Month: August 2025

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes can affect many parts of the body, and one of the most serious yet often overlooked complications is Charcot foot. The condition is caused by the fact that nerve damage and poor circulation weakens the bones and joints of the foot, resulting in fractures, deformities and even disability, unless it is treated on time. Due to its blurred symptoms in the initial stages, like swelling, redness, and handiness, Charcot foot is often diagnosed at late stages when the problem is already in the progression stage. Learning about the Charcot foot, its formation, and preventive and curative steps is the key to maintaining long-term foot health in diabetic patients.

What is Charcot Foot?

Charcot Foot is a progressive disorder whereby there is weakening of bones, joints, and soft tissues in the foot or ankle. It is mostly due to peripheral neuropathy (damage to the nerves) which is often found in individuals with diabetes, and this leads to loss of sensation in the foot. Because of this numbness, minor or repeated injuries go undiagnosed and unattended resulting in fractures, joint dislocations and subsequent foot deformity like the rocker-bottom foot, arch collapses. This malformation adds a risk of skin sores, ulcers, infection and even amputation unless treated aggressively.

The process occurs in phases starting with inflammation and swelling, bone fragmentation, and dislocation of the joints, bone healing, and deformities. Redness, warmth (usually with the affected foot being warmer than the opposite), swelling, and pain or soreness are common. Unattended, Charcot Foot may cause severe deformity and instability of the foot and ankle joints, making walking hard and predisposing to severe complications.

Causes and Risk Factors

Causes and Risk Factors include:

• Charcot foot is mostly seen in individuals with peripheral neuropathy (usually diabetes). The numbness in the foot causes injuries and recurring trauma to go undetected, initiating inflammation and the destruction of bones.
• History of prior diabetic foot issues like ulcers, surgery, amputation or trauma is the biggest risk factor. This preceding injury triggers the inflammatory event that causes Charcot arthropathy.
• Other significant risk factors include:

•            Long duration of diabetes (over 10 years)

•            Poor blood sugar control and complications like nephropathy and retinopathy

• Objective: Obesity that causes pressure and stress to the insensate foot.

•            Age less than 60 years but with chronic diabetes.

•            Previous foot surgeries and deformities

•            Kidney disease and poor circulation

•            Lifestyle factors like smoking, alcohol consumption, and sudden increases in activity in patients with neuropathy.

• Charcot foot may also be presented in other circumstances with nerve damage, including spinal cord injury, Parkinson, multiple sclerosis, or syphilis.
• Such a cascade can be initiated by minor, repetitive trauma or foot sprain in a person with neuropathy, resulting in bone erosion and deformity.

Symptoms and Warning Signs

Symptoms and Warning Signs of Charcot Foot:

• It is the first indicators of Charcot foot and may at times be very sudden and sudden such as reddening, swelling of the foot or ankle and/or even at night. It can be much warmer around one foot than around the other.
• There can be mild pain or discomfort, and many patients have little or no pain despite severe injury because of nerve damage.
• The foot can also be swollen and reddish, and these symptoms may resemble infection or sprain, being often misdiagnosed.
• Later in the condition, the foot can become deformed with collapse of the midfoot arch (also known as rocker-bottom foot), curled toes as well as misalignment or dislocation of bones.
• The alterations of foot form may create irregular pressure sites, which result in blisters, wounds, or open ulcers. Such wounds are subject to infections and slow healing owing to reduced sensation and inadequate circulation.
• The foot swells and alters its shape, leaving patients with difficulty fitting into shoes.
• Charcot Foot Often, swelling and redness decrease with foot elevation and distinguishes it from infections where the redness and swelling do not disappear with elevation.
• Without treatment, deformity deteriorates, and this may lead to instability, walking problems and high chances of serious infections that may need amputation.

Stages of Charcot Foot Development

Charcot Foot develops through distinct stages, classically described in three main phases:

Stage I (Development or Fragmentation):

• The acute or the first stage is characterized by intense inflammation, redness, swelling and heat in the foot.
• The foot used to be hot in comparison with the other foot.
• Radiographs reveal destruction of bones with bone fragmentation, joint dislocation, fractures, and debris.
• This phase can take weeks to months, during which the foot is highly susceptible, and damage increases when weight bears are maintained.

Stage II (Coalescence):

• As the inflammation heals, swelling, redness, and warmth start to fade.
• The body begins to reabsorb bone debris and certain bone repairs take place.
• Radiographs reveal early bone sclerosis (hardness) and bone fusion beginning in selected locations.
• Foot stabilizing but deforming.

Stage III (Reconstruction or Consolidation):

• In this chronic stage, inflammation usually resolves, and the foot is no longer swollen or warm.
• Radiographs show bone healing with signs of remodeling, joint space narrowing, arthrosis (joint degeneration), and bone fusion.
• Despite healing, deformities—such as collapsed arches and foot misalignment—remain, often leading to a permanent change in foot shape.
• The foot becomes stable but structurally altered and prone to ulcers and other complications.

An additional Stage 0 has been described for clinical cases with signs of inflammation but no radiographic changes yet.

Diagnosis of Charcot Foot

Diagnosis of Charcot Foot involves clinical evaluation and imaging, with key components as follows:

Clinical Examination:

• Typical signs include edema (swelling), redness (erythema), and high temperature of the involved foot or ankle.
• Foot is usually warm, relative to other foot, occasionally by as much as 2C.
• The disorder is often free or with minimal pain because of peripheral neuropathy, yet patients complain of mild discomfort.
• A useful bedside exam is to raise up the affected foot when the patient is in the lying position with his feet raised up 5-10 minutes; swelling and redness in Charcot Foot will generally reduce, but swelling related to infection will likely not.
• Peripheral neuropathy should be evaluated with the help of the Semmes-Weinstein 10-g monofilament to determine absence of protective sensation.
• Infection should be assessed; foul odor, purulence, or gangrene are indicators of infection, not pure Charcot.

Imaging:

• X-rays (radiographs): the first and most common imaging modality to consider fracture, bone destruction, joint dislocation, and changes in alignment.
• Early acute Charcot can be missed in X-rays and not detected until weeks later; repeat X-rays in 2 weeks can be useful.
• MRI can help identify bone marrow edema and subtle changes early and distinguish between Charcot Foot and osteomyelitis, particularly when ulcers or infections are suspected.
• Bone scans and leukocyte scintigraphy may occasionally help differentiate Charcot and infection, but are limited.

Laboratory Tests:

• Blood glucose testing and HbA1c to assess diabetes control.
• Inflammatory markers like ESR and CRP can help differentiate infection (usually elevated) from Charcot (may be normal or mildly elevated).

