EDP column by Dr Ketan Dhatariya

“My GP told me I have had a mini-stroke after I temporarily lost my speech. What is this?”

The number of people with diabetes in Norfolk is increasing by over 2000 people per year. It is a long term condition that needs regular review. Why is it important to keep blood sugar levels under control?

Diabetes affects almost 1 in 25 people in the UK, 90% of whom have type 2 diabetes. This used to be called maturity onset, or non-insulin dependent diabetes. Unfortunately these terms are out of date because as the population gets heavier, the number of people under the age of 20 with type 2 increases and is no longer ‘maturity onset’. Also, because it is important to keep diabetes under control, more people with type 2 diabetes need to go onto insulin and thus, it is not ‘non-insulin dependent’. The other obsolete term is ‘mild’ diabetes. Diabetes is never mild. It needs to be treated aggressively because if left inadequately treated for a prolonged length of time, then complications can occur.

The complications of diabetes can be divided into two categories. These depend on the size of the blood vessels that are affected. If small blood vessels are affected, then microvascular complications occur. These are eye disease, nerve disease, and kidney disease. If large blood vessels are affected, then this is known as macrovascular disease and can cause heart attacks and strokes.

The eye disease can be serious - diabetes is the most common cause of blindness in the developed world. Unfortunately it can be completely without symptoms until the vision goes. It can only be assessed by someone looking into the back of your eyes – these days this is likely to be using a digital camera that is in the back of a van that visits your GP surgery. The images are then looked at by a specialist and they can tell you if your eyes are OK, or if you have some diabetes related eye disease. If you have any evidence of early eye disease then the treatment is getting your diabetes control better, as well as getting the blood pressure under control. Early eye disease is completely reversible with good diabetes and good blood pressure control. If the eye disease is quite bad (remember, you may know nothing about this) then you may be asked to see an eye specialist at the hospital.

The nerve disease can cause several symptoms. Often the nerves that are affected are the finest nerves furthest away from the brain. These are the sensation nerves in the feet. These can die away. This happens so slowly that you may not know that you are losing the sensation in your feet and so if you – for example – step on a pin, or cut your toenails too short, you may not feel it and you may introduce an infection. Other symptoms that can occur are a burning sensation in the feet. Occasionally, some tablets or ointments can be used to ease the burning pains. However, once the nerve disease has set in, currently there are no treatments to reverse it. Again, the treatment to stop it getting any worse is getting the diabetes and the blood pressure under optimal control. Your feet should be looked at every year during your annual review to check for any evidence of nerve damage.

The kidney disease that happens in diabetes is one of the most common causes of kidney failure in the world. Again, it is completely preventable with good long term diabetes and blood pressure control. The earliest sign of kidney damage is the presence of small amounts of protein in your urine. Your urine should be checked every year as part of your annual review. Again, if picked up early the kidney disease is reversible with good long term diabetes and blood pressure control. If the kidney disease then it is very likely that some tablets will be started that can help prevent it getting worse.  It is important to have a regular blood test as well, because it can show if the kidneys are working well or not. If they are not, it can mean that the tablets used to treat the diabetes may need to change as well. 

The message with diabetes is simple – have regular checks at your doctors; keep your diabetes and blood pressure under control to prevent the complications from occurring – or if they are already present, to slow down how fast they will get worse.

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