NMA physicians discuss how diabetes impacts the human anatomy

What is Diabetes?

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

Complications of Diabetes

The complications that often develop with a diabetic occur when the patient has consistently been unable to manage to their glucose levels.To learn more about healthy glucose levels click here

These complications if untreated can lead to other health concerns that make the patients life uncomfortable or can lead to death.  Common complications include:¹

• Heart Disease and Stroke – Both cause 65% of all deaths in people with diabetes.
• High Blood Pressure – About 73% of people with diabetes have high blood pressure.130/80.
• Eye Disease – Diabetes is leading cause of new causes of blindness in adults 20-74 years of age.
• Kidney Disease – Diabetes is leading cause, contributing to 44% of new cases occurring in 2005.
• Dental Disease – Almost one-third of people with diabetes have sever periodontal disease.
• Nerve Disease – About 60% to 70% of people with diabetes have mild to sever nerve damage.
• Amputations – Over 60% to 70% of people with diabetes have mild to sever nerve damage.

1.  General diabetes statistics are from the American Diabetes Association website, accessed on January 15, 2009.  http://diabetes.org. 

The National Medical Association (NMA) Diabetes Education Program asked NMA specialist to explain some of the complications the diabetic patient may encounter.

A person with diabetes begins to develop complications as their body is unable to manage insulin levels.  These complications if untreated can lead to health complications, difficulties and/or death.  The National Medical Association (NMA) Diabetes Education Program asked NMA specialist to explain some of the complications the diabetic patients may encounter.

Neurological Complications
Hypertension as it relates to Diabetes
Diabetic Depression
Erectile Dysfunction
Eye Disease

Neurological Complications

Name: Carolyn Barley Britton, M.D. M.S
Specialty:  Neurology
NMA position/office:  NMA - President

Diabetes mellitus can affect the normal function of brain and nerves.  Neurologic complications in diabetes include coma, stroke, seizures and neuropathy. 

Elevated blood sugar during a stroke lessens the chance for complete recovery and increases the chance for stroke-associated death.

Nerve damage or neuropathy is the most common neurologic complication of diabetes, and occurs in up to half of diabetics.  This problem may be missed by the diabetic and by the doctor.  There are several types of neuropathy:  peripheral neuropathy, focal (mononeuropathy or a single nerve) and generalized symmetric- sensory, sensori-motor or motor; and autonomic neuropathy.  When diabetes affects a single nerve (mononeuropathy), the diabetic may have double vision (6th cranial nerve), hand pain and numbness (carpal tunnel syndrome) or leg weakness (femoral nerve).  When diabetes affects multiple nerves (generalized), symptoms include tingling, burning, electric shock like sensations and pain in the feet, worse at night.  Some patients also complain of numbness or feeling as if they are wearing socks or tight bands while others have no symptoms.  The examination shows loss of pinprick, temperature, position sense and vibratory sensation in the legs.  Ankle reflexes are often absent.

Autonomic neuropathy is common in diabetics and is related to bladder symptoms of urgency and incontinence, bowel symptoms of constipation, impotence and dizziness due to low blood pressure or hypotension when standing.  Diabetics with autonomic involvement are at risk for sudden death or heart attack. 

Nerve damage predisposes the diabetic to limb injury and sometimes amputation because of delayed recognition of injury and infection.  Joint damage also occurs when there is nerve damage.

Although commonplace and often serious, neurologic complications of diabetes may be prevented or improved by strict control of blood glucose.  All diabetics should be screened for nerve damage by focused history and regular examination that includes testing for sensation and reflexes.

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Hypertension as it relates to Diabetes

Name:  Sandra Gadson, M.D.
Specialty: Nephrology
NMA position/office:  Past President

Hypertension or as it is commonly referred to is high blood pressure.  It is an aggressive disease that is multiplied with intensity in the face of Diabetes Mellitus.

The combination of diabetes, hypertension and proteinuria (high amounts of protein in the urine) is defined as Diabetic Nephropathy, a complication of diabetes where the kidney loses its ability to function properly. ¹

Diabetics with protein acceleration of greater than 3 grams per day defines nephritic syndrome.  Diabetes, hypertension and proteinuria can progress to chronic renal failure and end stage renal disease rather rapidly. There is a high incidence of hypertension as well as Diabetes Mellitus in the African American Community. ²

There are many complications that occur with hypertension such as stroke, heart disease, and vascular disease. Diagnosis and treatment can help to prevent many of these complications.  Hypertension in the face of diabetes is also treatable, but there are two things to control: blood sugar and blood glucose.

The proteinuria that occurs with diabetic nephropathy can be controlled or decreased with a special group of blood pressure medicines called Angiotensin-Converting Enzyme Inhibitors (ACE).  These blood pressure medicines reduce the protein which helps to preserve the kidney function. 

It is important to monitor your blood pressure and glucose levels.  HBA1c levels are used to evaluate glucose levels over three months.  A level less than 7 indicates good control.  Taking care of blood pressure and diabetes can help to prevent the complication of End Stage Renal Disease (ESRD) – chronic kidney failure.

There is a high incidence of ESRD in the African American community. 2
The most common reasons for this are hypertension and diabetes mellitus.  Dialysis is a treatment that cleanses the blood of waste and toxins.  People on dialysis can live quality lives but there are restrictions on diet and fluid, and it is a treatment done on a regular basis.

Hypertension and diabetes mellitus are treatable, with good control many of the known complications can be avoidable and you can live a healthy productive life.

