Archive for April 23rd, 2009


What are the late complications of diabetes?

Late complications may occur many years after diagnosis of diabetes. They are most worrying because they may result from damage to vital organs of the body such as eyes, kidneys, heart, blood circulation or the nervous system. On the other hand, these complications are often treatable and early detection may help to prevent their harmful effect.

How can complications develop?

They may develop in a number of ways:

1.     By weakening and blockage of small blood vessels that supply blood to the organs of the body. This is called ‘microvascular disease’ and can lead to impaired vision if they affect the eyes or reduce kidney function if they affect the kidneys.

2.     By thickening the wall of large arteries that supply blood to large organs such as the heart or the feet. This is called ‘macrovascular disease’.

3.     By changes within the cells of the body. This can lead to the ways that the body’s nervous system functions. This is called ‘neuropathy’. A similar process within the lens of the eye can cause clouding of the lens called a cataract.

Why do complications develop?

We do not always understand why complications develop. There is no doubt that constant high levels of glucose in the blood over a period of time leading to poor diabetic control, is a major factor in increasing the risk of complications.

Some people seem more at risk than others through no fault of their own. Perhaps this is because there is an inherited risk for some people to develop the complications of diabetes.

Other factors that can increase the risk of complications include physical inactivity, smoking, becoming overweight, high blood pressure and inappropriate diet.

What is the risk of myself or my child developing complications?

We cannot answer this question. We can only estimate risk on the basis of statistics from groups of people who have had diabetes a long time. New treatment that is now available will have diminished that risk so that the statistics may not apply to people developing diabetes now. A prediction based on a statistical risk also cannot reliably apply to an individual person in predicting their future.



Night and day, the recurring seasons, our breathing, our heart beat, the natural cycle of women is recurring phenomena. Growth, maturity, age and death are equally a part of our biological lifespan, just as it is with all that is living around us, treasured plants in our garden, the trees in the park, our pet dog, our family, our friends, ourselves not least. All participate in the recurring cycle of growth, maturity, age and death.

What has all this to do with our experience of stress? Unlike these matters, stress is not a naturally recurring phenomenon. Problems and adverse circumstances in the biological sense are a natural part of life, but stress is essentially pathological. Something to be avoided, and which to a great extent can be avoided.

An awareness of these naturally recurring cycles in which we participate helps the living matter which is us to run more smoothly, as it were. The problems of life which could cause stress are seen rather as incidents on the background of what is around us, and their power to disturb us and create stress is so much the less.

Our awareness of these matters, in the way that it affects stress, is more than our knowledge of the subject. We all know of birth, growth and death. Such a knowing is a function of our intellect, and is little related to our experience of stress. Nor is the awareness, which is significant, simply our emotional involvement in these things. We have a feeling of attachment to the countryside, our forests, and the long sweep of the beach. We love our mate in life, our children, our family. But the awareness that affects our stress is something different. It is an understanding of these matters which relates neither to our intellect nor our emotions. It is just the naturalness and the simplicity of it all. So simple that it defies clear description in the sophistication of words. Those fortunate people who have something of this basic human awareness do not come under stress from the problems of life in the same way as others do.



“It’s his responsibility. His responsibility, not mine. That’s what he is paid to do. That’s what accountants are for. If the tax people want to make a fuss, let them get on to him, not me. It’s his responsibility. But I can’t help worrying. Worrying and worrying. Worry that it was my responsibility. I knew they might say it wasn’t quite right. He was trying to do his job. Damn him! He thought I would sack him if he did not do it that way. What a mess!”

It is quite clear there are two problems. There is the major problem of being investigated by the tax authority and the likelihood of being fined. And then there is the associated problem – the inner disquiet of his own conscience. Without the augmentation from the associated problem, the major problem may not reach such a degree of intensity as to produce stress.

The whole situation may be further complicated by some background problem, such as his wife’s unexpected pregnancy. But in the individual’s mind his symptoms of stress are caused, simply and solely, by the tax problem.

The major problem, the tax trouble, must be dealt with, in a practical way, according to established business principles.

The secondary problem, his guilt, and the disturbing influences to his brain arising from it, need to be dealt with by letting his mind run freely for a short period each day to reduce his level of anxiety and so allow his mind to settle. And the background problem, his wife’s pregnancy, requires his mental adjustment to a changed situation.

The difficulty is that the individual sees only the major problem, and is loath to attend to the other matters, which in fact may be the key to resolving the whole situation.



•     Eat a high-fibre diet rich in fruit and vegetables, whole-grain breakfast cereals, and whole meal bread and other whole meal-flour products (including pasta), and cut down on refined sugar and refined flour.

•     Drink more fluid to ensure that constipation is a thing of the past.

•     Avoid long periods of sitting and standing if you have a history of varicose veins in your family or if you have early signs of them yourself. Do exercises frequently if you are in this group. Wiggle your toes a lot, raise and lower yourself on the balls of your feet while standing in a queue in the supermarket or at a bus stop. Raise your legs on to a table whenever you sit down (get them above heart level), break up long rail or car trips by walking every hour or so, and walk around on long plane journeys.

•     Get more exercise. Swim, run, jog, walk or cycle to improve nature’s muscle pump in your legs. Walking lowers the venous pressure to a third of standing pressure under normal conditions.

•     Go barefoot at home as much as possible to exercise your foot muscles and improve your venous flow.

•     If you have even a hint of varicose veins starting, shun tight boots, pants that are too tight at the groin and anything that restricts the legs such as self-supporting stockings.

•     Make trips to the lavatory short and to the point-don’t sit there reading for ages.

•     Avoid very hot baths – these seem to encourage varicose veins.

•     If you have a family history of varicose veins wear support stockings throughout pregnancy.