Every now and then, patients with diabetes ask me: “Doctor, even though most of my blood sugar numbers are high, I feel good. I don’t understand why I should take all these pills and insulin injections.” This is a great question. The main reason to have control of your blood sugar (glucose) is to prevent complications of diabetes. Diabetes, during its early years, produces no major symptoms unless the blood sugar gets very high. Then, the person will make a lot of urine, become thirsty, and not feel well. This is true in all types of diabetes.So, you may ask,“What are the complications we should prevent?”We classify diabetes complications into two categories:1) Complications that damage small blood vessels in your body.Diabetes can damage small vessels in the eyes, nerves, and kidneys. These can lead to blindness, loss of sensation in hands and feet, and kidney failure. These complications are serious, and can have a very negative effect on a person’s well-being.2) Complications that damage the large blood vessels.Complications that damage large blood vessels cause “hardening of the arteries” that feed your heart, brain, and body. These complications are also very serious and can lead to heart attack, stroke, loss of arms or legs, and even early death. It is important to know that all these complications can happen, even if you feel healthy.“How can I prevent these complications?”The answer to this question can vary depending on whether you have type 1 or type 2 diabetes. However, no matter which type of diabetes you have, good blood sugar control is the most important way to prevent damage to small blood vessels. Also, as described further below, you can do many things to prevent the complications related to the large blood vessels.“What is type 1 diabetes and who gets it?”
This type of diabetes (previously called juvenile diabetes) often starts in children and young adults, but it can start at any age. It begins after damage and loss of cells that produce insulin. For this reason, people with this form of diabetes do not produce insulin, and their health and wellness depends on taking insulin on a regular basis.Two important studies (called DCCT and EDIC), which involved more than 1,400 volunteers with type 1 diabetes, have shown that good blood sugar control plays a very important role in preventing small vessel complications in the eyes, nerves and the kidneys. The results were so dramatic that doctors and patients all over the world started to aim for better blood sugar control. The studies have also shown that good blood sugar control can help prevent large vessel disease that can lead to heart attacks and strokes in people with type 1 diabetes.“What is the best way to get good blood sugar control? Which insulin regimen is best?”These are questions that each person should discuss with their health-care team. Today we have better insulins and better tools and technologies to help people get their blood sugars under control.Like everyone else, people with type 1 diabetes can develop a rise in blood cholesterol and fats (lipids), high blood pressure, and “hardening of the arteries” with increasing age. Attention should be given to controlling the harmful effects of these changes, as well as stopping smoking.“What is type 2 diabetes and who gets it?”This form of diabetes (previously called “adult-onset diabetes”) is the most common form of the disease. Currently, more than 20 million people in the United States have it. Type 2 diabetes is on the rise, and it is estimated that millions more people in the USA and across the world will be affected in the next 20 to 30 years. Type 2 diabetes can run in families and is increasing in children and young adults. We often see this disease in people who are overweight. Type 2 diabetes is not just a problem of blood sugars. It also affects blood pressure, cholesterol, and fats, inflammation in the body, and blood clotting.Normally, cells in the pancreas release proper amounts of insulin. This helps sugar enter into cells throughout the body for energy. One main problem of type 2 diabetes is the “resistance” of cells to insulin. This means that it takes more insulin to produce the same effect. On top of that, people with type 2 diabetes do not make enough insulin for what their body needs.