With the exception of gestational diabetes, all other types of diabetes can lead to long term health problems . It is therefore important you are in regular contact with your diabetes healthcare professional to ensure they are giving you your diabetes MOT. You should see your diabetes team at least once a year and in some instances it may be appropriate to increase the frequency of contact.
The complications which can develop will depend on the length and severity of the disease and also how well you manage your glucose levels. Generally speaking there are several key checks you are entitled to because these are the most common problems which can manifest.
You should be having your eyes checked regularly. This is because diabetes can lead to a condition known as retinopathy whereby the glucose in the blood can damage the eye. If left over time this can lead to damage to the eye and even a loss of sight. With regular check ups the appropriate steps can be taken to avoid any complications.
Diabetes can lead to a loss of or heightened sensation in the peripheries, particularly in the feet. This reason is two fold. First, glucose can damage the nerves leading to the feet and second circulation can be impaired. This can range from very painful feet from the slightest of touches, such as a bed sheet resting upon them, or a loss of sensation which may lead to injuries going unnoticed. If a cut for example is not noticed and becomes infected this can lead to more severe complications and in some cases, amputation.
This is particularly pertinent if you have reduced circulation to the feet as a result of high blood glucose levels. Usually when the body is injured, it is the circulation which provides the necessary tools to help repair the wound. When the body is suffering with impaired circulation, this processes is slowed, leading to injured sites becoming more prone to infection.
It is therefore very important you and your healthcare team are regularly checking your feet for cuts, rashes, fungal infections or anything out of the ordinary. It is also recommend not to walk around bare foot and ensure any foot wear fits well and does not rub.
High glucose levels over time can severely hinder the cardiovascular system and damage the blood vessels which transport blood. This can result in plaques forming and consequently a narrowing of the blood vessels. As the blood now has a smaller space to circulate the pressure builds. Once blood pressure becomes too high for too long, it can over work the heart and complications can occur. Furthermore, if one of those plaques completely cuts off the supply of blood to the heart or brain it can lead to a heart attack or stroke.
Therefore, having your blood pressure regularly checked can give us some indication as to how well your cardiovascular health is doing. Ideally someone with diabetes will keep their blood pressure below 130/80, although you may encounter some healthcare professionals who are satisfied with 140/80.
Tying in with blood pressure, too much bad cholesterol and triglyceride levels, which are fats in the body, can also lead to cardiovascular problems. Much in the way we discussed plaques forming in the blood vessels above, too high levels of these circulating fats are associated with negative cardiovascular outcomes. These alongside blood pressure should be regularly monitored.
Ideally someone with diabetes will have a total cholesterol below 4, a bad LDL cholesterol below 2, and triglyceride levels below 1.7.
This sounds like it could be quite intensive but the reality is this is established via blood or urine test. Over time, raised glucose levels or high blood pressure can damage the kidneys. If you think of the kidneys as a sieve, when operating optimally they allow waste products to fall through the sieve whilst holding onto the essential nutrients such as proteins. If glucose damages the kidneys, holes can begin to open in the sieve. This means the kidneys are no longer able to catch all the nutrients they would like. As further damage is done, you may find the sieve is no longer functional at all and you are losing nutrients, particularly proteins, into the urine.
Your healthcare professional can easily test for this.
During your annual or perhaps more regular diabetes check ups, it of course makes sense that your blood glucose levels will be checked. However, if you test your own blood glucose levels at home, this test is different.
The HbA1c test measures the previous 3 months of your glucose control. I have previously written an article all about this test here.
A HbA1c result of between 48-59mmol/mol is optimal. At these levels, you are at no increased risk of developing complications long term. As these figures begin to climb however, the risk begins to significant increase. If you are able to get your HbA1c below 48mmol/mol without experiencing regular hypoglycaemic episodes (assuming you are taking medications which may induce these) then there is no harm getting below 48mmol/mol. However, this won’t necessarily translate into reduced risk of complications.
I would encourage you to know your HbA1c value and to not except the practice nurse or GP telling you it’s good or bad. Get to know this number and own it.
There are also plenty of other services which you will be entitled to if required. If you haven’t had education already, the GP should be able to refer you to a specialist service to provide group education and teach you everything you need to know to help manage your condition.
If you struggle with the dietary aspects of diabetes, referral to a dietitian may also be a practical solution which your GP can also organise.
There are also a range of stop smoking, psychological support, free flu vaccination and sexual health services which your GP should be able to refer to if available in your area.