Diabetic complications are usually listed as the five horrors: blindness, kidney disease, neuropathy, heart attack, and amputation.
The patient with diabetes who endures these complications is likely to have quite a different viewpoint. A man who suffers pain in his legs, who has gastroparesis, and is impotent is justified in believing that he has three serious complications, and not “just” neuropathy.
For people with diabetes, a complication is any problem that is caused by diabetes. Some of the complications perceived by people who live with diabetes are listed in the accompanying table.
Most people who have had diabetes for 10 years or more will have at least several, or perhaps many, of these complications at the same time. More are added with increasing age and duration of diabetes.
There is no way to predict which complications will affect which patient, nor even if or when the problems will arise. The stress caused by this enduring uncertainty becomes, in itself, yet another complication.
Often overlooked as a complicating factor is the incompatibility of so many of these problems. For example, a person who is visually impaired or obese, may be unable to examine his feet for abrasions or infection. A person who is suffering from gastroparesis or diarrhea can’t possibly maintain a normal blood glucose level. The dietary requirements for a person with diabetes are nearly the opposite of those for a person on kidney dialysis. And nearly half of the people who are on dialysis also have diabetes. Consider the frustration of those who must live with, and attempt to manage, daily, such multiple complications.
It has become popular to suggest that one could avoid diabetic complications by simply keeping a consistently normal blood glucose level. Obviously, this is possible only for people who don’t have diabetes. For those who are living with diabetes, and especially for those who already have some complications, constant euglycemia is not an achievable goal.
Uncontrollable physical and emotional impediments to a normal blood glucose level (such as infection, stress, menstruation, etc.) will soon defeat even the most conscientious and compliant individual. Health professionals who fail to understand this are often quick to “blame the victim” for the complications.
Be assured that no one would choose to add these complications to his or her life. If you suggest otherwise, you thoughtlessly burden a person who, more likely, deserves your admiration for meeting the difficult, daily challenge of managing diabetes.
Reprinted with permission from the Jan./Feb. 1994 issue of The Diabetes Educator