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2010-08-24 09:20 丁香园 苹果嘿嘿  发布范围:公开
Diabetes Complications: What's Your Risk?
Why are people with diabetes at high risk of nerve pain, heart disease, and blindness?
By Jeanie Lerche Davis


WebMD Feature Reviewed by Brunilda Nazario, MD Heart attack, stroke, blindness, amputation, kidney failure. When doctors describe these diabetes complications, it may sound melodramatic -- like an overblown worst-case scenario. The truth is, these things can happen when blood sugar, blood pressure, and cholesterol are out of control.
在一家医疗网站上Brunilda Nazario博士将其总结为心脏病、中风、失明、截肢、肾衰竭。医生们描述这些并发症的时候,听起来是有些伤感的——像是被夸大了的最坏的情况。事实是,当血糖、血压和胆固醇失去控制时,这些都是有可能发生的。

"A lot of people don't really think it will happen to them," says David C. Ziemer, MD, director of the Diabetes Clinic at Grady Hospital in Atlanta. "For a lot of folks, the wake-up comes when they actually have a complication ... a bad infection in the foot. That's a nasty wake-up call."
“很多人认为这些事情不会真的发生在他们身上,” David C. Ziemer博士说。他是亚特兰大Grady医院糖尿病诊所的指导医生,他说:“对很多人而言,当他们确实得了一种并发症的时候,例如一只感染的糖尿病足,就该清醒了。这是让人不那么愉快的警钟。”

If you have uncontrolled diabetes, a serious and deep-seated foot infection can mean loss of a toe, foot, or leg -- amputation -- to save your life. Seriously.

How is this possible? Over time, high blood sugar slowly injures the blood vessels, nerves, and organs in your body. The higher your blood sugar is -- and the longer it stays high -- the worse the damage is. Smoking and alcohol ratchet up the damage several more notches.

"Damage is slow and occurs over a period of years -- but it probably begins when blood sugar is at mildly elevated levels," says Ronald Goldberg, MD, associate director of the Diabetes Research Institute at the University of Miami Medical Center. "You may not be diagnosed with diabetes, but the damage has already begun."
“损伤时缓慢进行的,有时经过几年的时间才发生——但是当血糖在一个比较轻度水平提高的时候,它可能就已经开始损伤你的身体了。” 迈阿密医学中心大学糖尿病研究所的副指导员Ronald Goldberg博士说,“你可能还没有被诊断出糖尿病,但是损伤确实已经开始发生了。”

The damage from diabetes shows up a bit differently in everyone -- whether it attacks the nerves, eyes, or kidneys, Goldberg tells WebMD. "Genetics probably influence which complications you are more susceptible to."

The problem is, "many people have diabetes a lot longer than they realize," says Ziemer. "Most have diabetes an average of five to seven years before they're diagnosed."
问题是“很多人在患上糖尿病很久之之后才意识到自己得了糖尿病。” Ziemer说,“大部分人在诊断出患有糖尿病之前,已经有了平均5-7年的病史。”

Diabetes Complications: The Risks You Face
As blood vessels, nerves, and organs become damaged, your risk of diabetes complications increases.

These are the most serious:Heart disease, heart attack, heart failure, and stroke risks are doubled. Heart disease and stroke cause at least 65% of deaths from diabetes.
Major eye complications (diabetic retinopathy) are linked to blood vessel problems in the eyes. Diabetes is a leading cause of preventable blindness; cataracts and glaucoma are also common.

Reduced blood flow to nerves and high blood sugar results in nerve pain, burning, numbness (peripheral neuropathy).
Serious leg and foot infections, even gangrene and amputation, are due to poor blood circulation, lack of oxygen and nutrients to tissue, and nerve damage.

Kidney damage (diabetic nephropathy) is a common risk for people with diabetes.
The complications of diabetes are indeed serious -- but they are not inevitable, Ziemer tells WebMD. "Keeping blood sugar under control is the single the most important factor in preventing them. But people have a hard time grasping just how critical that is," he says. "It's hard to get them to tune into it."

