Coping with Complications

Whether you have type 1 or type 2 diabetes, you may someday face one or more diabetes complications.  Complications are medical problems that occur more often in people with diabetes.  Over time, diabetes can cause changes in blood vessels or nerves.  These changes can lead to medical problems. You may have diabetes for decades before complications show up, if they ever do.

If they do occur, these complications can affect many different parts of the body.  Large blood vessels may become narrow.  When blood flow is slowed, you run a risk of heart disease, stroke, or amputation.  Small blood vessels often get damaged, too.  Damage to vessels in the eyes (retinopathy) can threaten your vision.  The damage can lead to blindness if not treated early.  The small blood vessels in the kidney may also be injured, leading to kidney disease (nephropathy).

Nerve damage (neuropathy) is another common complication of diabetes.  Neuropathy can numb parts of the body, especially the feet and legs, or cause feelings of tingling or burning.  It can also impair the function of internal organs such as the stomach, intestines, and bladder.

The combination of neuropathy and blood vessel disease can lead to amputation.  If you lose feeling in your feet, you may not feel blisters, small sores, ulcers, or foreign bodies in your shoe.  Diabetes raises the chances that these wounds will become infected.  If they do, blood vessel damage can make infections hard to heal.  An out-of-control infection could require amputation to save the rest of the limb.

Warning Signs

Some complications, such as kidney disease, do not cause symptoms early on.  But they can be detected through special screening tests by your health care team, so regular checkups are important.

If you notice a change in your health, take action.  Do not ignore small warning signs that point to a complication.  You may be able to slow things down and avoid more serious trouble.  If you have any of the following symptoms, tell your doctor:

• blurry or spotty vision
• fatigue
• numbness or tingling in hands or feet
• chest pain
• infections that occur often or cuts that heal slowly

Any other changes in your health that feel "wrong" should be brought to the attention of your doctor.

New treatments exist for many complications.  Laser surgery can repair damage to the eyes and prevent blindness.  Many surgical techniques have made it easier to treat blocked arteries.  Kidney transplantation has grown more successful for people with kidney disease.  New methods of treating blocked blood vessels and wounds may help prevent amputation.  In many cases, the faster and earlier you spot the problem, the better the outcome.

Facing Trouble

Some people work hard to control their blood sugar and care for themselves.  Yet they may still face the shock of learning they have a complication.

News of a complication is not a signal to stop caring for your diabetes.  Yes, it is bad news.  You may feel angry or hopeless.  You may think, "I've done so much to take care of myself, and now this happens.  What was the point?"

The point was this:  the care you took may have delayed the complication for years.  In fact, the problem may be milder because you took such good care of yourself.  Keep it up, because a healthy body is better able to fight back.

Paying attention to your health will also help you cope mentally.  You will know that you are doing everything you can to live well with the complication.

• Do not smoke
• Keep your blood sugar levels as close to normal as possible
• Eat a healthy, balanced meal plan
• Get regular exercise (with your doctor's okay)
• See your doctor (dentist and eye doctor, too) regularly, even if you feel great
• Check your feet each day for small cuts or blisters.  Your doctor should check your feet at least once a year - more often if you have foot problems
• Keep your weight under control
• Keep your blood pressure and blood fat levels in the normal range

When you are diagnosed with a complication, you take on a new job:  learning to cope with this change.  An action plan can help.  Here are some suggestions:

• Keep a positive attitude.  Staying hopeful and upbeat can improve and possibly lengthen your life.  A negative attitude makes living with the complication harder not only on you but also on your family and friends.
• Be an active member of your health care team.  Speak up.  If you don't think something will work for you, explain your feelings.  Make suggestions.  Ask about other treatments.
• Learn about your complication.  Chances are, the better you understand your complication, the less out of control you will feel.

Groups that focus on your complication may be good resources.  Your local American Diabetes Association can refer you to organizations such as the National Kidney Foundation or the Foundation for the Blind.  Such organizations often know about the latest medical advances.  They may supply names of leading doctors in the field and medical centers doing the latest research.  They may even have information about insurance or government reimbursement.

• Think about seeing a specialist (a doctor with special training) who works with your complication.  Don't worry about making your primary care doctor angry.  Any doctor who wants the best for you will be glad you want to see a specialist.  In fact, your doctor may refer you to a specialist when your complication is diagnosed.
• Try to get a second opinion.  Any time you face a major change in your health or diabetes care, it is a good idea to get a second opinion. Before you go, check your health insurance.  It may pay for the second opinion or even require it.
• Ask questions of any health care professional who examines you.  What are the likely side effects of this treatment?  How often will I need the treatment?  Will I need new medications?  How many patients with this problem have you treated?  What were the results?
• Be a wise medical consumer.  Don't be afraid to discuss money with your doctor.  Some treatments cost more than others, but the most costly option may not be the best choice for you.  What are the alternatives? Know what your insurance will pay for.  If your insurance doesn't cover a treatment, you can try an appeal to the insurance company.
• Build a support system.  You will probably feel better if you can open up, at least to one or two people.

Make your family and friends part of that system.  Let them know what it's like to live with your complication.  Tell them about problems and choices you might face.  When you don't talk about your feelings and needs, it's hard for others to know how to help.

If you find it hard to talk with family or friends, you may want to get help from a social worker or psychologist.  Short-term counseling can help you through a time of high stress and change.  Social workers may be able to help you find other resources that would help.

Ask your doctor to put you in touch with others who have dealt with the same complication.  Talking with someone who has "been there" is a good way to get moral support.  It may also give you leads on treatment options or doctors.

Living Well With Complications

Coping with a complication may mean making some changes in your lifestyle.  But with work, you can often continue doing the same activities that you have always enjoyed.  To stay active, you will need the support of others.  You will also need to rely strongly on yourself.  There are many ways you can manage your own treatment and your own rehabilitation - retraining yourself to do tasks such as walking, preparing food, and exercising.

What Exercise Can Do

Staying active in your health care is a key aspect of coping well.  Staying physically active is equally important for most people.  When diabetes seems to be dealing you hard blows, exercise may be the last thing you want to think about.  After all, isn't it out of the question for someone in your condition?  No.  In fact, regular exercise is a good idea for almost everyone.  When you live with a diabetes complication, you may need exercise more than ever.

When a physical problem like vision loss or surgery keeps you from being active, your whole body suffers.  That's because parts of your body are not getting used enough.  Muscles need to be exercised regularly to stay strong.  If they aren't, they become too weak to even do easy tasks like taking out the trash or making the bed.

You can make your muscles stronger and more effective with regular exercise.  This doesn't mean you have to lift weights, go to the gym, or make drastic changes.  Regular exercise can be modest.  In fact, if you haven't done much for a long time or are adjusting to limited mobility, start slowly.  Of course, you need to talk about exercise with your doctor.  Never start an exercise program without your doctor's okay.  Very high or low blood sugar levels may make exercise dangerous.  Be sure to have a heart evaluation before starting an exercise program if you:

• are over 35 years of age
• have had type 2 diabetes more than 10 years
• have had type 1 diabetes more than 15 years
• have other risk factors for heart disease
• have eye, nerve, or kidney damage

Talk with your health care team about good exercise choices for you.  Ask your doctor to help you find an exercise physiologist who has worked with people with your complication.  You, your doctor, and the exercise specialist can plan a safe exercise program for you.

A Final Word

It's important to know that whatever diabetes complication you have, there are resources to help you cope.  Talk to your health care team, trained counselor, or other people in the same situation.  You do not have to face a complication alone.

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