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Selasa, 10 Februari 2009

The Complications of Diabetes

The Factors Behind Complications of Diabetes

Generally, you can't tell diabetic complications are developing, at least not without undergoing tests or medical procedures in a doctor's office. Diabetes proceeds unnoticed, silently ravaging the body. There is, however, one surefire indication that problems are developing: persistently high blood-sugar levels. The type of complications that develop also depends on diabetes type. For instance, type 1 diabetes tends to produce vision problems sooner than does type 2 diabetes, while type 2 diabetes appears to be linked to more heart attacks and strokes. Many long-term complications are tied to those structures that distribute blood throughout the body; the small and large blood vessels. Although scientists are not certain how it happens, they think that years of carrying blood with high sugar levels eventually damages or impairs blood vessels. Let's look now at some of the major long-term complications faced by people with diabetes.


Eye problems that diabetes might cause include minor problems in focusing, premature development of cataracts, and various degrees of retinal damage (otherwise known as diabetic retinopathy).


Although cataracts certainly impede good vision, they are less troublesome than another long-term complication, diabetic retinopathy.

Diabetic Retinopathy

Diabetic retinopathy is caused by changes or abnormalities in the small blood vessels of the retina--changes that take years to occur. Experts estimate that 6,000 people a year develop retinopathy. Almost everyone with diabetes develops this complication, but the first to feel its impact are people with type I diabetes, who frequently develop a mild form of this condition within five years of diagnosis of diabetes. Quite simply, the longer you have diabetes, the greater your chance of developing retinopathy. Within ten years of diabetes diagnosis, half of all people with type 1 diabetes and a quarter with type 2 have some damage to their retinas. By twenty years after diagnosis of diabetes, nearly everyone with type 1 diabetes and over 60 percent with type 2 have some degree of retinopathy.

The medical profession describes two forms of diabetic retinopathy: background retinopathy and proliferative retinopathy. Background retinopathy is a mild, early form of retinopathy that is characterized by gradual narrowing or weakening of the small blood vessels in the eye. Small bulges (called microaneurysms) develop on the vessels. The new vessels are an attempt by the eye to repair the damaged, worn-out vessels caused by diabetes. In some people, this is enough to stop the progression of diabetic retinopathy.

Vitrectomy is another, more intricate surgical procedure used in people with proliferative retinopathy. One small Norwegian study found that people with type 1 diabetes who maintained near-normal levels of blood sugar over a long period of time--at least seven years--were significantly less likely to develop severe retinopathy. The results of the Diabetes Control and Complications Trial show that tight blood-sugar control can prevent new cases of retinopathy. Scientists are also hoping to discover why high levels of blood glucose damage the body's blood vessels. There are other ways diabetes can exacerbate retinopathy. Poor blood-sugar control, high blood pressure, and a history of smoking increase the risk of retinopathy and increase the chances that the condition will worsen. And as we mentioned before, people with type 1 diabetes are more likely to develop severe retinopathy.

A woman with type 1, type 2, or gestational diabetes who has no retinopathy before pregnancy is unlikely to develop retinopathy during pregnancy. About 5 to 12 percent of women with diabetes with mild retinopathy will see their retinopathy worsen. In recent studies, about 47 percent of pregnant women with diabetes had an increase in severity in retinal damage, and 5 percent developed proliferative retinopathy.

In one study, 55 percent of pregnant women with diabetes who had high blood pressure in addition to retinopathy saw their retinopathy worsen, compared with 25 percent of the women who had normal blood pressure and retinopathy.

Experts say that pregnant women with signs of retinal damage can slow the progression of retinopathy by lowering blood-pressure levels.

This article originally wa written by : Authors: Janet Worsley Norwood and Charles B. Inlander
Excerpt from: Understanding Diabetes

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