LWD - Chapter K
Future Health
K1. Introduction
Lots of young people and their families have asked us for information on the possible long-term impact of diabetes on health or long-term complications which may occur in people living with diabetes. At the time of diagnosis, you or your parents and family may have searched the internet, read about these problems and may be worried about them.
We have tried to summarise these health concerns briefly below but please discuss any questions or worries with your diabetes team. We have tried to be open and honest but also explain that working with the diabetes team to keep glucose levels in the target range as much as possible will considerably reduce the risk of these occurring.
K2. Background
The body is designed to keep glucose levels in the blood within a very narrow range (3.9-7mmol/L). The only hormone which lowers glucose levels is insulin. As insulin is no longer sufficiently produced by the pancreas in type 1 diabetes, we need to provide fast acting insulin to match with the carbohydrate containing food you eat, as well as long-acting insulin in the background.
If glucose levels are running high for a long time or there are large swings in blood glucose, it can irritate and damage the blood vessels, particularly small vessels as seen in the eye and kidney. They can bleed and small clots can form.
A study in the United States (DCCT) showed very clearly that maintaining blood glucose levels in target range for most of the time significantly reduced the risk of all complications and this effect lasted for many years. It is therefore really important to try to do this from diagnosis and then maintain it throughout. This can be a challenge but is possible using intensive insulin regimens (multiple daily insulin injections and/or pumps).
You may hear or read about some experts in diabetes talking about your body’s ‘metabolic memory’. What they mean is ‘what your average blood glucose levels are like over the period you have had diabetes’. The HbA1c test is a marker of glucose levels; the nearer that is to 48mmol/mol or 6.5% without lots of hypoglycaemia the more benefit for your health, whether you have had diabetes for 2 years, 20 years or beyond. Even if you have a period of higher HbA1c, it is worth improving to reduce your risks of longer-term problems.
Although it is better to keep blood glucose within the target range as much as you can as soon as possible after diagnosis, it is never too late to do this. This will always help to improve the situation and reduce the risk of complications. Look at the ‘Top Tips’ listing ideas which have been shown to help with this (Chapter I).
K3. Nephropathy (Kidneys)
One of the first signs of problems occurring in the kidney is the leakage of an excess amount of protein into the urine. Your diabetes team will check your urine for this once per year. If it is raised, the test will be repeated using a sample of urine collected as soon as you wake up in the morning when you have rested.
Another important sign of a kidney problem is a rise in your blood pressure. This will be checked at clinic and if it is significantly high (particularly if it is associated with the ‘protein’ leak), then medication will be required (ACE inhibitors).To minimise the risk of these problems occurring it is important to:
- Keep blood glucose in the target range as much as possible.
- Avoid smoking as it is known that smoking increases the risk considerably.
- Try and maintain a healthy weight for your height.
The kidney filters your blood to get rid of waste; if it stops doing this, you may need dialysis or a transplant.
4. Retinopathy (Eyes)
The small blood vessels at the back of the eye are particularly susceptible to damage from high blood glucose levels and large swings in blood glucose. Over time, this can lead to leakage of blood into the back of the eye (retina) and damage your ability to see. This is particularly serious if it occurs in the part of the eye associated with fine vision (macula).
The lens of the eye can also be affected by high glucose levels leading to cataracts. This
leads to a blurring of your vision and may require surgery.
To minimise the risk and to stop further problems if any are detected, it is important to:
- Maintain blood glucose in target range as much as possible, reducing it slowly if it has been high for a while. Please discuss this with your diabetes team.
- Avoid smoking.
- If recognised, it can be treated by using a laser, but it is better to try and avoid the complication if at all possible.
K5. Sexual Health
At the time of diagnosis this may appear to be one of the least important things on your mind. As you reach adult life the ability for normal sexual relationships becomes increasingly important. To minimise the risk of complications occurring, it is important to try to keep blood glucose in target range as much as possible from diagnosis.
The problems that can occur include:
- In females, high glucose levels can be damaging in pregnancy. If you are planning to have children, it is very important to discuss this with your diabetes team early on. You will need to keep blood glucose in target range and try to maintain this before conceiving (getting pregnant) and throughout pregnancy, to minimise the risk to your baby.
- There is a specialist pre-conception clinic for women with diabetes. By doing this, you can have a healthy pregnancy and have a healthy baby. If you suspect you are pregnant, please let us know immediately so that you can have a test, be given appropriate advice and be referred to the specialist antenatal clinic if appropriate.
- In males, high blood glucose levels may over time be associated with difficulty achieving an erection and can affect the sex life of males and females with diabetes. Prevention is the best way of ensuring a healthy sex life but there are treatments available if problems do occur. Please discuss this with your diabetes team if you have any questions.
K6. Neuropathy (nerves)
Problems associated with the nerve supply to your body (similar to the electric supply to your house) are rarely recognised in childhood but can start to appear very slowly. There are two areas which can be affected:
- The long nerves to your legs and arms can lose the ability to feel ‘touch and sensation’. This can make it difficult to feel and pick up small objects and you could tread on a sharp object such as a stone or piece of glass without noticing.
- The nerves to your stomach can be affected, making it unable to empty properly leading to a feeling of sickness, pain and at its worst, frequent vomiting. This can also affect blood glucose after meals.
As with all long-term complications, minimising the risk relies on trying to keep blood glucose levels in the target range. The diabetes team are here to support you and your family to help with this.
K7. Blood vessels
The large blood vessels in your body can collect fat and ‘fur up’ like a kettle. This narrows your blood vessels and makes you more susceptible to heart damage. This is important to everyone whether they have diabetes or not and the risk can be reduced enormously if you:
- Avoid smoking and vaping at all costs and make every effort to stop if you have started (and avoid exposure to a smoky environment). There are lots of services available to support with stopping smoking so please let us know if you would like help with this.
- Make healthy food choices including your 5 fruit and vegetables each day.
- Aim to keep blood glucose levels in the target range.
- Try and be active for 60 minutes per day. See Chapter G about physical activity and exercise.