Treatment and Management

Treatment and Management of Charcot Foot:

• Treatment involves mainly immobilization and offloading of affected foot to prevent further damage, inflammation and enable healing. This is normally done with a non-removable below-knee Total Contact Cast (TCC) or an irremovable walker cast. Immobilization can last several months before the acute phase heals.
• Patients should also not bear weight on the affected foot much, which may necessitate the use of mobility aids like crutches or wheelchairs.
• Follow-up and re-cast (every week or biweek) might be required regularly to make swelling corrections and follow up on healing progress.
• Patient education on the condition, the significance of strict compliance with offloading and immobilization, and the control of blood sugar is essential to successful work.
• After the acute phase is over, patients switch to individual orthotics, special shoes, or braces to support foot defects and avoid ulcers or disease relapse.
• Surgical intervention can be discussed in severe deformation cases, instability, or when ulcers and infections occur. Surgery may consist of realignment and stabilization of foot bones or in severe cases, amputation.
• Multidisciplinary care, such as endocrinologists, podiatrists, orthopedic surgeons, and physical therapists, is frequently included as well.
• Psychological and emotional support can be helpful because anxiety and depression are frequent in patients.
• It should maximize management of diabetes, peripheral neuropathy, and other risk factors to avoid progression or relapse.
• The routine use of drugs such as bisphosphonates in Charcot foot is not supported by strong evidence.
• Prevention is also useful, like the use of the correct footwear on the opposite foot because both feet can be involved in Charcot.

Bottom Line

Charcot Foot: A Serious Complication of Diabetes is an illness that needs to be identified and managed at an early stage to avoid long-term disability. It may cause extreme deformities, infections, and even amputation but with early diagnosis, off-loading, and continued foot care, most of them are preventable. Foot reviews, suitable footwear, and routine medical engagements are fundamental components of mobility and the general quality of life among individuals with diabetes. Through awareness and active management, we can minimize the risks and assist people to live healthy and active lives in spite of the complications of diabetes.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes is more than just a condition of high blood sugar—it is a major risk factor for serious cardiovascular problems. Among the most concerning are macrovascular complications, which affect large blood vessels and significantly increase the chances of developing heart disease and stroke. These are the life-threatening conditions that are the top causes of death in diabetics making awareness and its prevention very essential. Getting a clear grasp of how diabetes causes blood vessel damage, how diabetes increases cardiovascular risks and what can be done to reduce such risks is pivotal in preserving long-term health.

Understanding Macrovascular Complications of Diabetes

Macrovascular complications of diabetes are the damage and disease of the major blood vessels, which cause cardiovascular issues like coronary artery disease, a stroke, and peripheral artery disease. They are mainly due to accelerated atherosclerosis caused by hyperglycemia, insulin resistance, inflammation and other metabolic abnormalities in diabetics.

Major Macrovascular Complications

• Coronary artery disease (CAD): Diabetes adds risk, and coronary interventions have greater complications in diabetic individuals.
• Stroke: Diabetes also increases the likelihood of Cerebro-vascular disease, ischemic and hemorrhagic strokes.
• Peripheral artery disease (PAD): PAD is more common in diabetics and leads to non-optimal blood flow in limbs, claudication, ischemic sores, and likelihood of limb loss.

Pathophysiology and Risk Factors

The development of atherosclerosis is enhanced by diabetes by mechanisms that include endothelial dysfunction, arterial stiffness, and activation of platelets.

Hyperglycemia, insulin resistance, lead to damage of large vessels.

Risk factors such as hypertension, dyslipidemia and obesity are common in addition to the macrovascular risk often being combined.

Large arteries are affected through neovascularization and plaque, which encourage vascular blockage and thrombosis.

Diabetes and Heart Disease

Diabetes is a major cause of heart disease and adults with diabetes are almost twice as likely to get heart disease or stroke than those without diabetes. Diabetically induced high blood sugar levels weaken and destroy blood vessels and nerves that regulate the heart resulting in diseases like heart attack, heart failure, heart attacks, and strokes. The damage leads to fatty deposits (plaque) formation in arteries, a process referred to as atherosclerosis, which reduces blood flow by narrowing the arteries.

Diabetics also tend to have additional risk factors (that contribute to heart disease), which include high blood pressure, unhealthy cholesterol (high LDL, low HDL, high triglycerides), obesity, and lack of physical exercise. The combination of these contributes still further to cardiovascular risk. Also, the duration of diabetes increases the incidence of heart disease and complications.

Controlling sugar levels as well as blood pressure and cholesterol will minimize risks of heart disease. Healthy lifestyle measures that include healthy food habits, proper physical exercise, smoking, and weight loss are essential to controlling diabetes and associated cardiovascular risks.

Diabetes and Stroke

Diabetes is a significant risk factor in causing stroke and a person with diabetes is at 1.5 to 2 times more risk of stroke than those without diabetes. This augmented risk increases as the diabetes progresses and is classified by elements like big artery atherosclerosis, cerebral small vessel diseases, and cardiac embolism. Excessive blood sugar levels result in damaged blood vessels, which accumulate fats or clot, obstructing the blood flow to the brain (strokes).

Additional causes are hypertension, inflammation, vascular endothelial dysfunction, obesity, and metabolic disorders that commonly accompany diabetes. The worst outcomes and risk of having a stroke recur occur in people with diabetes who have had a stroke. Prevention of stroke in diabetic patients involves control of blood sugar levels, blood pressure and blood cholesterol, and drugs like GLP-1 receptor agonist and pioglitazone, which were proven to deliver cardiovascular benefits in addition to sugar control.

In general, diabetes increases the risk of both hemorrhagic and ischemic stroke, and these findings support the need to treat vascular risk thoroughly in diabetic patients to prevent stroke and to ensure good results in the case it still happens.

Diagnosis and Screening

The classification of cardiovascular complications in diabetes is diagnosis and screening that aims at early detection of coronary artery disease (CAD) and cardiovascular risk stratification. Although diabetes has been considered as a high-risk factor to cardiovascular disease, it is important to consider heterogeneity in the risk of such patients to be able to pursue screening accordingly.

Screening Methods

·       Risk Stratification Tools: The conventional cardiovascular risk algorithms might underrepresent risk in diabetes, stratification biomarkers, and imaging can enhance risk stratification.

·       Non-Invasive Imaging: CAC Scoring and coronary CTA allow detecting subclinical atherosclerosis and coronary artery disease when it is still not symptomatic yet.

·       Functional Stress Testing: Functional stress testing would include exercise electrocardiogram (exercise ECG), stress echocardiography and myocardial perfusion imaging (nuclear scans like SPECT, PET).

·       Other Imaging: Cardiac magnetic resonance imaging (CMR) late gadolinium enhancement identifies cardiomyopathy and cardiac scarring.

