and extra fluid from the bloodstream. In people with diabetes, excess sugar in the blood makes the filters in the kidneys, called nephrons, work harder than usual. Eventually, the nephrons and the blood vessels running through them become overworked. Consequently, the kidneys suffer damage. They work and less efficiently, leading to a build-up of toxins in the body.

Many of the symptoms of kidney disease are easy to miss, as they could be caused by any number of reasons. Some of the symptoms include:ii changes in urination (burning sensation, difficulty in urinating, blood in the urine); fluid retention, causing swelling of the legs, ankles, feet, face, or hands; fatigue; skin rashes or itching; nausea or vomiting (also leading to weight loss); shortness of breath; coldness; dizziness or memory problems; and pain in the legs, back, or side. High blood pressure can also be an indicator of kidney disease, since even mild hypertension can impair the healthy functioning of the kidneys.iii

A reliable way to diagnose kidney problems is with a GFR test. The GFR, or glomerular filtration rate, is a measure of how well your kidneys are working. The GFR test tells how much creatinine is in your blood. Creatinine, which is formed when the muscles work, is a waste product that can accumulate over time. When the kidneys aren’t functioning properly, the creatinine levels rise. The GFR test gives a numerical “grade” that tells whether your kidneys are working optimally or not.

There are some important steps that people with diabetes can take to prevent or slow the progress of kidney disease. First and foremost is controlling your blood sugar. Keeping hypertension in check is important, too. Some high blood pressure medicines can even help to protect the kidneys. Finally, avoiding certain medications that are toxic to the kidneys is a good idea. These medications include some pain killers, such as those which combine aspirin, acetaminophen, and caffeine. Ask your doctor about the effects of pain killers such as aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs.iv

i http://www.sciencedaily.com/releases/2007/11/071106164813.htm
ii http://www.lifeoptions.org/kidneyinfo/ckdinfo.php?page=4
iii http://www.netwellness.org/healthtopics/kidney/kidneysigns.cfm#g
iv http://www.kidney.org/ATOZ/atozItem.cfm?id=23

Men & Diabetes

We had the privilege of talking with Dr. Richard Bergenstal, the Vice President of Medicine & Science of the American Diabetes Association (ADA; www.diabetes.org). Dr. Bergenstal has dedicated 30 years of his career to making life better for people with diabetes.

The ADA surveyed 1,000 men with type 2 diabetes, age 40-60, as well as 1,000 female spouses of men who have type 2 diabetes. The survey assessed their general knowledge of type 2 diabetes and associated complications.

The ADA's "National Men's Health Education Survey" revealed:

  • Only 30% men seemed to know "a lot" about their disease.
  • 60% of men surveyed felt more information could help them better manage their diabetes.
  • Men with type 2 diabetes were likely to get less enjoyment out of their lives and that diabetes has negatively impacted their sex lives.
  • More than ⅓ of men surveyed experienced four or more symptoms associated with low testosterone. Some symptoms of low testosterone include: depressed mood, erectile dysfunction and fatigue.

According to the ADA there are 12 milllon men in the U.S. who have diabetes. In addition to common complications from diabetes, diabetes complications can also specifically affect men in the following ways according to the ADA:

  • Men with diabetes are at greater risk for erectile dysfunction caused by nerve damage.
  • Testosterone deficiency is common in men with diabetes, regardless of the type.
  • Men with type 2 diabetes are twice as likely to have low testosterone. Symptoms of low testosterone can include: diminished interest in sex, erectile dysfunction (ED), reduced lean body mass, decreased bone mineral density and depressed mood and fatigue.

The ADA is recommending men be more proactive in managing their diabetes including: “monitoring the ABCs of diabetes which include A1c (a measure of blood glucose), blood pressure and cholesterol.”

In our interview, Dr. Bergenstal emphasized that men with diabetes need to be aware of the physical aspects of disease, but they also need to be aware of the emotional and sexual issues stemming from diabetes.

Listen to Dr. Richard Bergenstal’s interview for his viewpoint regarding how men with diabetes can be proactive in managing their diabetes to improve their overall health and quality of life.

The ADA has information on its website dedicated to men’s health issues. For more information and to download a free copy of the ADA’s booklet "Modern Man's Guide to Living Well With Diabetes," please visit www.diabetes.org/menshealth.