Diabetic complications are leading causes of blindness, amputations and kidney failure. Most diabetics develop a complication within 16 years of being diagnosed. Diabetologist's waiting rooms seem to be filled with people with white canes, overweight people, amputees in wheelchairs - people suffering the agonies of the darned.
A recent study I found called The Diabetes Control and Complications Trial followed two groups of insulin dependent diabetics, one following a casual regime of blood sugar control, the other attempting much tighter control with more frequent insulin injections. The results showed beyond doubt that high blood sugar is associated with neuropathies and microvascular (small blood vessel) complications, but does not lessen the macrovascular (large blood vessel) complications. In other words, tight control reduces the chance of kidney failure, foot problems, leg ulcers, blindness, amputation and neuropathy, but actually worsens weight gain, causes more and more severe hypoglycemia and increased risk of coronary artery disease (on the ADA-style high carbohydrate diet used in the DCCT).
The so-called microvascular complications are caused by high blood sugar and damage the capillaries and the organs dependent on them such as the kidneys (nephropathy), eyes (retinopathy), and the extremities which can lead to diabetic leg ulcers, gangrene and amputation. The neuropathies (nerve damage) include: itching, burning, numbness, and eventually the failure of organ systems to perform properly, as in delayed stomach emptying from damage to the vagus nerve, and eventually the progressive failure of the digestion.
The macrovascular complications - heart disease - are associated with and likely caused by high insulin levels: the so-called syndrome X. In this trial, the researchers acknowledge that high insulin levels are the price of tight control; and some of the tight control group gained weight and had increases in blood pressure and cholesterol, so they came to have an increased risk of vascular complications.. The larger vessels become blocked, like the coronary arteries which feed the heart muscle (setting the stage for heart attack), and the carotid artery which feeds the brain (setting the stage for a stroke). These conditions are shared with people without diabetes, but in diabetics they progress six times faster. Further, diabetics' blood has a greater tendency to clot, so that heart attacks and strokes are more common among them. The combination of numbness in the feet and poor circulation make diabetic feet and legs terribly vulnerable - even too-hot bath water can damage them - and wounds are slow to heal and may ulcerate.
So what can we as diabetics do about all this. Is it all just a "fait au compleat"?
All that really matters about complications is knowing how to avoid them. Our meds seem to mitigate the microvasular problems but I feel that giving up the high carb diet in place of something that promotes ketogenisis (low carb higher protein diet) is the answer to solving the macrovascular problem. This is something that not just diabetics can benefit from but that they happen to benefit from more than most.
So the long winded answer to your question is, NO, complications are not inevitable if you eat correctly and take the appropriate medications. AND of course get some exercise to help get your body into its proper metabolic state!!
I wonder what part of my post didn't state that "tight control reduces"......
Yes this was a "type 1 study" but most of the results will probably apply to type 2's. The syndrome x type damage from insulin is more specific to type 1's but not exclusive and can be found in many type twos that have taken sulfonylureas.
Yes, a total protein no carb Atkins/Bernstein diet can damage your kidneys. However, cutting back on the carbs and increasing the protein intake so that you are "realtively" low/lower carb is not a bad thing! After all, you can see when you start getting to much protein in the urine, but it is much harder to see when you are getting hardening of the arteries, and other macrovascular damage.
Six of one - half dozen of another, but I'll err on the side of lowering my carbs (bad carbs anyway) in hopes of staving off long term arterial damage! Unfortunately we are living with a broken endocrine system and since we can't fix it, all we can do is try to make everything else as healthy as possible!!
Now last but not least, the question of PREVENTABILITY/REVERSABILITY. Well there are a number of well documented cases of pre-diabetic and newly diagnosed type two cases where a reversal has occured. Usually these were in cases where there had been significant abuse of any appropriate dietary or exercise regimins. HOWEVER, there are an equal if not far greater number of us that are stuck with the disease for life, simply because whats broken isn't fixable. The near pandemic of diabetes in the US is mostly being caused by no exercise and horrendous diet. This is preventable. But lets not forget that there will always be those that are genetically pre disposed to this disease and nothing we do will prevent it!
So......the answer to the original question of this thread is YES & NO. It all depends on the circumstances.
Post Edited By Moderator (Jeannie143) : 1/10/2006 10:28:43 PM (GMT-7)
Type 2 diabetes is supposedly caused by either reduced insulin secretion or insulin resistance and usually both contibute.In lean individuals with a heavy genetic burden of diabetes in the family preponderantly have reduced insulin secretion as identified by insulin assays;an element of insulin resistance exists in these individuals.In the overweight and obese individuals it is the peripheral insulin resistance which contributes most to the development of type 2 diabetes,and insulin secretion is definitely reduced too.Professor Sutherland showed the world that every human cell has a chemical moiety called an insulin receptor and that these are present in normal numbers in non-obese or non-overweight persons.He dramatically demonstrated that these receptors simply disappeared once the person became obese leading to Diabetes;incidentally he received the Nobel prize for this discovery.These "insulin receptors facilitate the entry of the insulin- glucose complex into the cells,especially in the brain,liver,muscle and kidney.Accumulation of glucose in the circulation occurs once this is impaired leading to hyperglycemia.We should not lose sight of the contibution genetics makes in a person developing diabetes,type 2.Faulty food habits alone do not make a diabetic!