Diabetic comorbidities – what are the risks involved in diabetes?

TOPIC OVERVIEW

Since blood vessels are damaged by a high blood sugar level, the nerves responsible for the tactile sense and the musculoskeletal system are no longer sufficiently supplied with oxygen and nutrients. Together with other metabolic processes caused by hyperglycemia (e.g. higher formation of so-called AGEs or ‘advanced glycation end products’, i.e. modified proteins and/or lipids) this leads to gradual nerve destruction. On the one hand, AGEs (the waste products of the metabolism) increase the formation of reactive oxygen species and interfere with antioxidative systems; on the other hand, the formation of AGEs keeps increasing under oxidative conditions, thereby setting a vicious circle in motion and starting diabetic neuropathy, one of the most common diabetic comorbidities. Almost every third diabetic patient is affected by it, suffering from the severe limitations that this condition causes in everyday life. The farther away the nerve endings are from the heart, the more they are at risk of an insufficient supply. Accordingly, generally this affects the delicate nerves in the legs first, which are responsible for conveying the feelings of pain and temperature. The body's autonomic nervous system can also be affected by the neuropathy. It is responsible for the autonomic control of organs and body functions and cannot be consciously influenced by the person.

Diabetic neuropathy can manifest itself in the most varied way, depending on what nerves are acutely affected. The loss of the tactile sense as well as of the feeling of pain and temperature can be the result. The extremities become numb, as the nerves can no longer send sensory stimuli. However, the malfunctions of the nerves can also trigger chronic pain or lead to paresthesia like tingling or formication in the limbs that can even lead to paralysis. If the vegetative or autonomic nervous system is affected, arrhythmia can occur and erectile problems or lack of bladder contraction can set in. Under some conditions, it is harder for the affected persons to perceive the symptoms of dangerous diabetic hypoglycemia owing to their malfunctioning nerves. For this reason, prevention is better than cure, and this is why preventive treatment is so important.

Triggered by diabetic neuropathy or in rare cases by peripheral arterial occlusive disease, a malfunction of the nerves can lead to the amputation of a foot in severe cases – something that happens in Germany about 50,000 times a year. Since the nerves in the leg start dying off, patients no longer feel injuries and pressure points. Wounds can easily get infected and heal very slowly due to poor circulation. Abscesses can form around the wounds and attack tissue and bones until the foot can no longer be saved. Prevention and regular checking of the feet are indispensable. Doing so even small injuries can be recognized early and dangerous inflammations are prevented.

Damage of the blood vessel walls leads over time to calcium deposits – and arteriosclerosis sets in. This process constricts blood flow owing to the narrower arteries. The result is that not enough oxygen can reach the places where it is urgently needed. In addition, blood clots can form on the calcium deposits. The risk of a heart attack or stroke caused by the thrombosis and detaching calcium deposits drastically increases. Patients with type 2 diabetes, in particular, are prone to have a stroke, as they are affected by the frequently accompanying lipid metabolism disorders and high blood pressure. However, patients with type 1 diabetes are also more susceptible than those who do not have the condition.

If narrowing of the blood vessels takes place in the leg arteries, the condition is known as peripheral arterial occlusive disease or PAOD. Initially, it manifests itself as a feeling of coldness and tingling, later as leg pain, especially when walking. Therefore, the affected persons must often stop to rest a bit. A In advanced stages this condition can lead to the complete necrosis of the blood vessels, which leads to the amputation of the affected leg or foot. Since initial symptoms set in only after an artery has reached 90% blockage, early prevention is essential to prevent late complications.

Damage to the blood vessel walls triggered by a permanently elevated blood sugar level also affects the delicate blood vessels (capillaries) of the kidneys. When the renal corpuscles gradually stop functioning, the body's detoxification accomplished by the important renal filtering function steadily worsens. About one out of ten diabetic patients are affected by kidney damage caused by diabetes. The damage can already be present in an early stage of diabetes and worsen for a long time without being noticed. Typical symptoms and poisoning signs such as a yellow discoloration of the eyes and skin appear in many patients only in a late clinical stadium. In the worst case scenario, kidney function can cease completely.Then the only remedy is dialysis or kidney transplantation. In the early stages of the disease a blood test can already indicate an existing condition and should therefore be performed regularly.

Once diabetes is diagnosed, diabetic comorbidities that might have set in should be tested. During the course of the disease, diabetes patients should be examined in regular intervals for nerve damage and circulatory disorders in order to recognize possible comorbidities early on, that they can be treated. The physician, after talking extensively to the patient to ask about the most common symptoms, will measure the blood pressure and reflexes. Nerve sensitivity is measured with the tuning fork test, in which a struck tuning fork is placed on the foot to check nerve sensitivity for perceiving vibrations.

There are some measures that diabetes patients can take to prevent the onset of various secondary diseases caused by diabetes (lowering the risk of getting them or their progression). In the first place, smoking and alcohol consumption should largely be avoided. Smoking affects blood vessels, additionally endangering the arteries already damaged by elevated blood sugar levels. The neurotoxin alcohol should be especially avoided if diabetic neuropathy is present. The liver (working to break down the alcohol after a drink has been consumed) cannot perform its task of regulating the blood sugar level during this time very well. This can lead to hypoglycemia.

A healthy and balanced diet, together with enough exercise and the avoidance of excess weight helps to remain free of complaints for longer, in spite of having diabetes. Apart from the blood sugar level, blood pressure and blood lipids should be well managed to protect the endangered blood vessels even more. When doing so, it should not be forgotten that taking certain diabetes medications can also damage blood vessels – the active ingredient metformin lowers vitamin B12 and folic acid levels. However, these vitamins are responsible for regulating the homocysteine metabolism. A higher homocysteine concentration can, in turn, damage blood vessel. Thus, it can indirectly happen that the medication unwillingly triggers the typical diabetic comorbidities. A blood check for these important B-vitamins is therefore indispensable when diabetes medications are permanently taken.

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