Preventing Diabetes Complications With Medication
Getting blood sugar under control isn't always difficult. Sometimes all you need are lifestyle changes -- eating right, getting regular exercise, losing weight -- to get it into a safe range. If you're a smoker, there's no question -- you've got to quit.

Also, finding ways to ease the stress in your life helps control blood sugar, as does treatment for depression. Both stress and depression increase the level of cortisol, a hormone that affects blood sugar. "Cortisol makes the diabetes worse," Ziemer tells WebMD. "There is evidence that treating depression may help blood sugar control." He is heading a study investigating that link.
For some people, taking just one diabetes medication helps tremendously. Complex new drugs like Byetta, Januvia, and Symlin work from different angles to attack high blood sugar. "All the new drugs hold a lot of promise," says Ziemer, who is also a professor of endocrinology at Emory University School of Medicine in Atlanta.
对有些人而言,仅服用一种治疗糖尿病的药物后果是可怕的。复杂的新型药物,例如Byetta,Januvia和 Symlin从不同的方面起效治疗更高水平的血糖。“所有这些新的药物都有很多疗效,”
If you need to take insulin, you'll find the injections aren't that bad. "The new versions of insulin are far less cumbersome," Ziemer explains. You don't need to lay out a lot of needles and vials on the table. The insulin can be discreetly injected via a little pen -- much like a cartridge writing pen. Insulin mouth sprays and insulin patches are being developed.
如果你需要使用胰岛素,那么就要确定注射不是那么坏的方法。“胰岛素的新剂型远没有那么繁琐,” Ziemer解释说。你不需要使用许多针管和小玻璃瓶,胰岛素可以一个小钢笔——或许更像一个书写墨盒的东西,直接注射入身体。胰岛素口腔喷剂和贴剂正在开发中。

Fewer Diabetes Complications = Less Pain
By reining in blood sugar, you slow down the damage to the body's nerves and blood vessels. You can even halt damage altogether. The benefits show up in many ways.
You can ease the pain or numbness you feel in hands, arms, feet, and legs. "When you prevent more damage to nerves, you keep pain from getting worse," Ziemer explains. "We don't have any medications to repair nerve damage. Mostly, we're protecting what's left."
可以减轻疼痛或者手部、胳膊、脚和腿部的麻木。“当阻止了对神经的大部分损害之后,就阻止了疼痛的进一步恶化。” Ziemer说,“没有任何一种药物能够修复损伤的神经。大部分情况下,我们只是保护剩余的神经。”

Gum disease and tooth loss can be halted when blood sugar is controlled, adds Ziemer. "In fact, when you get gum infection under control, you help keep blood sugar under control. Infection in the gums increases inflammation in the body, which makes controlling diabetes harder."

Don't put dental visits on the back burner, says Ziemer. "A lot of folks end up losing lots of teeth. Nobody likes going to the dentist, me included. But seeing a dentist is very important."

Blood sugar isn't the only issue, diabetes experts agree. If there are cholesterol and blood pressure problems -- as there typically are -- they need aggressive treatment with medication. Both these conditions affect the health of large and small blood vessels, and greatly aggravate the damage done by diabetes.

Cholesterol-lowering drugs like statins are a mainstay in diabetes treatment. Blood pressure drugs like ACE inhibitors can also improve blood flow throughout the body, including legs and kidneys. "These drugs protect kidneys from damage and they protect the heart muscle, which helps prevent heart failure," Ziemer tells WebMD.
降胆固醇药物例如statins是治疗糖尿病药物的主要药物。血压药物例如血管张力素转化酶抑制剂,也能促进血流流通身体,包括腿和肾脏。“这些药物保护肾脏不受损害,保护心肌以防止心力衰竭。” Ziemer说。

With these diabetes complications, there's a lot at stake. Can you really prevent the worst-case scenario? "Absolutely," Goldberg tells WebMD. "If you do all these things, you can substantially reduce risk of heart attack, stroke, and the blood vessel damage that leads to blindness, amputations, and kidney damage. But you must start doing them as early as possible. And you have to keep things under control ... strict control."
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