Diabetes Complications: How Do They Develop?

Dr Jedha, Host 

Hello wonderful people and welcome to episode 30. 

Today we are going to cover a more serious topic, but it’s a topic that is so very important to you and that is diabetes complications. Now please, don’t stop this podcast episode. It is really important to hear about this topic, because we’re going to cover why complications develop and ways you can be proactive to reduce your risk of getting them too, so listen through to the end and you’ll not only be more informed, but you’ll also find some new motivation for getting more proactive as well. 

I wanted to share some sobering statistics with you. While these can seem depressing, I think it gives us all some perspective, and also encourages us to be proactive with taking care of our health. 

The International Diabetes Federation suggests that in 2021 there were around 537 million people living with diabetes, that’s about 10.5% of people aged 20-79 years. And we know there are millions of people with undiagnosed diabetes. By 2030 rates are predicted to rise from 537 million to 643 million. And by 2045 it is predicted that approximately 783 million will be living with diabetes. Type 2 diabetes makes up over 90% of all diabetes. In the past we’ve seen estimates greatly exceeded, so this is crazy stuff people. 

There are a wide range of contributors, some of which include:

• Urbanization 
• Poor quality nutrition
• Decreasing levels of physical activity
• Increasing overweight and obesity 
• An aging population
• And socioeconomic, environmental and genetic factors, among others

Many of these contributors come down to modern life, right? And the pressures of modern life. 

Anyway, prediabetes isn’t included in the numbers I’ve just shared. According to a paper published in Diabetes Care in 2023, there were around 298 million people living with prediabetes in 2021, which is estimated to increase to 414 million in 2045. It is difficult to get true estimates so these numbers could be underestimated. Still, this is crazy, crazy stuff! Diabetes affects millions of people worldwide. 

One of the things we don’t often like hearing or talking about is the negative effects of diabetes. But even though we don’t like to hear things, it doesn’t mean we should ignore them. And I don’t think people get educated enough about these effects and more importantly, how you can counteract them. We’re talking things like blindness, kidney failure, heart attacks, stroke, foot ulcers that can lead to lower limb amputation. These are potentially very real consequences. Serious, serious issues, even life-threatening issues, so please, don’t stick your head in the sand, it’s not going to save you from these terrible things, but being proactive can help reduce risk of these dreadful complications, by a lot!

The reason I don’t want you to put your head in the sand and ignore these things is because statistics indicate they do affect quite a large proportion of people. 

For instance, up to 50% of people with diabetes may develop neuropathy, a condition characterized by nerve damage that can lead to pain, tingling, and loss of sensation, particularly in the hands and feet.

Diabetic kidney disease affects approximately 20-40% of individuals with diabetes. It’s a leading cause of kidney failure, requiring dialysis or kidney transplantation in advanced cases.

Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults. Research suggests that after 20 years of diabetes, more than 60% of people develop some degree of retinopathy.

People with type 2 diabetes are at 2 to 4 times higher risk of cardiovascular disease than those without diabetes. cardiovascular disease is the leading cause of death in people with diabetes, accounting for 50-80% of all deaths in diabetes.

Peripheral Artery Disease, affects about 1 in 3 people with diabetes, leading to reduced blood flow to the limbs, causing pain and infections, and in severe cases, may require amputation.

As I said, don’t stick your head in the sand, it’s not going to save you from these terrible things, but being proactive can help reduce risk of these dreadful complications, by a lot!

So let’s delve into understanding how these complications develop, as this is crucial for managing and preventing them and protecting your own health. 

To get our head around this, we need to go back to the basics of blood sugar and diabetes, understanding the role of blood sugar (glucose) and insulin in the body. Insulin is a hormone produced by the pancreas that helps glucose enter the cells to be used for energy. In diabetes, this process doesn’t work as it should. In type 2 diabetes, the body either resists the effects of insulin – insulin resistance, as we covered in detail in episode 26 and this is the most common disruption that leads to abnormal glucose levels; or sometimes the pancreas doesn’t produce enough insulin to maintain a normal glucose level. Either way, this leads to elevated levels of glucose in the bloodstream; and it’s the high blood sugar levels that can damage various body systems over time.

Uncontrolled or poorly controlled blood sugar levels is what causes diabetes complications to develop. 

What does uncontrolled diabetes mean? It means when your blood sugar or A1c levels are tracking above the normal or recommended range for prolonged periods. Or in other words, chronically high blood sugar levels. If your A1c is up at 9, this isn’t good for you in terms of complications, you’re putting yourself at significant risk the longer you have high levels. 

If you can imagine, our blood sugar levels are meant to be within a certain range that is optimal for our health. We’ve covered normal blood sugar and goals in detail in episode 11, but briefly, in terms of A1c you want a level below 7% and below 6% is even better. So if your A1c is over 7% this is high. And it’s the High blood sugar, which is the main thing that sets off a chain of events. 

