A complicated topic

What are “diabetes complications”? This is a term I have real problems with: it’s misleading, and has unfortunate impacts on everyone.

I tend to think of there not actually being any such thing as a “diabetes complication”. There’s usually nothing “diabetic” about health complications.

What are people referring to?

Basically, at a crude level it’s about health complications that are more likely if you have diabetes. However calling them “diabetes complications” make them sound like automatic outcomes of having diabetes, which isn’t true.

There’s a scary list including these examples:

• Kidney damage (nephropathy)
• Nerve damage (neuropathy)
• Eye damage (retinopathy)
• Vascular disease (circulation issues)
• Heart disease
• Amputations
• Mental health (e.g. fear of hypoglycaemia, disordered eating, and diabulimia)

Of course some of those are inter-related. If someone starts to lose nerve sensation and then gets a cut on the underside of their foot, they might not notice it. And if they have reduced circulation in that area then it can be easier for infections to take hold. With those things combined, if the infection is advanced enough by the time it is detected, that could lead to the need for amputation, which is how amputation ends up on the above list.

Not doom and gloom!

The above list of health problems can be very scary, but it’s important to realise that having diabetes does not mean you will develop those problems. I’ll say that again:

Having diabetes does not mean you will develop any of these complications.

In fact these (or similar) health complications can also happen to people without diabetes. This is where risk, statistics, and probability come into play.

It’s all about risk

Many studies have shown that the risk of developing these complications increases with elevated blood glucose levels. Or more accurately, with sustained elevated BG levels. This can be seen for example in studies such as the UKPDS.

How elevated the BG levels have been for the last 3 months is indicated by the HbA1c measurement, and one of the general targets of managing diabetes has been to avoid elevated HbA1c results.

But the risk has never been shown to be 100% if your levels are elevated.
Nor 0.0000% risk with “non-diabetic” levels.

Just like your risk of developing cancer is never 0.0000%. No-one wants health complications like these, and everyone wants their risk to be as low as reasonably possible. But many things can be seen to increase your risks. Smoking is an example of something that significantly increases your risk of developing “complications” such as cancer. But there’s a cause-effect relationship there which seems pretty obvious to most people. Other risk relationships can seem more tenuous.

Another example:

You might be judged by doctors to be in excellent health, but if your parent or sibling is suddenly diagnosed with a heart condition today then your own risk of heart issues will jump up significantly.
Enough to change the treatment options doctors suggest (for example target cholesterol numbers might change). And enough that it might affect your health or travel insurance.

But yet you’re still as healthy as you were yesterday!
It can be frustrating, but that’s how the real-world mathematics of probability works.

Managing risks

Managing all these risks is tricky. We want to do whatever we can to reduce our risks (without reducing our quality of life). But at the same time it’s important not to somehow imagine that every probability will come true. That can be a road to hyperchondria and further mental health issues.

Admittedly, developing one of these health conditions does increase your risk of developing further conditions. But your risk only ever reaches 100% if you actually develop those conditions.

There are always examples of people who somehow make it through high-risk situations without issue. Whether it’s smoking, having high BG levels for years, or other “high-risk” situations, there are people who just manage to survive without side-effects. But that doesn’t mean the risk isn’t real or isn’t elevated.

No guarantees

Statistically, it’s known that maintaining lower HbA1c results (ideally by keeping our BG tightly controlled and then bringing it slowly down) can reduce our risk of developing other health conditions. But even then it’s not a guarantee. The same goes for managing dietary intake, lipid levels, etc, etc.

We can’t even say that having higher HbA1c results “will” cause health complications. All we can say is that it increases the risks.

We all need to find our own compromise of what level we’re happy (and able) to run at.

No blame

Neither are these health complications a result of being “a bad diabetic” (there’s actually no such thing).

It is possible to develop these health complications even if we “do everything by the book”. Hopefully if we’re looking after ourselves we might notice and treat them sooner, with good outcomes. But they can still happen, and we are not to blame.

Blame and threats are poor tools that don’t work as incentive. Hopefully the days of doctors “threatening” people with “complications” are a thing of the past.

“Diabetes Complications” are not a thing

When we hear about “Diabetes Complications” it puts the wrong emphasis on them.

Yes our risks of developing some of these health conditions are greater than for people without diabetes, but (once you remove the “diabetic” label) it would be rare to find a condition that only develops in people with diabetes. Ok, fear of hypoglycaemia might be a valid example…

It seems that the only reason researchers and clinicians sometimes lump the conditions together under a “diabetic” label is because they’re interested in the interaction between those conditions and having diabetes. Or as a vehicle to focus funding. But there’s rarely anything inherently “diabetic” about the conditions.

Calling them “diabetes complications” inherently associates them with diabetes, and drives an unnecessary sense of panic and doom in many people with diabetes.
#LanguageMatters again.

Please, we can talk about diabetes-related health conditions, health complications, or even diabetes-related health complications. But no more “diabetes complications”!