·       Electrocardiogram (EKG): Helpful to monitor baseline electrical status and changes of ischemic or arrhythmia.

Screening Recommendations

• Universal screening of all asymptomatic diabetic patients is not advised as there is limited evidence on improving outcome.
• They should screen high-risk patients (with symptoms, abnormal ECG, peripheral vascular disease, chronic kidney disease, or high CAC scores).
• Annual ECG is usually recommended in asymptomatic patients.
• Unusual results in non-invasive tests should be referred to an echocardiographic or coronary angiography.
• Screening aids in informing an individualized prevention plan such as increased medical treatment.

You may also like to read: Diabetic Retinopathy

Prevention and Management Strategies

Cardiovascular disease (CVD) management and prevention in diabetes patients is multifactorial and comprises multifactorial strategies aimed at lifestyle interventions and optimization of risk factor control.

Lifestyle Modifications

• Physical Activity: The combination of moderate-intensity exercise (150 or more minutes per week) with aerobic and resistance training enhances cardiovascular fitness, glycemia, and lessens risk factors such as blood pressure and dyslipidemia.
• Healthful Diet: A Mediterranean-style diet, which is rich in fruits, vegetables, whole grains, legumes, nuts, and olive oil, has resulted in a decrease in CVD and an improvement in glycemic levels. Reduction of saturated fats, trans fats, processed food, and added sugars is important.
• Weight Management: Weight loss programs as little as 3-5 percent result in significant blood pressure, blood sugar, and lipid improvements. It reduces heart disease and stroke by lowering central obesity.
• Smoking Cessation: Smoking in diabetes is very dangerous as this is a major risk factor to the heart.

Medical Management

• Glycemic Control: A target HbA1c of generally <7% will reduce microvascular complications; an individualized target may be applicable to patients based on patient factors.
• Blood Pressure Management: Blood pressure should be controlled to less than 140/90 mm Hg in most patients; patients with additional CV risk factors or younger patients may require tighter blood pressure targets, less than 130/80 mm Hg.
• Management of Lipids: Patients with diabetes aged 40-75 years are advised to take statin to reduce LDL cholesterol and cardiovascular risk.
• Antiplatelet Therapy: Aspirin can be used as a primary prevention in diabetics who have further risk factors keeping in mind the risk of bleeding.

Multifactorial Approaches

• Trials such as Steno-2 indicate that merging prescription of glucose, blood pressure, lipids, smoking cessation and lifestyle can yield significant improvement of cardiovascular events and mortality in diabetes.
• Treatment of all risk factors results in patients with diabetes being closer to those without it.

Bottom Line

In conclusion, the macrovascular complications of diabetes, particularly heart disease and stroke, remain among the most serious threats to long-term health. The constant uncontrolled blood sugar and associated excessive risks, including blood pressure and cholesterol, ruins the large arteries and hastens cardiovascular issues. The good part of it is that with frequent screening, proper blood sugar control, lifestyle changes and medical support, it is possible to cut these risks drastically. With the information and being proactive, individuals with diabetes can ensure the safety of their heart, reduce the risks of stroke, and live longer healthy lives.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Living with diabetes involves more than just keeping blood sugar levels in check—it also means staying alert to the complications that can quietly develop over time. One of the most common and sight-threatening of these is diabetic retinopathy, a condition that damages the delicate blood vessels in the retina. Usually developing without any advanced notice, it can cause quite severe sight issues unless dealt with in due time. This article will discuss the causative factors of diabetic retinopathy and the quality it can cause to eye health, and why early awareness and management are critical in protecting their sight.

What is Diabetic Retinopathy?

Diabetic retinopathy is a diabetic condition that affects the eye by damaging the blood vessels in the retina or the light sensitive tissue found at the back of the eye that converts light into images. The condition makes the retinal blood vessels swell, leak, or bleed to cause vision changes, blurry vision, or blindness without treatment. It normally impacts both eyes, and is the most frequent cause of vision loss in people with diabetes, and the most prevalent cause of blindness in adults.

Causes

Diabetic retinopathy is chiefly caused by the long-term effects of excessive sugar levels in the blood (hyperglycemia) whereby the small blood vessels supplying the retina, the light sensitive area on the inside at the back part of the eye, are damaged. This damage enlarges the blood vessels, drips fluid or blood, or blocks completely, resulting in poor blood circulation and oxygen deprivation in the retina.

There are two main types of diabetic retinopathy caused by these blood vessel changes:

• Nonproliferative diabetic retinopathy (NPDR), in which the thin walls of blood vessels have small bulges that in some cases leak blood or water causing swelling (macular edema) and destruction to the retina.
• Proliferative diabetic retinopathy (PDR), still more advanced when damaged vessels are occluded, which triggers the formation of new abnormal blood vessels (neovascularization) that may break, bleed, and lead to scar tissue. This may cause retinal detachment, vitreous bleed, glaucoma and irreparable blindness.

Additional factors that contribute to the risk and severity of diabetic retinopathy include:

• Poorly controlled blood sugar over time
• High blood pressure
• High cholesterol
• Smoking
• Pregnancy
• Ethnic factors (higher risk in Black, Latino, Native American populations)
• Longer duration of diabetes

The pathophysiology in this is the biochemical processes that lead to oxidative stress, inflammation, and vascular growth factor alterations leading to Leakage of the blood vessels in the retina and other blood vessels grow abnormally.

Stages of Diabetic Retinopathy

Diabetic retinopathy advances through a series of stages, which are mostly broadly divided into nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). These levels show additional retinal blood vessel damage.

• Stage 1: Mild Nonproliferative Diabetic Retinopathy (Mild NPDR)
  • Defined by microaneurysm, small blister-like growths in the vessels of the retina.
  • This initial phase does not interfere with the vision but is the onset of diabetes damage in the retina.
• Stage 2: Moderate Nonproliferative Diabetic Retinopathy (Moderate NPDR)
  • More blood vessels are destroyed, with blood and water leaking into the retina.
  • The buildup of the fluid can lead to macular edema and blurred vision.
• Stage 3: Severe Nonproliferative Diabetic Retinopathy (Severe NPDR)
  • Extensive blocking of blood vessels leads to serious retinal ischemia (incapacity).
  • Signals the retina to begin growing new blood vessels, which will lead to the risk of severe vision problems.
• Stage 4: Proliferative Diabetic Retinopathy (PDR)
  • The worst and further developed stage.
  • New abnormal vessels develop (neovascularization) that are susceptible to bleeding.

These vessels form scar tissue, which may lead to retinal detachment and blindness or serious loss of vision.

