Managing Your Diabetes Controlling diabetes is all about keeping control of our blood glucose levels. The problems of diabetes are caused when your control slips.

Diabetes Complications

The acute diabetes complications in type 1 and type 2 diabetes

Maintaining blood glucose levels which are persistently elevated can lead to the many complications associated with diabetes. The complications may be acute or chronic. The acute complications develop over several days or weeks. In type 1 diabetes, diabetic ketoacidosis (DKA) can develop if insulin is omitted or if is insufficient. The patient becomes very symptomatic and may require immediate treatment or in more severe cases admission to hospital. In type 2 diabetes the development of hyper-osmolar hyperglycaemic state (HHS) may take several weeks with the patient becoming increasing unwell with blood glucose levels greater than 50 mmols/l. Both acute complications are potentially fatal and the patient may require hospitalisation. Diabetic feet damage may be chronic but active lesions often require urgent medical attention in a hospital setting.

Statistics of the long-term diabetes complications

The long-term complications of both type 1 and type 2 diabetes are many and the prevention of this is one of the main goals of managing diabetes. There is strong evidence to show that the severity of microvascular complications is associated with the duration and degree of hyperglycaemia. Several medical research studies have shown that the higher the average blood glucose, the greater the risk of damage to the small blood vessels and nerves. The Diabetes Control and Complications Trial (DCCT, 1993) which studied glycaemic control in patients with type 1 diabetes demonstrated that maintaining blood glucose levels within 4 - 9 mmols/L reduced the incidence of micro-vascular complications by 35 - 75 %. The landmark study in type 2 diabetes, the UK Prospective Diabetes Study (UKPDS, 1998) also demonstrated up to 25% reduction in microvascular endpoints. Both studies proved that with intensive treatment the risk of new complications were reduced and the risk of progression of existing complications was reduced.

The microvascular complications include retinopathy (eye disease), nephropathy (kidney disease) and neuropathy (nerve damage which leads to diabetic foot disease). The macrovascular complications are cardiovascular disease, cerebro-vascular disease and peripheral vascular disease. The statistics show that up to 50% of people newly diagnosed with type 2 diabetes already show evidence of complications. For both type 1 and type 2 diabetes the statistics illustrate that the incidence of complications are related to duration of diabetes and degree of hyperglycaemia. It is for these reasons, patients are 'treated to target' ie treatments are initiated and adjusted so that the targets of blood glucose, blood pressure and lipid are maintained so as to reduce the risk of new complications and retard progression of existing diabetes complications. Intensive treatments versus conventional treatments in both studies emphasised the difference in endpoints. In clinical practice, these findings have guided treatment options for the management of diabetes complications.

Written by a Diabetes Specialist Nurse