What causes complications?

[NatJS]

What actually causes diabetic complications (foot problems, retinopathy etc)?

I had been under the impression that uncontrolled high blood sugar was the cause but have just read an article in the Guardian about a young man (early 30s) who recently lost his big toe due to an ulcer, despite having well controlled blood sugar. And in the comments beneath the article someone posted saying that they'd lost one and a half legs at 39 despite also having well controlled sugars. And thinking about it, an older friend/colleague recently lost half his foot despite apparently tight control for many years. It makes you wonder - if they all had good control, why did they suffer from complications? Is it something else besides high blood sugar?

 

[Pinkorchid]

Well I think there is more to complications than just having good blood sugar levels. Maybe some people are more predisposed to them however good their control is. Some believe doing the LCHF...low carb high fat.. diet will stop them getting complications but it has never yet been medically proved that it will so only time will tell. All we can do is try to keep our diabetes as well controlled as we can and hope we will not have complications

 

[GrantGam]

There are other factors as well that can accelerate complications in diabetics. Blood pressure is one example, smoking, drinking excessively, etc.

And it also depends on how good the control is. No diabetic is really exempt from BG spikes (such as post prandial ones) and I'd imagine that frequent recurring spikes could play a part too.

 

[Bluetit1802]

How long they were uncontrolled before doing something about it may be an issue, and these people in the article who say they are well controlled - how well controlled are they? It might have been more useful if their levels were disclosed. Frequent post meal spikes cause damage yet they can still have good HbA1cs.

I agree that other factors play a part. High blood pressure especially

 

[dancer]

I once had a discussion about complications with my DSN. She said that it's complicated and they don't fully understand it all. Some people with dreadful control don't get any complications, while others with fantastic control do. The one thing that they are positive about is, the better your control (along with good BP), the less likely you are to suffer from complications.

 

[Art Of Flowers]

About 3/4 of people who have diabetic amputations are men. This is probably because they don't look after themselves as well as women and have a reluctance to seek treatment when they have a problem. There was a story in the news about a man who had his foot amputated after getting a ulcer on his toe which refused to heal. See http://www.cornwalllive.com/st-aust...rife-holiday/story-30314766-detail/story.html. In this case he had worn a new pair of sandals on holiday in Tenerife and picked up an infection on his foot. Any foot ulcer needs urgent medical treatment, otherwise you can lose a foot or leg.

About 10% of people with diabetes are likely to get a foot ulcer at some time. Poor circulation and nerve damage are the reasons why they don't heal. Nerve damage could be caused by many years of high blood sugar. Getting blood sugars under control will help, but you could still have a residual problem from high blood sugars in the past. There is a whole section on foot health on this site ... See http://www.diabetes.co.uk/diabetes-complications/diabetic-foot-ulcers.html

Wearing well fitting shoes is essential, plus good socks. Personally I use Clarks shoes with thick socks made by Bridgedale or Rohan.

 

[noblehead]

What actually causes diabetic complications (foot problems, retinopathy etc)?

The main cause is uncontrolled diabetes, but having good bg control doesn't mean to say you won't develop complications it just reduces the chance of it happening.

But as @Pinkorchid alluded to earlier, some people are sadly predisposed to have complications (possibly through heredity factors) which you can't do much about. The following article makes for interesting reading, it's a study in the USA carried out by the Joslin Institute looking at why some long-term type 1's develop complications whilst others don't:

http://www.joslin.org/medalist/6268.html

 

[JohnEGreen]

I had complications when diagnosed I still have them now even though technically in remission, it seems to me once the damage is done it is often sadly not reversible but maybe good control may stop it getting worse.

 

[Resurgam]

Since being diagnosed and going back to low carb eating my feet have shrunk so I had to throw out footwear from the recent past and dig out older things. My feet were swollen, but now look quite skinny!!
The hot baths just before bed have further reduced the width of my feet, as the warmth helps keep up the circulation even when the DH pinches the duvet - I have now started to use a separate cover for my feet. My lower legs now look thinner and a better colour - I think that quite small changes can improve circulation below the knees and so assist in keeping the feet and toes attached and healthy.

 

[Freema]

hmm sometimes it is also genetical, or if one has had very high stress levels for years and years, stress also raises blood glucose in people without diabetes. Night shift work is also a stress factor..

My mother a retired nurse has got neuropathy and sufferts a lot, but she hasn´t got diabetes yet..

