Diabetes: What problems does it cause?

First published in Beyond India, November 2016 edition

Dr Rahul Barmanray

I told you to look after your sugar. Now you’re going to the doctor every second day!

Diabetes is a disease that affects every organ in the body; from the brain right down to the toes no body part is spared. The main organs that may be affected include:


When it is not well-controlled, diabetes is one of the strongest risk factors for heart disease. Most heart attacks (reduced oxygen reaching the heart muscle) occur because of a cholesterol deposit in the coronary arteries (blood vessels that supply the heart muscle) breaking off and blocking the artery downstream. Diabetes increases the risk of this happening, and this is related to how well the blood sugar and blood pressure are controlled. If the blockage occurs gradually you may get angina, which is chest pain that typically occurs with exertion and goes away with rest. However, due to high sugar-related nerve damage a diabetic may not get any pain with exercise or during a heart attack, so the features may instead be shortness of breath, sweating, palpitations, and feeling unwell.


Just like in the coronary arteries, diabetes increases cholesterol deposit formation in the arteries supplying the brain. When these break off they cause a stroke (there are other causes too). A stroke can occur anywhere in the brain and the features are quite different depending on what that part of the brain does. If you think someone is having a stroke, remember the word FAST. If someone has Facial weakness, Arm weakness, or Speech abnormality it is Time to call 000 quickly. Just like a heart attack, a big stroke can kill you so it is very important to reduce the risk of this by controlling blood pressure and sugar.


The other large blood vessels affected in diabetes are those in the legs. The early signs of blockage are leg pains that occur with exercise, especially walking and running, which go away very quickly with rest. If this progresses you may even have pain at rest, which is a bad sign of severe disease.


Diabetes can affect vision by causing cataracts (white hard pieces) to form at the front of the eyes, and by damaging the layer of nerve fibres at the back (called the retina). Diabetic eye disease is painless and may not be noticed until it is severe. This is why it is very important for people with diabetes to get their eyes checked regularly.


In the last few decades, diabetes has become the leading cause of kidney disease around the world. Unless you are getting regular blood and urine tests kidney disease is often not detected until it is at a very advanced stage, at which point the only treatments may be dialysis or a kidney transplant. Good control of blood sugars is the best way to prevent this.


Diabetes can also damage the nerves; the longer the nerve the more likely it is to be affected. The nerve cells that go to the toes are the longest in the body and are thus most likely to be affected. When the nerves are damaged you lose feeling in the toes. If you injure them you may not be aware of this and the wound may develop into an ulcer. The high blood sugar of a patient with diabetes helps bacteria to grow, which makes diabetic foot ulcers difficult to treat and potentially life-threatening. It is thus important to check your feet with a mirror (to look at the soles) frequently, to pick up injuries early.