Ask The Expert
Complications

It's not just following a careful meal plan that matters, but rather looking at the big picture--controlling your blood glucose levels, blood fats, and blood pressure through meal planning, exercise and, often, diabetes medication and perhaps blood pressure medication.

There are some people who don't follow a careful meal plan, but they adjust their insulin dosage accordingly and are able to control their blood glucose levels very well and, likely, will not develop complications.

I realize you might be a diet-controlled person, who is not taking medication, or perhaps you are on an oral agent. Either way, probably you have been advised by your doctor and dietitian to follow a healthy meal plan. The reason this is important is to keep your blood glucose levels in a good range.

More information about complications:

Complications of diabetes develop over time, due to the accumulation of too much glucose in your system. It is known that too much glucose clogs the small blood vessels, which can cause problems in the eyes and kidneys. Excess glucose also speeds up the process of hardening of the arteries that occurs with aging. Decreased blood flow to the heart can cause a heart attack, and decreased flow to the brain can cause a stroke. Excess accumulation of glucose can damage nerve cells as well, and delay, change, or halt the electrical signals that your nerve cells send throughout your body.

These complications do not happen overnight, but rather take many years to develop. What is significant with type 2 diabetes is that many people have no early warning symptoms of diabetes-in fact it is estimated that the average time a person has type 2 diabetes before diagnosis is 7-10 years. That is why some people are diagnosed with complications at the same time they are diagnosed with diabetes - they have had elevated blood glucose levels for years, which already caused some damage.

We now have solid evidence from numerous studies that good control makes a difference. The two most important studies are described below:

• The Diabetes Control and Complications Trial (DCCT) studied 1441 people with type 1 diabetes, comparing conventional treatment (which in the mid 1980's meant 1-2 shots/day, urine or blood testing 2-3 times /day, periodic doctor visits, and an average glucose goal around 200), with intensive treatment (3 or 4 shots/day or an insulin pump, 4 or more tests/day, adjusting insulin doses to match exercise and food intake to achieve a glucose goal of 120). The results reported in 1993 were very dramatic: tight control of glucose reduced the risk of developing diabetic eye disease (retinopathy) by 76%; among those who already had early signs of eye disease before entering the study, intensive control slowed the progression of retinopathy by 54%; the risk of kidney disease (nephropathy) was reduced by 50%, and nerve disease (neuropathy) was reduced by 60%. The study volunteers, age 13 to 39, were too young to develop many heart-related problems, but the study found that the intensive control group had a 35% lower risk of developing high cholesterol levels, a major contributor of heart disease. As stated in the ADA's Complete Guide to Diabetes, "Before the DCCT, many people with diabetes thought that complications would progress no matter what they did. After the DCCT, we know that way of thinking is wrong - keeping glucose levels in control does matter."

  Because these results were so impressive, the National Institutes of Health continued to follow the participants of the DCCT, in a new trial called the Epidemiology of Diabetes Interventions and Complications Study (EDIC). The EDIC study began in 1993 at the end of the DCCT and followed these patients to this day. After the DCCT ended, participants were encouraged to continue to control their diabetes carefully, but over time, A1Cs in both the intensive control and the conventional control groups crept up and leveled off at approximately 8%. Despite this loss of control, the people who were part of the intensive control group have had only half as many cardiovascular events (such as heart attack, stroke, or chest pain) as those who were part of the conventional control group. According to Sheldon Gottlieb, MD, in the November, 2005 issue of Diabetes Care, "Exactly how this 'therapeutic memory' works is not clear...Recent genetic research also suggests that intensive therapy-even over just a few years-may result in beneficial changes in the structure of the heart."

• The United Kingdom Prospective Diabetes Study (UKPDS) looked at 5000 people with type 2 diabetes. The results, reported in 1998, confirmed that not only do intensively controlled people with type 2 diabetes experience fewer complications but also, if they control their blood pressure, they significantly reduce their risk of virtually all cardiovascular and micro-vascular complications. The treatment goal for the intensive group was a fasting plasma glucose of less than 108 mg/dl, and the study found that in this group:

  • Microvascular complications decreased by 25%.
  • Over 10 years, the average A1C dropped from 9.1% to about 7%.
  • For every percentage point decrease, A1C complications were reduced by 35%, heart attacks were reduced by 18%, and diabetes-related deaths were reduced by 25%.
  • Tight blood pressure control reduced the risk of stroke by 44% and the risk of heart failure by 56% (which is why the current recommendation is to maintain a blood pressure under 130/80).

So from these studies, it has become clear that any improvement you can make in lowering your blood glucose levels will help you. Even if you already have some of the complications of diabetes, it's not too late to improve your glucose control and, at the very least, prevent the complications from getting worse.

If you haven't met with a dietitian and diabetes educator, I would encourage you to do so, as you need to obtain individualized information on what meal plan is right for you.