It is well known that persistent hyperglycemia is closely related to the high risk of complications. However, the relationship between the two is still not fully clarified, which may involve many different processes.
Can diabetic complications occur when blood sugar is high?
To answer this question, we must first make clear that there is a what relationship between blood sugar changes and diabetic complications.
At present, studies have shown that glucose can adhere to various proteins (just as they adhere to hemoglobin, thus forming glycosylated hemoglobin). Over time, glucose may change the function of proteins and damage various tissues through [adhesion]. This is the [sugar toxicity theory].
Hyperglycemia can also affect the rate at which certain molecules are generated and removed from tissues, eventually causing tissues to fail to maintain normal function or to accumulate molecules that cause damage to tissues. Peripheral nerves and the lens of the eyeball are the victims of these two methods. Limb numbness and lens turbidity are their unfortunate outcomes under the action of hyperglycemia.
In addition, when poor blood sugar control causes an increase in blood lipid level, Fat builds up in the arteries, causing arteriosclerosis. Arteriosclerosis is a major cause of large vascular diseases such as myocardial infarction and stroke. Diabetics are also more likely to develop high blood pressure, which in turn can aggravate arteriosclerosis. It is also a risk factor for large vascular diseases.
Diabetes control and complication tests show that the long-term control of blood sugar is closely related to the occurrence and development of diabetes-related complications.
This test established the importance of controlling blood sugar: if blood sugar is not well controlled, the probability of complications will increase.
However, note: This does not mean that patients with poor blood sugar control will definitely have complications, nor does it mean that patients with good blood sugar control will definitely not have complications.
What are the chronic complications of diabetes?
The most common chronic complication is injury to blood vessels. According to the classification of damaged blood vessels, there are two categories:
- Microangiopathy: Involving small blood vessels and causing damage through molecular accumulation or reduction; Macrovascular lesion: Involves large blood vessels and causes damage by causing arteriosclerosis.
Generally speaking, type 1 diabetes is often manifested as microangiopathy in the onset of the disease, but the situation may change as the disease progresses. Type 2 diabetes mellitus is dominated by macroangiopathy, but microangiopathy also exists.
The following may seem sensational. But the more you know, the better you can prevent the common chronic complications of diabetes.
This type of disease only occurs in diabetics. They include the following aspects:
- Eye damage, that is, diabetic retinopathy; Kidney damage, also known as diabetic nephropathy; Diabetic cardiomyopathy may induce heart failure, arrhythmia, cardiogenic shock and even sudden death.
This kind of disease can also occur in the general population, but it is more common in diabetics. They include the following aspects:
- Risk of heart attack (cardiovascular diseases), such as angina pectoris, myocardial infarction, etc.; Stroke risk (cerebrovascular disease); Limb circulation deteriorates (peripheral vascular diseases), which may act together with neuropathy to lead to diabetic foot.
In addition to damaging blood vessels, diabetes can also cause neuropathy. Patients will feel abnormal sensation, numbness or acupuncture in the area where gloves or socks are worn, and even affect exercise in the later period.
It should be noted here that not every diabetic patient will necessarily have these complications.
Who is more likely to suffer from chronic complications of diabetes?
In addition to the above-mentioned blood sugar control factors, diabetic patients have a higher risk of chronic complications in the following situations.
1. Long course of diabetes
Patients with a course of diabetes less than five years, as well as adolescent patients who are still in puberty, generally have few complications.
However, once this stage is passed, the probability of complications will increase significantly as the course of the disease lengthens.
Step 2: Smoking
Many studies have found that among diabetics, smokers are more likely to have complications than non-smokers.
After complications occur, the disease progresses much faster in the former than in the latter.
Therefore, refusing smoking can greatly reduce this risk.
Diabetes patients with hypertension are more likely to have complications.
Elevated blood pressure has negative effects on kidneys, heart and blood vessels. Taking effective antihypertensive drugs to control blood pressure can reduce this risk.
Therefore, regular monitoring of blood pressure is an important aspect of diabetes monitoring.
4. Hyperlipidemia (lipid): Cholesterol and triglyceride
Patients with poor blood sugar control will have elevated blood lipid levels (called [hyperlipidemia]), and some are born more prone to hyperlipidemia.
In both cases, increased blood lipid levels can increase the incidence probability of diabetic complications.
Therefore, screening hyperlipidemia is another important aspect in diabetes monitoring.
Severe obese patients are more prone to macroangiopathy. Therefore, healthy eating habits and regular exercise lifestyle should not only be used to reduce the risk of diabetic complications, but also be extended to everyone.
Do children with diabetes get complications?
The above complications hardly occur in children with diabetes and are rare in adolescents. However, from the moment diabetes occurs, they may have begun to grow.
Children before puberty are relatively less affected by complications, but from puberty onwards, the early changes of complications will progress rapidly.
Therefore, controlling blood sugar from the moment of diagnosis is beneficial and harmless to improving overall long-term health.
For children with type 1 diabetes, screening for diabetic complications and risk factors should begin from puberty and when the course of disease of children with diabetes reaches 3 to 5 years.
For children with type 2 diabetes, screening for diabetic complications and risk factors should begin from the moment they are diagnosed.
Although the probability of complications among children and adolescents is small, screening is still unavoidable.
How to do diabetes complication screening?
Here are some blood and urine tests that doctors may suggest you to complete routinely. Some of these tests are to check for complications, some are to monitor blood sugar control, and some are to monitor common lesions of specific diabetes types.
If there is no problem, then you can spend a period of time with confidence for the time being. If the early manifestations of complications are found, measures must be taken to avoid further development of complications, or at least delay the progress of the disease.
If problems are found, the doctor will advise you to increase the frequency of testing.
1. Screening Items and Frequency of Type 1 Diabetes Mellitus Patients
- Blood pressure: glycosylated hemoglobin (HbA1c) every 3-6 months: used to evaluate blood glucose control, laboratory blood glucose examination every 3-4 months: used to compare with the results of household blood glucose meters to detect the accuracy of blood glucose meters, thyroid function examination every 3-6 months: once every 2 years; If thyroid antibodies are found to be positive, Blood lipid (triglyceride and cholesterol) needs to be checked once a year: Once 3 ~ 6 months after diagnosis, If the result is normal, After entering puberty, check the 24-hour urine microalbumin or albumin determination again, and randomly determine the creatinine ratio in urine: It is used for screening early diabetic nephropathy, once after diagnosis 3 to 5 years, and once a year after puberty. Ophthalmic examination is required for screening early diabetic retinopathy, once after diagnosis 3 to 5 years, and once a year after puberty, dental examination is required every 6 months.
2. Screening Items and Frequency of Type 2 Diabetes Mellitus Patients
- Blood pressure: glycosylated hemoglobin (HbA1c) every 3 ~ 6 months: Used to evaluate blood glucose control, 1 ~ 2 laboratory blood glucose tests per year: It is used for comparing with the results of household blood glucose meters, detecting the accuracy of blood glucose meters, Blood lipid (triglyceride and cholesterol) every 3 ~ 4 months: At least once a year, 24-hour urine microalbumin or albumin is measured, and creatinine ratio is randomly measured in urine: It is used for screening early diabetic nephropathy. After entering puberty, it is necessary to review the ophthalmic examination at least once a year. After screening early diabetic retinopathy, it is necessary to accept the first examination as soon as possible after diagnosis, and then it is examined once every 1-2 years. After 15 years old, it is necessary to review the dental examination once a year: every 6 months.
Responsible Editor: Ding Ruoshui