Consequences of Diabetic Retinopathy

Diabetic retinopathy may have catastrophic sequels, mainly related to the loss of sight and blindness. The key complications arise because of damage to the retinal blood vessels due to diabetes.

Key Consequences

• Loss of Vision and Blindness: The eye has numerous blood vessels, which when damaged cause their leakage to produce blurred vision. Untreated, diabetic retinopathy can worsen to total loss of sight or blindness.
• Vitreous Hemorrhage: When the weak, damaged new blood vessel growth in proliferative retinopathy bleeds into the vitreous (a gel-like material inside the eye), people will have floaters or severe blurring. Though vision may recover when the blood is clear, repeated bleeding may cause permanent loss.
• Retinal Detachment: A defective network of blood vessels can grow and pull the retina off the back of the eye (tractional retinal detachment), resulting in poor vision or blindness unless it is treated early.
• Macular Edema: Liquid getting into the macula (the central part of the retina that gives clear and distinct vision) will result in the macula getting swollen (macular edema) and central vision becoming nonexistent or distorted. This may happen at any stage, and it is a usual cause of sight loss in diabetic eye disease.
• Glaucoma: Due to the formation of new blood vessels on the iris, liver flow of fluid that balances the eye pressure may be blocked, which in turn leads to glaucoma and severe damage to the optic nerve and the loss of sight.

All in all, diabetic retinopathy is the primary cause of blindness in the working-age population, so preventing this adverse event through early diagnosis, close monitoring, and proper diabetic control is essential.

Symptoms and Warning Signs

Diabetic retinopathy may not show any symptoms in its initial stages so it is hard to notice without an eye test. As the condition develops, there are various warning signs and symptoms such as:

• Blurred or distorted vision may pass, or become progressively worse.
• Eye floaters, which are spots, dark strings, or cobwebs that move in the vision field.
• Bad eyesight in poorly lighted areas.
• Trouble to remember color shades and change in their appearance.
• Blind spots in the field of vision.
• Narrowing side vision.
• Change in day-to-day vision regarding nearsightedness or farsightedness.
• Acute malfunction or blindness, usually a symptom of complications that must be urgently treated.

Diagnosis and Screening

Diagnosis and Screening of Diabetic Retinopathy

• Dilated Eye Exam: Widens pupils to check retina and optic nerve for damage.
• OCT (Optical Coherence Tomography): Scans retinal thickness and swelling.
• Fluorescein Angiography: Uses dye to detect leaking or blocked vessels.
• Visual Acuity Test: Measures clarity of vision.
• Fundus Photography: Captures retinal images to track changes.
• OCT Angiography (OCTA): New imaging method for detailed blood flow without dye.

Screening Recommendation:

• Annual eye exams for people with diabetes (more frequent if advanced).
• Early detection helps prevent vision loss.

You may also like to read: Diabetic Neuropathy

Treatment Options

The main treatment options for diabetic retinopathy include:

·       Laser Therapy (Photocoagulation): It shrinks or blocks the blood vessels; it is particularly successful in proliferative diabetic retinopathy and macular edema.

·       Anti-VEGF Injections: Drugs placed in eye to inhibit vascular endothelial growth factor that prevents abnormal blood vessel development and leakage of fluids.

·       Steroid Implants: Retina inflammation and swelling are subdued with corticosteroid implants that offer slow-release properties.

·       Vitrectomy Surgery: The surgical act of eliminating the blood/scar tissue found in the vitreous gel in severe cases involving hemorrhage and retinal detachment.

·       Diabetes and Risk Factors Management: Management of diabetes and associated risk factors is imperative in slowing progression and enhancing the outcomes of treatment.

Final Thoughts

Diabetic retinopathy is a dangerous side effect that may have hampered sight in analogy if not treated early. By learning its causes and effects, regular eye exams, controlling blood sugar and overall health management, a person can significantly reduce the possibility of losing his/her eyesight. The best methods of saving vision and quality of life are early detection and early treatment.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetic neuropathy is the altogether most widespread and acute issue of diabetes that affects a great number of people in the world. It happens when nerves are damaged by excess blood sugar making them accompanied by pain, numbness, or weakness in the hands and feet. In addition to pain, the condition may impede everyday functions and lead to serious health complications when ignored. This knowledge will be critical to the treatment of diabetic neuropathy and the long-term health care of diabetic patients.

What is Diabetic Neuropathy?

Diabetic neuropathy is the result of nerve damage that develops because of sustained elevated glucose levels over time and affects the transmission of signals between the brain, spinal cord, and the rest of the body. It can impact sensory nerves (which sense), motor nerves (which operate muscles), and the autonomic nerves (which regulate uncontrolled motions like heart rate and digestion).

Causes of Diabetic Neuropathy

Diabetic neuropathy occurs chiefly because of long-term chronically raised blood sugar level (hyperglycemia) in people with diabetes. This high blood sugar breaks nerves and damages small blood vessels (capillaries) that carry oxygen and nutrients to the nerves, causing nerve damage and dysfunction.

Additional contributing causes and risk factors include:

• Ineffective blood sugar management puts the chances and severity of nerve damage at risk.
• Chronic period of diabetes with the risk growing the longer the individual has diabetes.
• Hypertension and elevated cholesterol level, which aggravate damage of the blood vessels and nerves.
• Kidney disease (diabetes nephropathy) harbors toxins that cause further damage to womb nerves.
• The result of being overweight or even being obese constitutes metabolic stress.
• Smoking, an activity that constricts blood vessels and decreases blood flow to nerves.
• High triglycerides or fats in the blood harm nerves.
• Some genetic predispositions that can pre-dispose one into risk of nerve damage.

Symptoms

Symptoms of diabetic neuropathy vary according to the nervous system affected. Our diabetic neuropathy comes in four specific types, each with their specific symptoms:

Peripheral Neuropathy (Most Common)

• Numbness or reduced ability to feel pain or temperature changes, especially in the feet and legs.
• Tingling or burning sensations.
• Sharp, stabbing pains or cramps.
• Muscle weakness.
• Heightened sensitivity to touch, where even the lightest touch like a bedsheet can cause pain.
• Significant foot complications like ulcers, infections, damage to the bones or joints.
• Symptoms can begin in the feet and legs and become more intense at night.

Autonomic Neuropathy

• Influences autonomic functions (those effected by ANS)
• Its symptoms are a lack of warning of low blood sugar (hypoglycemia unawareness), dizziness or fainting when standing because of blood pressure drop (orthostatic hypotension), bladder and bowel problems, stomach problems like nausea, vomiting, constipation or diarrhea, slow emptying of the stomach (gastroparesis).
• Sexual dysfunction like erectile dysfunction as well as vaginal dryness
• Variations in the faculties of sweating and impaired reaction of the heart rate.

