After spending the past year as a student in hospitals and clinics I have seen a lot of patients. While in medical school we learned about a lot of different diseases but when working with patients I have seen re-occurring themes. There are a few diseases that come up day after day after day…. High blood pressure, high cholesterol, and diabetes. These three diseases are present in an astonishing number of patients I see every single day. The vast majority of these diabetics are type 2 but stripping away the contributing causes we still have similar outcomes; hyperglycemia leading to damage within multiple organ systems.
Another reoccurring theme is poor control. Now for the most part those with good control are not seen as often and do not typically need to be hospitalized. There are too many people today who do not meet the goals for therapy with blood pressure, cholesterol, or diabetes management. These together can contribute to major health issues like stroke and heart attack. Poorly managed diabetes can lead to neuropathy presenting as numbness, tingling, and possibly pain in your fingers, toes, and feet. These changes are often not reversible and can lead to terrible outcomes including sores, ulcers, bone infections, and amputation. I have seen many patients missing toes, feet, and legs because of both poorly controlled diabetes and peripheral vascular disease related to increased cholesterol. These patients can have significant changes to their daily lives following these surgeries.
I have seen people with poor vision because of damage to their eyes directly related to diabetes. The National Eye Institute has a great website explaining eye problems associated with diabetes, symptoms, and common treatment options. If you don’t mind poor vision or eventual blindness from poorly controlled diabetes then don’t worry about it. For those wondering, two possible treatments include lasers burning small spots on the retina and injections directly into your eye itself. If you, like me, don’t want to risk vision loss and these pleasant treatment options then good glycemic control and regular visits to an eye doctor are both good ideas.
The American Diabetes Association recommends keeping an A1c of less than 7% which correlates to an average blood sugar (eAG) of 154 mg/dL. I have always wondered about life expectancy having diabetes if you take care of yourself. In my experience so far I have met a man above the age of 80 who had kidney function better than mine, had no issues with neuropathy, and no vision problems. His A1c was always below 7% and he was well managed on a pump. Conversely, I recently saw a patient in her early 40’s admitted with hyperglycemia who had significantly reduced kidney function and diminished vision with an A1c of 23.3%!!! This is an astronomically high value and according to this handy ADA A1c/eAG calculator her eAG was 622 mg/dL!
At the end of the day diabetes is similar to other diseases and life choices. It’s the thing we hate hearing when you ask how to prevent obesity, high blood pressure, high cholesterol, and many other diseases. ” In order to avoid poor health outcomes we have to take care of ourselves. This is clearly easier to talk about than to execute but the effects of ignoring your health can be catastrophic. It won’t hurt today. It may not hurt tomorrow, but eventually these choices catch up to us.
Public Service Announcement: TAKE CARE OF YOURSELF!!
The concept is simple but not easy. Going through the daily grind that every diabetic goes through can be difficult at times and there are many days I would rather ignore everything and do what I feel like. I know this would ultimately catch up to me and there are too many positive things I want to live for. You too have things to live for and to be healthy for. For those having a tough time compiling a list, ask a friend or loved one for help. You may feel alone but ask for help. This site is designed to help connect diabetic patients in similar situations and experiencing similar concerns so USE IT to say something. We can all learn from and support each other.