The thing is, with high blood sugar, this slowly causes damage to the vessels and cells all throughout the body. This is what contributes to diabetes complications. For example, damage to the small vessels and cells in the eyes leads to eye problems and can cause blindness. Damage to the large vessels feeding your heart can lead to heart attacks or stroke. This stuff really happens to people. The sooner you can get your blood sugar and A1c levels in check, the better your long term health will be and the greater chance you have to avoid diabetes complications.

High blood sugar doesn’t just damage vessels, other pathways also contribute to the development of complications, but these are also related to high blood sugar levels and high insulin levels. For example, High levels of glucose in the blood can lead to an increase in inflammatory markers and oxidative stress. This state of heightened inflammation and oxidative damage contributes to the deterioration of bodily tissues and organs, further accelerating the development of complications. Prolonged high blood sugar levels lead to the formation of advanced glycation end products (AGEs). These substances can cause further damage to the body’s proteins, contributing to the dysfunction and failure of various organs. Too much insulin can cause the walls of your blood vessels to grow thicker than normal. Thicker walls mean narrower vessels, making it harder for blood to flow. These changes impair blood flow, reducing oxygen and nutrient delivery to tissues and organs, which can lead to complications such as peripheral artery disease and erectile dysfunction.

This stuff really happens to people. The sooner you can get your blood sugar and A1c levels in check, the better your long term health will be and the greater chance you have to avoid diabetes complications.

In brief, diabetes complications develop through complex mechanisms driven by high blood sugar levels, inflammation, oxidative stress, and the formation of harmful substances like advanced glycation end products. 

But, achieving and maintaining your blood sugar and A1c in a healthy range reduces your risk of getting these complications, and the impact can be huge.  

According to research, an estimated 12% of diabetes-related deaths could be prevented with just a 0.1% A1c reduction, just 0.1%. Overall, if your levels are high, with each 1% reduction in A1c, you reduce your risk of diabetes-related deaths by 21%, reduce your risk of heart attacks by 14%, and reduce your risk of microvascular complications like eye issues, neuropathy and kidney damage by 37%. Imagine if your levels are up at 9% and you can get them down to a better level, 7% or even 6% – you can dramatically slash your risk of these complications. Based on this research for example, a 3% reduction in A1c reduces your risk of dying from diabetes by 63%, that’s huge. And the thing is, the sooner you can normalize your blood sugar levels the better. The sooner you can do this in your prediabetes or diabetes diagnosis, the better. But no matter where you are, improving your levels can help reduce risk of these things. 

Diabetes complications are not something anyone wants to get, as anyone with these issues will tell you. But again, they can happen so being proactive with diet and lifestyle is key. Please don’t stick your head in the sand and ignore high blood sugar and A1c levels. 

In episode 3 we talked about the power of nutrition to change your diabetes health. It is incredibly powerful, and huge changes can be experienced in a short period of time. If you monitor blood sugar levels on a daily basis, you can see observable changes within days. But the best measure to assess your overall blood sugar control is an A1c test, which your doctor orders through pathology. With this you want to give yourself at least 4 months initially, to see these tangible changes. 4 months is 16 weeks. In the randomized controlled trial I conducted, of my T2Diet Program, people lowered A1c by an average of almost 1% in 16 weeks, with some lowering A1c by as much as 3% in the trial. 

Your diet and nutrition is incredibly powerful in helping you achieve and maintain great A1c levels, but also to help reduce your risk of complications by improving so many other layers of your health as well. Diet helps stabilize blood sugar levels, reduce inflammation, and improve overall vascular health, for example. Diet and nutrition really is incredibly powerful and we’ve covered so many great topics that can help support you to achieve the best outcomes:

For example, as I said, we talked about the effectiveness of diet and nutrition in episode 3, We covered what to eat to treat diabetes in episode 5, we covered Normal blood sugar ranges and goals in episode 11 with a key tip on getting your A1c levels down, we talked about macronutrients in episode 20 – proteins, fats and carbs, and we dove right in to insulin resistance in episode 26 – so you could understand the intricate connection it has with your diabetes. Take all these pieces of the puzzle that I’ve been sharing throughout the podcast and put them into action in your own life because each step you take will make a big difference. 

And here’s the thing: in future episodes we will cover some of these complications in more detail, for example, we’ll have a guest cardiologist on to chat about heart health, we’ll cover effective remedies for neuropathy, and other things too. 

Just remember, it’s high blood sugar levels that contribute to the development of nasty diabetes complications, which is why it’s so important to be proactive and get your levels into a healthy range, under 7% for A1c, or under 6% is even better if you can achieve it. 

That’s all from me this week. 

Take care until next time. 

Dr Jedha, over and out.