Proximal Neuropathy (Diabetic Amyotrophy)

• Sudden, sharp pain in the hips, thighs, buttocks or legs, usually unilateral.
• Weakness of the muscles and distress in getting up after sitting posture.
• Symptoms are contagious and Iggy: they get better eventually.

Focal Neuropathy (Mononeuropathy)

• It involves destruction of one nerve or sets of nerves.
• Acute pain or weakness of a particular body part like the face, torso, arm or leg.
• Symptoms are possible to be double vision, lack of the ability to move facial muscles, pain or weakness of a particular limb or an area, and carpel tunnel syndrome symptoms.

Symptoms appear slowly in most cases and are mild or severe. Preventing progression starts by early detection and treatment to control symptoms.

Risk Factors for Developing Diabetic Neuropathy

The main risk factors for developing diabetic neuropathy include:

• Ineffective blood sugar control: High, consistent levels of glucose worsen and increases the likelihood of nerve damage. The chronic elevated A1C levels are strongly associated with neuropathy.
• Long term diabetes: The risk is greater with the number of years the person has diabetes, often after 10-15 years.
• Kidney disease: Diabetic kidney damage causes toxins to be built up in the blood, which destroys nerves.
• Obesity or overweight: Obesity or being overweight increases the risk of neuropathy.
• Smoking: Smoking constricts blood vessels and hinders blood flow to the nerves, injuring them and slows wound healing.
• Blood pressure and high cholesterol: Both are associated with the damage of vessels aggravating the health of nerves.
• Age: The older age promotes the potential of nerve damage.
• Other causes: Diabetic complications like eye damage (retinopathy) and changes in metabolism like dyslipidemia would also put you at risk.

Diagnosis

Diagnosis of diabetic neuropathy entails a mixture of clinical assessment, patient history, and specialized tests to support nerve damage and the measuring of the side effects.

Clinical Evaluation

• Specific symptoms history, such as numbness, tingling, burning, pain, muscle weakness.
• Physical assessment with special emphasis on sensation (light touch, pinprick, vibration, heat), reflexes (reflexes (specifically, ankle jerks), and strength tests.

Screening Tools

• Michigan Neuropathy Screening Instrument (MNSI): A combination of both patient questionnaire and physical examination to screen peripheral neuropathy.
• Symptomatology The Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS) evaluate symptom severity and neurological function.

Electrophysiological Tests

• Nerve Conduction Studies (NCS): This is considered the gold standard, and it is used to measure the strength and speed of electrical messages in peripheral nerves. Handy especially in large fiber neuropathy.
• Electromyography (EMG): The electrical activity of a muscle, and the signal transmitted by a nerve to the muscle, can be measured.

Quantitative Sensory Testing (QST)

Tests the response of the small and large nerve fibers using stimulus of vibration, temperature and pressure. It helps diagnose the early nerve damage.

Specialized Tests

• Skin biopsy to measure intra-epidermal nerve fiber density (IENFD), which is especially useful to diagnose the small fiber neuropathy.
• Corneal confocal microscopy (CCM) as a promising non-invasive technique to image small nerve fibers in the cornea.

Additional Tests

• Blood tests to eliminate other non DPP causes of neuropathy (ex. vitamin deficiencies, thyroid function).
• Evaluation of blood sugar control and diabetes complications.

Treatment

There is no cure to diabetic neuropathy, and treatment is aimed at controlling symptoms, halting illness, and enhancing quality of life.

Key Treatment Approaches

Blood Sugar Control

• In type 1 diabetes, tight control of glucose slows, or even halts, the progression of nerve damage. The data on type 2 diabetes is inconclusive, but it is generally accepted that blood sugar should be kept within individualized target ranges (usually A1C at 7.0 percent or below).

Pain Management

• Medications for neuropathic pain include:
  • Antidepressants: Duloxetine, amitriptyline.
  • Anticonvulsants: Pregabalin, gabapentin (FDA-approved).
  • Opioid-like drugs (used cautiously): Tramadol, tapentadol.
  • Topical agents: Capsaicin cream, lidocaine patches.
• Neuromodulation methods such as spinal cord stimulation are emerging possibilities of severe, refractive pain.

Symptom Relief and Supportive Care

·       Heralded conditions such as blood pressure and cholesterol and obesity management contribute to the health of nerves overall.

·       Occupational therapy, along with physical therapy, may increase mobility and functioning.

·       The symptoms and overall, wellbeing are alleviated by lifestyle changes such as stopping smoking, exercising and adopting proper diet.

Pathogenetic Treatments (Targeting Underlying Nerve Damage)

• Antioxidants such as alpha-lipoic acid.
• Benfotiamine to prevent vascular damage.
• Inhibitors of the polyol pathway include aldose reductase inhibitors that are under development.

Advanced Therapies

Pancreas or islet cell transplantation in type 1 diabetes has limited nerve functional improvement but is impeded by its availability and risks.

You may also like to read: Metabolic Acidosis

Complications of Untreated Diabetic Neuropathy

• Loss of Sensation and Injuries: The loss of feeling in feet and legs nerve damage does not notice cuts, blisters, and sores easily.
• Infections and Ulcer: A sore with minor infection heals slowly and, in some cases, leads to gangrene and amputation.
• Autonomic Dysfunction: Cause of bladder problems, blood pressure, digestive problems (gastroparesis, diarrhea, constipation), and sexual dysfunction.
• Risk of falls: Lightheadedness, muscle loss, and poor coordination result in an increased risk of falls and injuries.
• Cardiovascular Issues: Cardiovascular Issues: May initiate heart rhythm disorders and silent heart attacks.
• Disability and Chronic Pain: Chronic nerve pain affects daily functionality, mobility and mental health.
• Increased Risk of Death: The patients with neuropathy, particularly those with ulcers on their feet are at risk of dying prematurely.

Bottom Line

Diabetic neuropathy is a severe consequence of diabetes which may severely affect the quality of life when not approached early. People with diabetes can enhance nerve protection by knowing their risk factors, spotting warning signs, and addressing them to prevent chronic complications. Controlling blood sugar, a healthy lifestyle, and adherence to the recommendations of a medical worker are steps to reduce risks. Diabetic neuropathy can be managed with prevention and proper care and live a healthy and safe life.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Health conditions that affect the body’s delicate balance often develop silently but can have serious consequences if left untreated. One such condition is metabolic acidosis, a disorder that changes how the body manages acids and bases. It may manifest in diabetics, kidney disease or even due to infections and some medications. Since its initial symptoms can be only vague, it is essential to learn about what metabolic acidosis is, how it can occur, and what diagnosing and treating it requires to ensure overall health and avoid complications.

