Diabetic comorbidities – what are the risks involved in diabetes?

The risks of a poorly managed blood sugar level are comorbidities that are often more dangerous than the actual diabetic disease itself. The cause of the various diabetic comorbidities is always en excessively high blood sugar level of the affected persons. This means the breakdown of glucose in the cells is overloaded and oxygenradicals – more specifically: superoxide anion radicals – are released, which then trigger the additional complications. They damage the delicate blood vessels first and later the larger ones, thereby causing nerve damage, vision problems, and kidney failure in the long run. The heart attack and stroke risk increases considerably due to the risk of thrombosis and arteriosclerosis. Diabetic comorbidities occur in many patients – it is very difficult to detect the risk early.

Diabetic neuropathy – nerve damage caused by diabetes

Since blood vessels are damaged by a high blood sugar level, the nerves responsible for the tactile sense and the musculoskeletal system are no longer sufficiently supplied with oxygen and nutrients. Together with other metabolic processes caused by hyperglycemia (like the higher formation of so-called AGEs or ‘advanced glycation end products’, i.e. modified proteins and/or lipids) this leads to gradual nerve destruction. On the one hand, AGEs (the waste products of the metabolism) increase the formation of reactive oxygen species and interfere with antioxidative systems; on the other hand, the formation of AGEs keeps increasing under oxidative conditions, thereby setting a vicious circle in motion and starting diabetic neuropathy, one of the most common diabetic comorbidities. Almost every third diabetic patient is affected by it, suffering from the severe limitations that this condition causes in everyday life. The farther away the nerve endings are from the heart, the more they are at risk of an insufficient supply. Accordingly, generally this affects the delicate nerves in the legs first, which are responsible for conveying the feelings of pain and temperature. The body's autonomic nervous system can also be affected by the neuropathy. It is responsible for the autonomic control of organs and body functions and cannot be consciously influenced by the person.

The symptoms of diabetic neuropathy

Diabetic neuropathy can manifest itself in the most varied way, depending on what nerves are acutely affected:

• Loss of sense of touch, pain, or temperature
• Numb extremities or paralysis
• Chronic pain
• Tingling or formication in the limbs
• Arrhythmia
• Bladder weakness or erectile problems

Under some conditions, it is harder for the affected persons to perceive the symptoms of dangerous diabetic hypoglycemia owing to their malfunctioning nerves. For this reason, prevention is better than cure, and this is why preventive treatment is so important.

Treating diabetic neuropathy the right way

The treatment of diabetic neuropathy should always be based on three essential pillars:

• Optimization of blood sugar regulation by changing the lifestyle and, as far as necessary, correctly adjusting the medications
• Symptomatic pain therapy with the corresponding centrally-acting medications
• Blocking pathogenic metabolic pathways, such as the aforementioned formation of AGEs, to counteract disease progression. In this context, compensating for a vitamin B1 deficiency with the vitamin B1 precursor benfotiamine is also relevant

Diabetic foot – frequent consequence of diabetic neuropathy

Triggered by diabetic neuropathy or in rare cases by peripheral arterial occlusive disease, a malfunction of the nerves can lead to the amputation of a foot in severe cases. Since the nerves in the leg start dying off, patients no longer feel injuries and pressure points. Wounds can easily get infected and heal very slowly due to poor circulation. Abscesses can form around the wounds and attack tissue and bones until the foot can no longer be saved. Prevention and regular checking of the feet are indispensable. Doing so even small injuries can be recognized early and dangerous inflammations are prevented.

Risk of thrombosis and peripheral arterial occlusive disease as diabetic comorbidity

Damage of the blood vessel walls leads over time to calcium deposits – and arteriosclerosis sets in. This process constricts blood flow owing to the narrower arteries. The result is that not enough oxygen can reach the places where it is urgently needed. In addition, blood clots can form on the calcium deposits. The risk of a heart attack or stroke caused by the thrombosis and detaching calcium deposits drastically increases. Patients with type 2 diabetes, in particular, are prone to have a stroke, as they are affected by the frequently accompanying lipid metabolism disorders and high blood pressure. However, patients with type 1 diabetes are also more susceptible than those who do not have the condition.

Prevention and regular checking of the feet are indispensable. Doing so even small injuries can be recognized early and dangerous inflammations are prevented.

Intermittent claudication as diabetic comorbidity

If narrowing of the blood vessels takes place in the leg arteries, the condition is known as peripheral arterial occlusive disease (PAOD). Initially, it manifests itself as a feeling of coldness and tingling, later as leg pain, especially when walking. Therefore, the affected persons must often stop to rest a bit. A In advanced stages this condition can lead to the complete necrosis of the blood vessels, which leads to the amputation of the affected leg or foot. Since initial symptoms set in only after an artery has reached 90 percent blockage, early prevention is essential to prevent late complications.

Kidney damage caused by diabetes – diabetic nephropathy as secondary disease

Damage to the blood vessel walls triggered by a permanently elevated blood sugar level also affects the delicate blood vessels (capillaries) of the kidneys. When the renal corpuscles gradually stop functioning, the body's detoxification accomplished by the important renal filtering function steadily worsens. About one out of ten diabetic patients are affected by kidney damage caused by diabetes. The damage can already be present in an early stage of diabetes and worsen for a long time without being noticed. Typical symptoms and poisoning signs such as a yellow discoloration of the eyes and skin appear in many patients only in a late clinical stadium. In the worst case scenario, kidney function can cease completely.Then the only remedy is dialysis or kidney transplantation. In the early stages of the disease a blood test can already indicate an existing condition and should therefore be performed regularly.

Retinal damage as secondary disease of diabetes – diabetic retinopathy

The capillaries in the retina are also affected by the consequences of the elevated blood sugar level. Diabetic retinopathy is a frequent cause of blindness. The small, delicate arteries in the retina die off, and aneurysms and vascular occlusions are formed. New arteries form to compensate for the loss of the ones that died, but these can easily tear and cause a retinal detachment. Together with other preventive measures, laser treatment can help the retina to stop a worsening of the symptoms.