But thats said the levels of blood glucose in average and the high spikings in particulary seem to be a main cause in adding conditions in diabetes, so I think we all should go after getting as low blood glucose as possible till around the normal levels between 4-6mmol in between meals.. Not all can achieve that but we can do our best at least combined with adequate medication if that is needed.

http://www.phlaunt.com/diabetes/14045678.php

 

[Daibell]

Hi. I can only guess that their problems had little to do with their diabetes? My understanding is that complications result from sticky blood blocking capillaries. I also wonder what they meant by 'well-controleld' blood sugar as some

 

[Squire Fulwood]

The complications of diabetes and smoking are similar. Smoking causes your red blood cells to deliver carbon monoxide to your cells which they can't use. Diabetes makes the blood sugar level high and changes the viscosity so blood might not go to the important places like anywhere that has capillary arteries delivering the blood. Nerves and eyes are affected and extremities since this is a circulation issue.

It would be interesting to know if any of the cases quoted also smoked.

 

[covknit]

Since being diagnosed and going back to low carb eating my feet have shrunk so I had to throw out footwear from the recent past and dig out older things. My feet were swollen, but now look quite skinny!!
The hot baths just before bed have further reduced the width of my feet, as the warmth helps keep up the circulation even when the DH pinches the duvet - I have now started to use a separate cover for my feet. My lower legs now look thinner and a better colour - I think that quite small changes can improve circulation below the knees and so assist in keeping the feet and toes attached and healthy.

Try using 2 single quilts rather than one double/kingsize. Hubby can have a whole quilt to himself then. We use another quilt at the foot of the bed to keep tootsies warm and for the comfort of kitty. We use Ikea bedding as it seems more generous in its sizing.

 

[DaftThoughts]

I once had a discussion about complications with my DSN. She said that it's complicated and they don't fully understand it all. Some people with dreadful control don't get any complications, while others with fantastic control do. The one thing that they are positive about is, the better your control (along with good BP), the less likely you are to suffer from complications.

A lady I know, in her early 50's and diagnosed at 25, never really seems to dip below 25mmol/L on average - she's been like this for years. On most days her bloodsugar readings are HI. She somehow managed to live like this and still does, refusing to take the insulin she needs in the right way. (She takes 'just enough' not to go into full DKA I'm guessing.)

How she's still walking and hasn't had organ failure yet is beyond me, but some people just get lucky.

I think like with everything in life, sometimes **** just happens. As diabetics we are always at higher risk for complications by default, regardless of whether we're well controlled or not, because diabetes affects how our body responds to situations like injuries, stress and so forth. Being well controlled minimizes the risks dramatically, but it doesn't take them away. Our bodies just don't fully function like they should, and if you have anything happening on the side that affects your overall health it bumps your risks up again.

Being well controlled is the same as wearing your seat belt and driving safely. You're not as likely to get into a fatal car accident, and more likely to survive one because you took precautions, but it can still happen due to unexpected circumstances, either from in- or outside the car.

 

[Pinkorchid]

I have noticed on here from time to time that some people have said... mostly to newbies just joining...that they do LCHF because they do not want to get complications. I think saying that it gives the newbies the wrong idea that if they follow the LCHF diet they will never get complications. That is not so because all we know is we can try to lower the risk of complications by keeping our BG levels good with whatever diet works for us but none of us know if we will get complications.

 

[zand]

Regarding the newspaper articles, I wonder what the definition of 'well controlled blood sugars' is? Many of us here aim for control better than that which the NHS calls 'good control'. Also simply getting an HbA1c that is 'good' doesn't mean that the BGs are always well controlled as it's simply a (kind of) average, so there can still be high spikes within the period of the HbA1c that aren't picked up.

 

[Pinkorchid]

I imagine if the article said the people were well controlled then they were. I don't think it said the people mentioned had ever been uncontrolled. It is not just people on this forum who have well controlled diabetes The OP said he knows someone with tight controlled diabetes who had an amputation.

 

[Avocado Sevenfold]

The complications of diabetes and smoking are similar. Smoking causes your red blood cells to deliver carbon monoxide to your cells which they can't use. Diabetes makes the blood sugar level high and changes the viscosity so blood might not go to the important places like anywhere that has capillary arteries delivering the blood. Nerves and eyes are affected and extremities since this is a circulation issue.

It would be interesting to know if any of the cases quoted also smoked.

The very first question my GP asked me when I was diagnosed T2 was, "Do you smoke?" My late uncle did not have diabetes but was a smoker. He cut his foot and, due to poor circulation and putting off going to the doctor, ended up losing both his feet to gangrene.

 

[JohnEGreen]

My wife's cousin T1 since infancy amputated his own big toe With a lawnmower.

 

[KitSileya]

I also question what "good control" means. Someone close to me with T2 had a check-up recently, and got praise for a 7,4% HbA1c. When I reacted by asking "And will the next goal be to get it under 6%?" they got all huffy and said that their doctor was fine as long as it was under 7.5% No wonder people get complications!