 What is Metabolic Acidosis?

Metabolic acidosis is a health condition whereby the body fluids contain excess acid, which causes the blood pH to drop abnormally (below 7.35). It arises in case of excess acid by the body, inability of the kidneys to eliminate enough acid, or loss of bicarbonate that normally neutralizes acid in the blood.

Types of Metabolic Acidosis

Metabolic acidosis is classified primarily into two major types based on the anion gap (AG):

1. High Anion Gap Metabolic Acidosis (HAGMA)

• Marked by a greater number of unmeasured anions in the blood.
• Common causes include:
  • Ketoacidosis (e.g., diabetic ketoacidosis)
  • Lactic acidosis (due to tissue hypoxia or other causes)
  • Renal failure (accumulation of acids normally cleared by kidneys)
  • Ingestion of toxins such as methanol, ethylene glycol, salicylates, and metformin
• The anion gap rises as the acid accumulates, contributing to unmeasured anions such as lactate and ketones.

2. Normal Anion Gap Metabolic Acidosis (NAGMA) or Hyperchloremic Acidosis

• Characterized by loss of bicarbonate or inability of the kidneys to produce bicarbonate without an augmentation in unmeasured anions, resulting in a comparatively normal anion gap.
• Common causes include:
  • Renal tubular acidosis (types 1, 2, and 4)
  • Gastrointestinal bicarbonate loss (e.g., diarrhea, fistulas)
  • Certain drug effects, like carbonic anhydrase inhibitors
• Chloride levels tend to rise to compensate for bicarbonate loss.

Subtypes of Renal Tubular Acidosis (RTA)

• Type 1 (Distal RTA): Distal tubule failure to release hydrogen ions, resulting in the retention of acid.
• Type 2 (Proximal RTA): Loss of bicarbonate due to defects in the bicarbonate reabsorption in the proximal tubule.
• Type 4 RTA: Complicated by hypoaldosteronism with the lack of ammonium excretion and hyperkalemia.

Other variants of metabolic acidosis are lactic acidosis subtypes (Type A associated with tissue hypoxia and Type B without hypoxia), and ketoacidosis associated with elevated ketone bodies due to fat metabolism.

Causes and Risk Factors

Metabolic acidosis occurs due to factors that increase acid secretion, bicarbonate loss, or failure to eliminate acid by the kidneys. Important causes and risk factors are:

Causes

• Kidney Disease: Chronic kidney disease (CKD) and acute kidney injury impairs the kidneys to eliminate acids and the ketones are accumulated.
• Diabetic Ketoacidosis (DKA): When diabetes is not controlled, the body accumulates ketone bodies that are acidic.
• Lactic Acidosis: This is the accumulation of lactic acid caused by conditions such as cancer, acute anemia, sepsis, heart failure, liver failure, excessive exercising and alcohol abuse.
• Severe Diarrhea: Causes great loss of bicarbonate that is a base neutralizing acid.
• Ingestion of Toxins: Poisoning by aspirin, ethylene glycol (antifreeze), and methanol.
• Renal Tubular Acidosis: the kidney tubules are unable to remove acid normally, which accumulates.

Risk Factors

• Chronic Illness: Diabetes, kidney disease, liver disease.
• Medications: Drugs like diuretics, certain chemotherapy agents, and aspirin.
• Dehydration: A severe loss of fluids due to illness or diarrhea may influence acid-base balance.
• Lifestyle Factors: High-fat, low-carbohydrate diets, heavy alcohol use.
• Genetic Conditions: There are unusual genetic diseases of kidney function.
• Age: Elderly people are more susceptible to this because of kidney failure.
• Other Factors: Smoking, anemia, hyperkalemia (high potassium), and certain infections (e.g., sepsis).

Altogether, metabolic acidosis may be caused by a mixture of causes and is more probable in persons with some chronic illness or a poisonous exposure.

Signs and Symptoms

The signs and symptoms of metabolic acidosis vary depending on the acid-base imbalance and the cause. Signs and symptoms include:

• Pulmonary alterations: Deep and fast breathing at the onset (Kussmaul respirations) to drive out carbon dioxide as an adaptation, which may subsequently slow and become deeper as acidosis advances.
• Neurological symptoms: Confusion, headache, lethargy, sleepiness, and in severe cases, stupor or coma.
• Cardiovascular effects: Fast heartbeat (tachycardia) and palpitations.
• Gastrointestinal: Nausea, vomiting, and appetite loss.
• General symptoms: Fatigue, weakness, and malaise.
• Special signs: Fruity-smelling breath, especially in diabetic ketoacidosis.

Mild cases can be silent, or more severe or faster acidosis develops, leading to clear clinical symptoms. Physical examination may be unpromising except insofar as it indicates the underlying disorder. Severe metabolic acidosis may precondition cardiac dysfunction, arrhythmia, and shock.

You may also like to read: Diabetes Mellitus and Kidney

Diagnosis of Metabolic Acidosis

The diagnosis of metabolic acidosis involves several key laboratory tests and clinical assessments:

Primary Diagnostic Tests

• Blood Tests:
  • Serum bicarbonate (or serum CO2), which is usually included in a basic metabolic panel (BMP) or comprehensive metabolic panel (CMP). Less than 22 mEq/L of bicarbonate indicates metabolic acidosis.
  • ABG analysis to determine blood pH, partial carbon dioxide pressure (pCO2), and bicarbonate. Low bicarbonate and pH under 7.35 confirm the metabolic acidemia.
• Anion Gap Calculation:
  • Anion gap = Na – (Cl + HCO3). This helps differentiate high anion gap metabolic acidosis from normal anion gap types.
  • The normal anion gap is around 12 mEq/L; values higher than this indicate high anion gap acidosis.

Additional Tests to Identify Cause

• Serum lactate to check for lactic acidosis.
• Blood ketones for ketoacidosis.
• Kidney function tests (BUN, creatinine) to assess renal impairment.
• Urinalysis to check urine pH and presence of ketones or other abnormalities.
• Toxin levels if poisoning is suspected (e.g., salicylates, methanol).

Interpretation Steps

• Confirm acidemia (pH < 7.35).
• Confirm metabolic origin by low bicarbonate and low/normal pCO2.
• Calculate the anion gap to classify metabolic acidosis.
• Determine if respiratory compensation is appropriate using Winter’s formula.
• Assess for mixed acid-base disorders if the clinical picture is complex.

Treatment and Management

Treatment and management of metabolic acidosis focus primarily on correcting the underlying cause and restoring the body’s acid-base balance.

