Over 17 million people in the United States have diabetes, but many of them don't know it. Regular medical checkups are important so that people who are prone to diabetes or are diabetic can take steps to control their blood sugar and avoid the long-term complications that may accompany the disease. When blood sugar levels are high, blood does not circulate properly. The kidneys can be damaged by poor circulation, and there may be eventual loss of kidney function, a condition known as end stage renal disease (ESRD). Kidney failure can lead to the need for dialysis. In addition to damage to blood vessels, another medical complication of long-standing diabetes is damage to the nerves, called neuropathy. Nerve damage can cause tingling, burning or numbness in the fingers and hands, feet and legs, and prevent the stomach, intestines and bladder from working normally. Other complications of diabetes are infections that do not heal, skin conditions, and eye and gum disease that can lead to blindness and amputation. People with diabetes should report any symptoms or warning signs of complications to their doctor as soon as they are noticed. Regular check-ups, a healthy diet and consistent exercise are all important to stay healthy. In general, careful control of blood sugar is vital to prevent the complications of diabetes.

Patients with diabetes must learn the warning signs or symptoms of diabetic complications. These include changes in vision, tiredness, numbness or tingling in the hands or feet, headaches, cuts or breaks in the skin that do not heal, or frequent infections.

How Can ESRD Be Treated?

The complications of diabetes can often be traced back to changes in nerve or blood vessels that result from poor blood sugar control. When nerves are damaged, a loss of feeling, tingling or a burning sensation can occur in the extremities, especially the feet and legs. Nerve damage can also cause stomach, intestinal and bladder problems. When blood vessels become narrow, blood circulation is slowed. Poor circulation can cause skin problems and prevent healing of bacterial and fungal infections. This is especially true of infections of the feet and legs. Narrowing of the arteries can also trigger heart disease and stroke, as well as a variety of skin conditions. Damage to the blood vessels in the eye can lead to blindness. Blood vessels in the kidney, which act as tiny filters to remove wastes and water from the blood, can become damaged and leak protein into the urine. If not caught early, it can lead to a complete breakdown in the functioning of the kidneys, the condition known as end stage renal disease (ESRD).

End Stage Renal Disease: Kidney disease, called nephropathy, develops in 10% to 20% of all diabetics. The risk is 12 times higher in type 1 diabetics than in type 2 diabetics, and it is more common in African Americans, Mexican Americans and Native Americans. This condition develops over many years, beginning with a mild leakage of protein into the urine, known as microalbuminuria. Although there are no symptoms at this stage of kidney disease, the protein in the urine can be detected by a laboratory test during a routine examination. Research has shown that if blood sugar levels are carefully controlled, the risk of kidney damage from diabetes can be significantly reduced. What's more, if diabetic kidney disease is caught early, when only small amounts of protein are leaking into the urine, antihypertensive drugs known as ACE-inhibitors are able to slow the worsening of damage to the kidneys. If kidney damage is allowed to continue and large amounts of protein leak into the urine, ESRD follows. This is a serious condition, and the only treatments are dialysis or a kidney transplant.

Dialysis: Dialysis is a treatment that cleans the blood. Two types of dialysis are available, and each has advantages and disadvantages. Hemodialysis cleans the blood of wastes by filtering blood through a dialysis machine, usually in an outpatient dialysis center. A patient is treated three times a week, with each session lasting three to five hours. In some situations, hemodialysis is done at home with a trained partner. Some patients may have symptoms during treatment such as changes in blood pressure, nausea or muscle cramps. A special diet is prescribed for patients who undergo hemodialysis, since their blood is not cleared of waste products each day. Peritoneal dialysis works by cleaning the blood with a solution that flows through a tube into the abdomen. A patient must be able to perform the steps without causing infection. An advantage of peritoneal dialysis is that it cleans the blood each day, more like a human kidney, which allows the patient to eat more normally since wastes do not build up.

How to Prevent Complications: Have regular checkups; check feet regularly for signs of infection; keep weight near normal; don't smoke; eat sensibly; and exercise regularly. Most important of all, keep your blood sugar in the recommended range. Your pharmacist can help you with questions about your medications, insulin, or devices to check your blood sugar.