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Complications Associated with Diabetes

Program: Taking Care of Diabetes and Avoiding Complications
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Andrew Schorr:

Right, right, I think about that too every time I go to the gym. So doctor, we talked about the heart issues, but you mentioned, I know there are issues about kidney failure for instance and many people who unfortunately find themselves on dialysis or in line for a kidney transplant, diabetes and high blood pressure were an issue, so kidney complications would be one fear, and then also there are foot problems, circulatory problems. Maybe help us understand what are the things we never want to get to.

Dr. Choudhury:

Diabetes causes many complications. It can cause circulatory problems everywhere in the body. So basically hardening and blockage of the circulation and degeneration of the circulation. This may occur in the eyes, that’s called retinopathy, and leads to blindness. In the kidneys it can lead to kidney failure and the need for dialysis, and actually now the major cause for kidney failure and dialysis is diabetes in this country. So diabetes is basically the main cause for kidney failure in most people in this country now.

In the heart it can cause heart attacks and complications from frequent heart attacks, which is heart failure. In the rest of the body circulatory complications would include stroke, one can have stroke from diabetes eventually, circulatory blockage in the feet which can cause infections…

Andrew Schorr:

Foot sores and even lead to amputations, right?

Dr. Choudhury:

…and eventually lead to amputations. It can also cause problems with the nerves, what we call neuropathy, and a lot of complicated diabetics who have not taken care of themselves will eventually develop neuropathy, which is degeneration of the nerves that can affect the feet or elsewhere also.

Andrew Schorr:

All right, I got the picture. I think we’ve scared people enough. All right let’s give them some solutions. So first of all Rick, you started working with Dr. Choudhury, and she changed your medications right?

Rick:

Yes.

Andrew Schorr:

And that’s helped as well.

Rick:

That was a real big help in everything, and she expressed an interest in my total health and everything, and the entire UW system has done that. I’m not one to really want to go to the doctor, but I’ve really been impressed with Dr. Choudhury and the UW system. They really care about you, and they keep working with you to make sure you get the right solutions.

Andrew Schorr:

Dr. Choudhury, so let’s talk about that. Someone’s on a journey with diabetes hopefully to get it under control and much less a factor in their life, and part of that may be medications or even changes, so it seems like active monitoring, regular visits with your doctor, discussions about is your treatment plan and lifestyle plan optimized; that’s a very ongoing discussion isn’t it?

Dr. Choudhury:

Yes. Definitely close monitoring is very important because the only way you can assess how you’re doing with your diabetes is monitoring your blood glucose, getting in to see the doctor frequently to check your cholesterol, to check your blood pressure, to get an eye exam, to check your feet and make sure you’re not developing any complications, a urine test to check if you’re having any kind of very early signs of kidney problems. So it’s very important to monitor yourself while you’re working on diabetes control.

Andrew Schorr:

And review of medicines?

Dr. Choudhury:

We always start, I’m talking about type 2 diabetes. We do give people a chance to do lifestyle modifications; diet restrictions and exercise. We usually recommend that someone who is diagnosed with diabetes should see a dietician to get good instructions on how to eat healthy from the diabetes standpoint and develop some kind of a plan for some consistent exercise.

Like I keep stressing, it’s just modest exercise is all that one needs. Approximately, some studies have shown, about 20 minutes to 30 minutes 4-5 days a week will decrease, will improve your diabetes, will decrease your chance for progressing to diabetes by almost 50%, so some modest change in lifestyle with the diet and exercise and then if that doesn’t work starting medications.

So there are several classes of pills that we use. We add these pills step-wise. There are some medications called metformin and a new one called Januvia that does not cause any weight gain. They do help with insulin resistance. So these are the pills that we will usually start patients off with, and a lot of patients will do well with just these pills, but unfortunately there are some patients who will not do well with one of two types of pills, and then we have to add a third pill occasionally. Of course the last step in type 2 diabetics is if they are not being controlled on one or two pills as well as they have not really made any lifestyle modifications eventually the bottom line is controlling that glucose, and sometimes type 2 diabetics may eventually progress on to requiring insulin.

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