Key Treatment Approaches

• Treat the underlying cause: This entails the management of the underlying problem or condition using interventions such as insulin, antibiotics, dialysis, or antidote ingestion.
• Nutritional care: A higher intake of fruits, vegetables and plant-based proteins may be used to decrease acidic load by supplying alkaline substances. It can also be reduced by eating fewer foods that produce acid such as meats, egg yolks, and processed cheeses. Eating habits must be individualized and guided by a professional.
• Alkali therapy: Sodium bicarbonate or sodium citrate preparations can be used to counteract excess acid, particularly in chronic metabolic acidosis, or in severe acute cases with a very low pH(e.g. below 7.2). Potassium citrate can be administered under some circumstances, but with care to prevent hyperkalemia.
• IV fluids: Fluid replacement with the right electrolytes is necessary, particularly in diabetic ketoacidosis or lactic acidosis.
• Renal replacement therapy: Hemodialysis or continuous renal replacement therapy might be required in severe cases or in cases where metabolic acidosis is not responding to normal treatment, especially in acute renal failure or toxicity.
• Other adjunctive therapies: Therapies can be vitamin supplementation (e.g., B1 in lactic acidosis), antidotes in case of poisoning, or inotropes to augment cardiac output.

Important Considerations

• The therapy depends on the severity of acidosis and disease.
• It is important to monitor to prevent such complications as electrolyte imbalances, fluid overload, or rebound alkalosis.
• Acidosis of pH 7.20 or below is in many cases severe enough to warrant intensive care.

Bottom Line

Metabolic acidosis is a severe illness and it may afflict anybody, but particularly diabetes, kidney and other chronic illness patients. Early diagnosis, early medical consultation, and prevention of underlying cause are essential in avoiding life threatening complications. Most individuals can manage metabolic acidosis and preserve their health in the long-term with adequate diagnosis, treatment, and lifestyle modifications. The most appropriate action to remain healthy is to be informed and active.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes mellitus is one of the most common chronic conditions worldwide, and its impact goes far beyond high blood sugar levels. Among the most serious complications is the effect on the kidneys, often leading to diabetic kidney disease or chronic kidney disease (CKD). The connection between diabetes mellitus and kidney health is critical because uncontrolled blood sugar and high blood pressure can silently damage kidney function over time. Understanding how diabetes affects the kidneys, recognizing early warning signs, and taking preventive steps are essential to protect long-term health and quality of life.

How Diabetes Mellitus Affects the Kidneys

Diabetes mellitus has an impact on the kidneys in the form of damage to the tiny blood vessel and filtration units (nephrons) within the kidneys, a condition called diabetic nephropathy or diabetic kidney disease. With a high level of sugar (glucose) in the blood, the blood vessels in the kidneys become small and clogged, reducing their efficiency to remove waste. This damage results in loss of proteins like albumin in the urine, and it may result in inflammation, cell stress, and eventual death of kidney cells. The process also hampers kidney functionality over time and can lead to kidney disease and future kidney failure should it go without treatment.

How Diabetes Damages the Kidneys

• Millions of small filters called glomeruli, composed of capillaries, are found in the kidneys. Elevated blood glucose levels injure these blood vessels, making them thicken, scar, and stiffen, thereby decreasing kidney functionality.
• This damage leads to the leakage of proteins into the urine (proteinuria or albuminuria), which is an early indication of kidney damage.
• The elevated glucose condition also enhances oxidative stress and inflammation in kidney cells, further aggravating damage and triggering cell death.
• Diabetes may also affect nerves regulating the bladder, resulting in urinary retention and infections that worsen the kidneys.

Signs and Symptoms of Diabetic Kidney Disease

Signs and symptoms of diabetic kidney disease (diabetic nephropathy) often do not appear in the early stages. As the disease progresses and kidney damage worsens, symptoms may include:

• Swelling of the hands, feet, ankles, or around the eyes due to fluid retention.
• Foamy or bubbly urine, indicates protein leakage (proteinuria).
• Increased frequency of urination, especially at night.
• High blood pressure that becomes difficult to control.
• Fatigue, weakness, or feeling generally unwell.
• Poor appetite, nausea, or vomiting.
• Itching and dry skin, particularly in late-stage kidney disease.
• Trouble concentrating or confusion, sometimes associated with the accumulation of waste products (uremia).
• Muscle cramps or twitching.
• Shortness of breath and irregular heartbeat in advanced disease due to fluid overload and increased potassium levels.
• Metallic taste in the mouth.

Risk Factors 

The key risk factors for kidney disease in diabetes, specifically diabetic kidney disease (DKD), include:

• Duration of Diabetes: Longer time duration, over 10-15 years is highly risky.
• Poor Control of Blood Glucose: A high level of HbA1c means high risk.
• Blood Pressure (Hypertension): It is one of the strongest modifiable risk factors.
• Dyslipidemia: An over level of cholesterol and triglyceride is more harmful.
• Obesity: Being overweight is an expansive cause of renal damage.
• Sick bed of other Diabetic associated Complications: Greater risk is associated with diabetic retinopathy and neuropathy.
• Age: This age-increases with advancing age beyond 45 or 50 years.
• Gender: Female gender has been cited to be at risk in some studies and male gender in others.
• Family History and Genetic Predisposition: There is increased risk in case of family history of kidney disease or hypertension.
• Risk Factors: Risk factors include lack of exercise and ever smoking.
• Ethnic Background: Increased risk among the South Asian, Black, African and African Caribbean groups.
• Socioeconomic Factors: Poverty and a lack of access to healthcare put people at greater risk because of late diagnosis and treatment.

Diagnosis and Screening

Diagnosis and screening of diabetic kidney disease (DKD) primarily rely on detecting abnormal kidney function and early signs of kidney damage through urine and blood tests:

• ACR: This makes it the most accurate and sensitive test to identify early kidney damage (Microalbuminuria). An ACR of 30 to 300 mg/g is microalbuminuria, which is the first sign of DKD. Higher than 300 mg/g represents macroalbuminuria, which is the more serious phase.
• Urinalysis: Protein (albumin) in urine (proteinuria) is detected by a routine urine dipstick test. It is common in screening, but it only picks up macroalbuminuria.
• Estimated Glomerular Filtration Rate (eGFR): eGFR shows the efficiency of kidney filtration based on a blood test that measures the level of creatinine. A deteriorating eGFR is indicative of deteriorating renal health
• 24-hour Urine Collection: Looks at the total excretion of albumin in the urine, which is less practical as a frequent screen.
• Kidney Imaging: The imaging of the kidneys by measurement of size and structure; useful in ruling out other ailments or complications.
• Isolated to only when causes are uncertain or non-diabetic kidney disease is suspected, and to confirm the diagnosis, the kidney should be biopsied.

