DM status: It’s complicated!

If you are in Facebook (FB), you know what I mean if you’re asked about your relationship status. “It’s complicated” would probably evoke more questions than answers. What about your diabetes mellitus (DM) status?

What’s worse than knowing that you are a diabetic is that you already have complications. Diabetes mellitus is fairly asymptomatic up until you reach a certain stage where complications appear. There are two types of complications: those that affect the small blood vessels (microvascular) and those that affect the big ones (macrovascular). You might have heard of diabetics going blind or undergoing dialysis—two of the more devastating small vessel complications of DM. Together with these is diabetic neuropathy that affects the small and large nerve fibers. These complications appear as a consequence of long-standing uncontrolled high blood sugar.

Current recommendations propose that all type 2 diabetics should be screened for these complications at diagnosis. So upon knowing that you have diabetes, you should have your eyes checked by an ophthalmologist, who will examine your retina, where small blood vessels may proliferate (retinopathy), potentially burst, and lead to blindness. If you luckily don’t have this complication yet, then a once-a-year visit will suffice, but if not, more tests and treatment that can be done, ranging from applying some eye drops, laser photocoagulation and even surgery.

Just in case you have retinopathy, then you must make sure that you don’t have “nephropathy” since most diabetics with eye complications have kidney complications as well. Early DM nephropathy can manifest as bubbly urine, which is a sign of losing protein in the urine (proteinuria). Be tested early and ask for medications that can delay, if not arrest, nephropathy because if this complication progresses, dialysis or kidney transplant will be the ultimate therapy.

Diabetic neuropathy is a more complex microvascular complication since its presentation is less definite. Patients usually present with diabetic peripheral neuropathy, the manifestations of which range from pain perception due to a stimulus that does not normally provoke pain (allodynia) to total loss of sensation, especially tactile sensitivity (anesthesia).

Usual complaints are tingling, burning, pins and needles sensation, as well as numbness, coldness or insensitivity to pain or temperature in a “stocking and glove” distribution, together with cramps, loss of balance and coordination, muscle weakness and loss of reflexes that are often worse at night. Though pain is usually more troubling and irritating, numbness and decreased touch sensitivity is worse since this will increase your risk of diabetic foot ulcerations.

Horror stories of patients walking around unknowingly with staple wires, thumb tacks and even needles in their feet are more common than you think. This may cause undetected foot infections, thus increasing risk for leg amputations. Another unique manifestation of neuropathy is autonomic neuropathy, which may present as high-to-low blood pressure, slow-to-fast heart beat, diarrhea-constipation and among men, erectile dysfunction.

As mentioned earlier, big blood vessels may also be affected (macrovascular) manifesting as stroke, heart attack and peripheral arterial occlusive disease (PAOD). Unlike microvascular complication, macrovascular disease is not only due to high blood glucose since other factors contribute to this complication, like smoking, obesity, high cholesterol and blood pressure. That is why it is not enough for diabetics to take their anti-DM medications, but they should also take their anticholesterol, blood pressure medications and, for most people, aspirin.

We must remember that whatever disciplined diet and exercise or pills you pop or insulin you inject, diabetes per se is still not curable. These interventions are given to make sure that your blood sugar will be controlled and that these microvascular and macrovascular complications appear later than sooner. “An ounce of prevention is better than a pound of cure,” holds none truer than in diabetes mellitus.

Just like your FB status—answer your diabetes condition simply and squarely, don’t beat around the bush and address your diabetes responsibly. Make sure you are screened, tested and treated. Aim for a better DM status post than “It’s complicated,” because it should be in the first place “It’s controlled.”

Dr. Bien Matawaran is an endocrinologist and vice president of the Philippine Society of Endocrinology, Diabetes and Metabolism. The A to Z of Health Information Advocacy is a joint initiative of a group of medical specialists and supported by AstraZeneca Philippines aimed at raising public awareness on various diseases and providing health information and updates to the healthcare community.