Type 1 diabetes carries with it a much higher risk of developing some associated serious health problems. While in the past, getting diabetes-related health complications was almost a certainty, with modern blood glucose monitoring, control, and treatment, the risks have decreased significantly. Even a few decades ago, life expectancy for people with diabetes was regularly considered to be 10 years shorter than for people without the disorder. In 2012, however, a large-scale study found that life-expectancy was now only about 6 years less than average. For comparison, a lifetime of smoking will reduce life expectancy by 10 years.
So what are the diabetes complications that you need to be looking out for? Largely, they fall into either cardiovascular or neuropathic categories. To make diabetes complications even more complicated, they tend to affect people of different sexes and different ethnicities differently. One more wild card is that recent studies have found that some people with Type 1 diabetes actually never develop most of the complications associated with diabetes.
The good news is that with proper blood glucose control and a healthy lifestyle, the risks for developing Type 1 diabetes complications are drastically reduced. Some studies have actually found that careful monitoring and management can reduce the chances of developing any of these by as much as 50%. Still, everyone with Type 1 diabetes should keep a careful eye out for the five most common diabetes complications.
Diabetic Ketoacidosis (or DKA), is a condition caused by severe hyperglycemia (high blood sugar) which causes rapid fat breakdown in the body. As the fat breaks down, they release fatty acids which are then converted into chemicals called ketones, which are highly toxic in large doses. Symptoms of DKA can include hyperventilation, dehydration, nausea, and pneumonia-like symptoms. If the condition persists without treatment, it can lead to coma, cerebral adema (swelling of the brain), or even death. The more severe symptoms have grown much rarer over the last few years, with death occurring in only 2% of all cases, but it is still a very dangerous condition.
The risk for DKA is fairly low for people with diabetes who have a good handle on their blood glucose. Most often, the condition comes on during periods of stress or illness when normal diabetes control is difficult or impossible. Common causes for onset include urinary tract infections, pneumonia, physical injuries, and drug abuse. As a special note for teens with diabetes, clinicians have for a while now noted that there is a special cause of DKA among teenage girls who are body-conscious and choose to take less insulin than necessary to avoid gaining weight. This practice is incredibly unsafe, and we warn parents to look out for signs of it as much as possible.
Heart Disease and Stroke
If you have diabetes, you are at a much higher risk of having heart disease than someone without diabetes. Ten times higher, in fact, and heart attacks are the cause of about 60% of all deaths among people with diabetes. If you also add in strokes, you have three out of every four deaths among people with diabetes.
Type 1 diabetes lowers the amount of the good cholesterol, HDL, in your blood, and increases the amount of triglycerides – all things that lead to hardening of the arteries (atherosclerosis). Poor kidney functions also increase blood pressure, putting more strain on the heart. Finally, nerve damage can also cause the heart to react unpredictably.
Patients with Type 1 diabetes should be extra aware of their heart health, and take special measures to protect themselves. This should include routine screenings from your physician, a very heart-healthy diet, and plenty of exercise. As with other complications, the better you control your glucose, the less likely you are to suffer the worst effects.
Retinopathy and Blindness
The number one cause of new cases of blindness among adults aged 20-74 in developed countries is retinopathy brought about by diabetes. The heart and circulatory system problems mentioned above cause blood vessels in the eye to weaken and occasionally burst. When blood vessels grow back, they grow back abnormally (and potentially become closed off by micro blood clots). These abnormal vessels can get inside the retina and eyeball, and cause the retina to detach.
Maintaining a heart-healthy lifestyle can help to ameliorate the risks of eye damage and retinopathy. Additionally, anyone with diabetes should have a full eye exam done by an opthamologist (not simply the kind you get when getting new glasses). These eye exams should become annual to make sure any potential problems are caught early.
Diabetes, especially when it’s poorly controlled, can cause the kidneys to lose the ability to filter out protein, which then leaks into the urine and can cause complete kidney failure, or nephropathy. While modern medicine and treatment plans are greatly reducing the number of people with Type 1 diabetes who develop nephropathy, it is still one of the main problems faced by the diabetes community. Research estimates that 20-30% of all people with diabetes develop the condition.
Other than getting tested regularly and maintaining strong blood glucose control and a healthy diet, there is very little that can be done to prevent kidney failure. Once they do fail, the patient will likely require dialysis for the rest of their lives, and becomes 13 times more likely to die prematurely. This is why it is critical to check kidney functions often and stick to a physician-prescribed diet and treatment plan if early warning symptoms are detected.
Neuropathy is a disturbance or disorder of the nervous system that makes the nerves either cease to function or function in unpredictable and diminished ways. There are two primary types of neuropathy – Peripheral Neuropathy, which affects the extremities like feet, hands, toes, fingers, arms, and legs; and Autonomic Neuropathy, which affects the nerves that coordinate the “background” processes of the body like digestion, circulation, bladder control, and sexual function.
Neuropathy often starts off as tingling and loss of sensation in the fingers and toes, but can spread to encompass symptoms like lightheadedness, rapid breathing, incontinence, impotence, and heart problems. About half of all people with Type 1 diabetes will develop some level of peripheral neuropathy after 25 years with the disease.
Again, the best prevention is a tight control of blood glucose, and a heart-healthy diet. Quitting smoking is also especially helpful. Improving glucose control can often stop, delay, prevent, and in very rare cases undo some of the effects of diabetes-induced neuropathy.
While these complications may sound pretty serious (and they are, and should not be taken lightly), the good news is that all or most of them can be avoided through keeping your blood glucose in a safe range. With new treatments, devices (like the Timesulin timer, or the new bionic pancreas), and new ways of thinking about Type 1 diabetes, maintaining blood sugar control is easier than ever, and getting more manageable every day. When combined with a good diet, and plenty of exercise, there’s no reason why the risks for these complications can’t be reduced to no higher than someone without diabetes within the next couple of decades.
Good luck, and stay healthy!