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Breaking down diabetes: How to prevent complications

This is the fifth in a series of blog posts, by Randall Stafford, MD, PhD discussing prediabetes and Type 2 diabetes.

Diabetes is a disease defined by its complications. High blood sugar contributes to many, but not all, of these potential consequences, so it's logical that medications to lower blood sugar are central to managing diabetes. But focusing on blood sugar alone does not get the job done.

Diabetes treatment is successful only when patients pursue a variety of strategies, which may require more help than your doctor can provide.

In the last post, we met Mrs. R. and learned of her Type 2 diabetes diagnosis at the age of 57. Let's check in on her:

Mrs. R. had already developed two serious complications of diabetes, heart disease and foot ulcers. Soon after learning about her diabetes, she began taking metformin, a very effective blood sugar lowering drug. Unfortunately, she didn't always take these medications on time and sometimes ended up with extra tablets at the end of the month. At the same time, she found it difficult to stay away from sweets and get in the daily walk that her doctor recommended. She says these troubles were worsened by the depression that followed the discovery of her diabetes.

Lowering blood sugar is a critical goal in diabetes because high blood sugar levels cause kidney disease, eye disease, nerve problems, and foot ulcers. While lifestyle changes can help, blood sugar lowering in diabetes usually requires medications, a topic we'll cover in the next post.

But there are other strategies that can help protect the body against damage from diabetes complications and supplement the benefits of lowering blood sugar, including:

Blood Pressure - Even in those without diabetes, high blood pressure raises the likelihood of heart attacks, kidney disease and strokes. But because diabetes itself increases the risk of each of these problems, it becomes especially important to control high blood sugar. Also, high blood pressure is more closely linked to heart attacks and strokes than high blood sugar. I recently wrote a series of blog posts on maintaining a healthy blood pressure.

Cholesterol - People with diabetes often have abnormal lipid levels, in particular they may have low good cholesterol (HDL) and high triglycerides (fat circulating in bloodstream). Statins, medications that lower bad cholesterol (LDL) and have an anti-inflammatory effect on blood vessels, can significantly reduce the risk of heart attacks and strokes.

Diet -  A healthy diet that reduces simple carbohydrates (sugars and starchy foods) can help lower blood sugar. Eating a diet that helps with weight loss can help keep diabetes from worsening.

Aspirin - By reducing the body's ability to form blood clots, aspirin can help prevent heart attacks and strokes. People with diabetes have a greater tendency to form clots, so aspirin offsets this problem.

Smoking - Both diabetes and tobacco products attack the lining of blood vessels creating a deadly synergy that leads to poor and disrupted circulation. Major amputations in diabetes (like losing an entire leg) rarely occur in non-smokers.

Physical activity - Physical activity may be even more important for people with diabetes. Even simple walking helps by increasing fitness, reversing damage to the lining of blood vessels and improving the body's ability to respond to insulin. Physical activity should include movement that increases heart rate (aerobic exercise) as well as some form of strength or core training.

Other strategies - Getting adequate sleep and finding ways to cope with stress are part of diabetes treatment. Problems with depression and anxiety are often overlooked, but can interfere with managing all the other parts of diabetes treatment.

Patients with diabetes play a vital role in managing their own disease. Even when a strategy involves taking drugs, keeping on track is critical because too many patients, like Mrs. R, miss multiple medication doses. In her case, her diabetes treatment didn't really click until she received training from a diabetes educator. With this advice, she stopped developing new complications because she could finally deal with the complexity of diabetes treatment without becoming overwhelmed. If you have diabetes, it is critical to ask your doctor for additional help if needed.

This is the fifth in a series of blog posts discussing prediabetes and Type 2 diabetes. The first installments examined what happens inside the body in prediabetes, how to stop prediabetes from progressing and how doctors and patients can reframe their approach to diabetes and the importance of complicationsThe next post will simplify the vast array of medications used to lower blood sugar in diabetes.

Randall Stafford, MD, PhD, a professor of medicine and director of the Program on Prevention Outcomes and Practices, practices primary care internal medicine at Stanford. He is developing practical strategies to improve how physicians and consumers approach chronic disease treatment and prevention.

Photo by Lars Plougmann

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