Diabetes and Complications

Gretchen Becker Health Guide
  • Diabetes is the leading cause of blindness, kidney failure, and lower-limb amputation. We all know that's true, right?


    Except it's not.


    William Polansky, author of Diabetes Burnout said at the Roche-sponsored bloggers' summit in San Diego last week that it's poorly controlled diabetes that causes all those side effects. Well-controlled diabetes causes nothing, he said.


    This attitude that "diabetics" are at risk of this and that with no clarification of exactly what you mean by "diabetics" really ticks me off, more and more as I get older and crotchetier.


    For example, people say "diabetics" are at increased risk of heart disease and thus should keep their LDL levels below 70, instead of below 130 as is recommended for the general public. In order to do this, many people have to take powerful statin drugs. The statin drugs have powerful side effects, including memory loss and irreversible muscle damage.

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    Now, if we're really at high risk of heart disease despite being well controlled, then perhaps the risks of statins are worth taking. And this is a real conundrum for people with type 2 diabetes, because most of us had high blood glucose levels for 10 or 15 years before we were diagnosed. This means we had poorly controlled diabetes for 10 and 15 years.


    Did this cause irreversible changes to our cardiovascular system? We really don't know. Maybe we are at greatly increased risk of heart disease, even if the probability of blindness, kidney failure, and amputation (all called microvascular complications) is low.


    But what if we're not?


    So many studies refer only to "diabetics." Older studies don't even distinguish between type 1 and type 2, much less the less-common varieties like LADA, MODY, and ketosis prone diabetes. Most studies use "typical" patients, meaning patients without good control, with high A1c's, often between 8 and 10.


    How do we know whether or not some study that had a patient population of overweight people over 65 with type 2 or a patient population of 30-something people with type 1 applies to us if we're 50, not overweight, using insulin, but with no diabetes autoantibodies, or if we're 75, with typical middle-aged waists, on oral meds only, and have normal cholesterol levels?


    The answer is, we don't.


    And we can't count on our overworked primary care physicians to make such subtle distinctions. They rarely have time to read the original literature. Instead they read short summaries in general medical magazines, or get synopses from drug reps, both of which make blanket statements about "diabetics." Even endocrinologists can't always keep up with the research. They're in short supply, so they have to spend most of their time seeing patients.


    The confusion, not knowing what's really best for us, causes stress, and stress tends to make us give up, throw our efforts at control out the window and just wait for the "inevitable" blindness or kidney failure or amputation we've been promised is in our future.


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    With that scenario, Polansky's words should bring a lot of comfort. It should also provide incentive not to give up, to keep plugging away to get the best control we can possibly have.


    One woman at the conference said that Polansky's words a long time ago changed her life. She was depressed and about to give up and let diabetes rule her life. When he explained that diabetes alone "causes nothing," her zest for life returned, and she's been in good control since then, with a positive attitude about life, which she tries to spread to other patients.


    We can do the same. First, we can take control of our own lives. Then we can spread the word to others. The camaraderie at the Roche meeting was extraordinary. We knew that despite our diversity, we are all in the same boat. We have diabetes. And we know it can be difficult sometimes. When that happens, any support we can get is useful.


    Support by those around us is important. There was a lot of hugging at the meeting. But when that isn't possible, we can get support online through outlets like HealthCentral and the various social media sites. Working together we can tame the beast.


Published On: June 28, 2011