1. Retrieved from Health Line’s web site, September 12, 2007, at http://www.healthline.com/channel/diabetes.html
2. Retrieved from United States Renal Data System’s web site, September 12, 2007 at http://www.usrds.org/2007/ref/B_prevalence_07.pdf

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Diabetic Depression

Name:  Rahn Bailey, M.D
Specialty:  Psychiatry
NMA position/office:  Vice Speaker, House of Delegates

Co-morbidities have become very important in clinical medicine as we grow in our understanding of the impact of each disease on the whole system. African Americans have been shown for some time to consistently suffer from more episodes of obesity, hypertension and diabetes. These illnesses compounded with higher rates of chemical dependency, place patients at more risk of poor physical health and general disease. All of these concerns increase the likelihood of limited clinical functional outcomes both medically and psychiatrically. 

Depressed patients tend to eat more and exercise less, which results in weight gain further hindering efforts to control blood sugar levels.  It is noted that 13.3% of all African Americans aged 20 years or older have diabetes and they are 1.8 times more likely to have diabetes than other ethic groups.⁴ Results have shown that depression as a major factor can increase the symptoms of diabetes and decrease overall functional well-being.¹

African Americans have a higher rate of major depression and co-morbid substance abuse.^2,3 Higher such rates can alter the initial clinical response to psychotropic medication in the treatment of depression, as well as prolong the course of treatment. In general, these type co-morbidities have the potential of preventing effective chances at remission.² Further, any therapy which may worsen hypertension or obesity should be carefully assessed before beginning treatment in this patient population, for African Americans present initially with increased risk of heightened morbidity in these areas.⁵

Depression and diabetes require careful management of both diseases.  Failure to manage the diseases will severely impact the quality of life.⁶

References

1. Eaton WW, et al. Diabetes Care 1996;19(10):1097-1102
2. Fabrega H Jr, et al. Compr Psychiatry 1988;29:285-297
3. Grant BF, et al. Drug Alcohol Depend 1995;39:197-206, retrieved from American Diabetes Association http://www.diabetes.org/communityprograms-and-localevents/africanamerican/facts.jsp May 22, 2007.
4. Cooper RS, et al. The Puzzle of Hypertension in African-Americans. Scientific American Magazine. February 1999.
5. Retrieved from the American Obesity Society http://www.obesity.org/subs/fastfacts/Obesity_Minority_Pop.shtml May 22, 2007.
6. Goldney R, et al. Diabetes Care 2004;27:1066-1070

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Erectile Dysfunction

Name:  Brian A. Stone MD, FACS
Specialty:  Urology
NMA position/office:  Chair, Urology

Diabetes often co-exits in the presence of hypertension, dyslipidemia, obesity, nicotine abuse and chronic physical inactivity (sedentary lifestyle).  All of these conditions are risk factors for erectile dysfunction (ED) and cardiovascular disease. 

Approximately 10 years after the diagnosis of diabetes, 50% of diabetic males develop ED.  It tends to be more severe and resistant to medical treatments, than in non-diabetic males.  Diabetes results in significant damage to the tissues of the penis which are responsible for erections; resulting in biochemical, functional and structural abnormalities.  In medical terms this can be summarized as “endothelial dysfunction” and in lay terms it can be called “diabetic vascular disease”. 

Diabetes damages the blood vessels that carry blood to the penis for the erection and the veins which must retain the blood to maintain the erection.  The progressive nature of diabetes results in vascular damage that impairs a man’s response to the medical treatments for ED including the oral agents (Viagra, Cialis and Levitra), the urethral suppository (MUSE) and penile injections (Caverject, Edex and Trimix).  All of these “blood flow enhancers” are rendered ineffective by the progressive injury to blood vessels of the penis by impaired blood sugar regulation in poorly controlled diabetics.  This is further complicated by the peripheral neuropathy (nerve damage) that accompanies chronic diabetes.  The lack of response to medical therapies has made the inflatable penile pump the “back bone” of treatment of ED in diabetic males, achieving a >90% patient and partner satisfaction rate.

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Eye Disease

Name:  Deidre Holloway
Specialty:  Ophthalmology
NMA position/office:  Chairperson, Region IV

There are several complications of diabetes that can affect the eye.  These include diabetic retinopathy, cataract and glaucoma.

Diabetic Retinopathy is the most common of the diabetic eye diseases and is the leading cause of blindness in the United States.  It occurs when there is damage to the blood vessels of the retina of the eye.  Usually there are no symptoms such as pain or blurred vision early in the disease.  However, in the more advanced phases, loss of vision can occur due to leaking fluid from the damaged vessels or bleeding from abnormal blood vessels that grow on the back of the eye.

Almost half of all people with diabetes will develop some form of retinopathy during their lives. The development of retinopathy is influenced by the duration and severity of diabetes, the control of the blood sugar and other factors such as hypertension and smoking which increase the probability of its occurrence.  Research has shown, that better control of the blood sugar can slow onset and progression of this eye disease.

The good news is that retinopathy can be detected early and the severe complications that might occur later can often be prevented by treatment Laser treatment is used by the eye care professional to treat this disease by concentrating focused light energy on the back of the eye.  Since there are generally no early warning signs of diabetic retinopathy, the best defense is an annual dilated eye exam by an eye professional.

Cataract is the clouding of the natural lens in the eye. Cataracts cause blurred vision, glare and loss of contrast that can affect reading, driving and other daily activities.  People with diabetes are twice as likely to form cataracts as non-diabetics and their cataracts can occur earlier in life.  When they become bothersome to the vision, cataracts are removed by an out-patient surgical procedure.

Glaucoma is twice as likely to occur in diabetics as in other adults.  This is a disease in which the major nerve to the eye – the optic nerve – is damaged by factors such as elevated pressure within the eye.  Glaucoma can be treated by medications, laser
treatment or other forms of surgery. 

Finding the causes and better treatment for diabetic retinopathy and the other eye complications is one of the leading areas of eye research presently.  Regular eye exams to detect and treat the diabetic complications are the best defenses for preventing visual loss

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