Some long-term complications of diabetes

By Dr. Sylvester Ikhisemojie 

The prospect of suffering from some of the long-term complications of this disease condition is a real one facing the growing number of people living with diabetes in our country today. At some specific times in the past on this page, we have discussed this condition in various ways.

At those times, we were primarily focused on the criteria used in diagnosing the condition and how to manage it over time with a combination of dietary restraint, exercise, and prescribed medications. It is clear that there is no cure presently for this condition.

However, there are some instances where the onset of diabetes can actually be reversed. That scenario is quite different from the situation we are poised to discuss it in today’s essay. This week, we will be looking at some of the most profound changes the body can experience when people are faced with this condition over a period of 20 years or thereabouts. These complications of having to live with this problem for such a long time are the focus of the essay this week. It is an even more important question to answer in our kind of society where many of the true sufferers of the problem do not even realize that they have it because they do not visit the hospital. Therefore, we must acknowledge today that diabetes is rapidly emerging as one of the most common chronic disease conditions in Nigeria.

Some of these noted complications that have been well documented include peripheral neuropathy, kidney disease, cataract formation, glaucoma and blindness as well as peripheral artery disease and diabetic foot ulcers leading often to amputations. There have been cases in the past where diabetes was not diagnosed in some people until they presented at a hospital with its complications, some of which we have discussed in the past such as diabetic ketoacidosis and even hypoglycemic coma. However, diabetics who are aware of their condition are some of the most knowledgeable patients about their ailment than in most other conditions. As they now live much longer and enjoy better lives, it is reasonable to expect that we are likely going to see a lot more of these more serious conditions as the years go by. Some of these conditions include the prominence of infections of various types, cancer and cognitive decline associated with the rise in neurodegenerative diseases. The list is long but it is something we must pay some attention to in order to update patients with this condition with the challenges which they are likely to face. As some of these problems become increasingly evident in an ageing population, so will they assume a place of enhanced prominence among ageing diabetics who have managed their condition well as a result of superior knowledge and the adoption of positive health practices.

One of these conditions that is likely to see a rise in incidence is diabetic retinopathy, which is a cluster of features seen in this condition. Apart from the more common eye conditions we described above, there now arises the specter of blurred vision, distortion, micro aneurysms, oedema of the retina, hemorrhages, hard exudates, cotton-wool spots, floaters and the increased risk of retinal detachment with sudden blindness being the final consequence. It is a considerable loss, as anyone can imagine when somebody who used to see the world around them and enjoy the sights and sounds of their surrounding environment suddenly become blind. It is also harder to accept from a psychological point of view and the effects can be very profound. These individuals are candidates for at least an annual eye examination at the point of initial diagnosis and can be improved to examination every two years depending on the severity of the features seen at the time of the initial diagnosis. These individuals can also have their problems resolved by the smart deployment of some of the most sophisticated modern tools and laser-powered equipment available that can deliver accurate surgical treatments. Sadly, many of these emerging equipment are not available in our country. In other countries, the injection of laser photocoagulation and intravenous injection of anti-vascular growth factor are considered reasonable therapies for diabetics who do not have a proliferative type of eye disease.

As mentioned earlier, neuropathy, which is the gradual loss of sensation in parts of the body supplied by certain nerves, soon becomes a casualty of long-term diabetes. This impaired sense of feeling compounded by its eventual loss is a major reason why some people with diabetes are unable to feel that their limbs have suffered from some kind of injury until such wounds have become complicated by the development of an ulcer. The ulcers then get worse, of course, except they are promptly diagnosed and energetic use of antibiotics, generous excision of such a wound is performed and strict control of the blood sugar is started. Similar nerve damage affects the nerves supplying the genitals with the result that in men especially, erectile dysfunction becomes a major issue. The other chronic condition that is often in evidence among people who now fall in this category are those people with chronic kidney disease. After some fifteen to twenty years of living with diabetes, even very good blood sugar control can still lead to the development of a kind of inflammatory condition of the kidneys resembling what is seen in some infective conditions called glomerulonephritis. Indeed, it is speculated that as many as one-quarter to more than one-third of people who have had diabetes for this long are often at risk of developing such a condition. It leads to progressive kidney failure that will occasionally lead to a lifetime of kidney dialysis and misery if they live long enough.

It is not for nothing that we often see how some centenarians are celebrated around the world as a mark of honour for their longevity.  It is evident from all accounts that none of these people live with a chronic health condition such as diabetes, hypertension or heart disease. Earlier in the last paragraph, we talked about diabetic neuropathy. It makes the people who have developed that particular complication feel as though they have been administered with some anaesthesia in that part of the body. They, therefore, develop wounds without realizing it. These wounds progressively worsen without aggressive treatment and the only solution left in order to save their lives is to perform an amputation. In several Nigerian hospitals where one has been honoured to work, even this life-saving option is often rejected by the patients affected. In one amazing case, a certain patient informed us that it is not right to go back to God with an incomplete body. He died a few days later. Another leading disease condition associated with chronic diabetes is cardiovascular disease. The deposition of plaques within the lumen of these vessels can involve blood vessels in the lower limbs especially, and also the heart. These developments make the risk of heart attack, stroke and gangrene of the foot a lot more likely with the passing of the years. This triad is often a huge problem for these individuals to cope with.