Screening Recommendations:

• Patients with type 2 diabetes should be screened annually for albuminuria (via spot urine ACR) and eGFR at diagnosis, and type 1 diabetes patients should be tested 5 years after diagnosis.
• Microalbuminuria also needs confirmation by at least 2 urine tests, split by 3 to 6 months, since albumin excretion is inconsistent.

You may also like to read: Warning Signs of Diabetes in Women

Prevention and Management

Prevention and management of diabetic kidney disease (DKD) focus on controlling blood sugar, blood pressure, and other related risk factors to slow disease progression and reduce complications.

Prevention Strategies

• Excellent Blood Sugar Control: Controlling blood sugar in its target level lowers the chances of developing DKD and its advancement. Periodic monitoring of long term glucose control with A1C testing is advised.
• Blood Pressure- It is essential to ensure that blood pressure is kept below 140/90 mmHg (or better 130/80 mmHg). Such medicine as ACE inhibitors or angiotensin receptor blockers (ARBs) is prescribed to keep kidneys safe in addition to reducing blood pressure.
• Lifestyle Modifications:
  • Plenty of vegetables, fruits, whole grains, and low sodium and refined carbohydrates, processed food, and sugary drinks.
  • Regular (at least 150 minutes per week) physical activity to maintain a healthy weight and to maintain cardiovascular health.
  • Kick the smoke to inhibit kidney and cardiovascular damage.
  • Avoiding nephrotoxic drugs, including NSAIDs, unless advised and followed up.

• Weight Management: Healthy weight loss and management take pressure off the kidneys and overall metabolic health.
• Lipid Management: Statins can be used to control cholesterol and lower cardiovascular DKD risks.
• Periodic Checks: Urine albumin (ACR) and kidney-function (eGFR) checkups ought to be done annually to pick up problems early and initiate treatments.

Management Approaches

• Medications:
  • Glycemic control with agents that also offer kidney protection (e.g., SGLT2 inhibitors, GLP-1 receptor agonists).
  • ACE inhibitors/ARBs for hypertension and kidney protection.
  • Statins for lipid control.
• Dietary Recommendations:
  • Limiting protein intake to reduce kidney workload.
  • Controlling sodium, phosphorus, and potassium intake to prevent complications.
• Advanced Disease Management:
  • For end-stage renal disease (ESRD), dialysis or a kidney transplant may be necessary.
• Patient Education and Support: Diabetes self-management education, behavioral interventions, and a multidisciplinary care team improve adherence and outcomes.

 Treatment Options for Advanced Kidney Disease

The treatment of advanced diabetic kidney disease, especially when the disease moves to ESKD, includes several methods aimed at the replacement of kidney functions and symptom control:

Dialysis

• Hemodialysis: The machine removes waste, excess fluids and toxins in the blood outside the body. Administered generally thrice per week in a dialysis clinic or at home with instruction.
• Peritoneal Dialysis: The peritoneum or lining of the abdomen is used as a natural filter. Special fluid is introduced into the abdomen by a catheter to absorb waste and drained. Can be done both at home or in work but not everyone.

Kidney Transplant

• A kidney transplant is the preferred treatment due to good results in the long run, in eligible patients having kidney failure. The kidney is removed and transplanted into the recipient surgically, and connections with the bladder are restored.
• Transplant has better life quality than dialysis, however, it needs permanent immunosuppressive agents thus preventing immediate rejection.

Pharmacological Treatments

• Further utilization of renin-angiotensin system (RAS) blockers (ACE inhibitor or ARB) can help slow progression.
• SGLT2i and GLP-1 RA agents have demonstrated a benefit on the reduction of kidney disease and cardiovascular risk even in the presence of advanced chronic kidney disease.
• Blood pressure, blood sugar, lipids, and electrolytes should be managed carefully.

Lifestyle and Supportive Care

• Dietary restrictions (limiting protein, sodium, phosphorus, and potassium depending on disease stage).
• Fluid management and symptom control.
• Multidisciplinary care teams to support complex medical regimens and patient education.

Emerging and Future Therapies

• New pharmacological agents and regenerative medicine are being studied to repair or delay kidney damage in diabetic nephropathy, but are not standard of care.

Bottom Line

The relationship between diabetes mellitus and kidney health highlights the importance of early detection, strict blood sugar control, and proactive lifestyle choices. As diabetic kidney disease may develop unnoticed, early detection and medical assistance may delay or even prevent the critical complications. With the help of a healthy diet, maintaining blood pressure, exercising, and other treatments, people with diabetes can preserve their kidney health and have a better life. It is not only essential to prevent disease when focusing on kidney health, but also to achieve a healthier and longer life among people with diabetes.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes is a widespread health condition that affects millions of people worldwide, but its impact can differ significantly between men and women. Recognizing the early signs of diabetes in women is crucial, as timely detection helps prevent serious complications and improves long-term well-being. Though frequent thirst or weakness are manifestations typical of both genders, women exhibit other signs specific to hormonal activity or reproductive condition, and greater susceptibility to infection. Being aware of these peculiar warning signs is the first step toward better management and a healthier life.

Understanding Diabetes in Women

Diabetes in females is a set of metabolic disorders that results in excessive blood sugar levels because of impairment in insulin production or usage. Women can share the same symptoms of diabetes, like increased thirst, frequency of urination, and fatigue, but have some other symptoms, i.e., having recurrent yeast infections, urinary tract infections (UTIs), and vaginal dryness. Diabetes is primarily three-fold, including type 1 ( autoimmune, insulin deficiency), type 2 (insulin resistance or insufficient insulin), and gestational diabetes ( which occurs during pregnancy). In Diabetes, Women also have increased risks of some complications, including heart disease and depression, as opposed to men with diabetes. Women who have polycystic ovary syndrome (PCOS), are known to be insulin-resistant and are prone to type 2 diabetes. Signs, which can be early detectable and treated, are often associated with feelings of excessive thirst, frequent urination, and/or unexplained weight loss.

Types of Diabetes in Women

• Type 1 Diabetes: Destruction of Insulin-producing cells through autoimmune reactions usually occurs at an early age.
• Type 2 Diabetes: Resistance to insulin or insufficient insulin manufactured; the most widespread.
• Gestational Diabetes: Diabetes during pregnancy, which usually goes away after childbirth, but increases the risk of diabetes in the future.

Common Signs of Diabetes in Women

The most common symptoms of diabetes in women are: frequent urination, thirst, unexplained weight loss or gain, fatigue, blurred vision, and poor wound healing. The distinctive aspects in women include frequent yeast infection (vaginal or oral), frequent UTIs, vaginal dryness, and irregular menstruation. These symptoms occur due to the interference of high blood sugar with the usage of glucose as the source of energy, and since it also deteriorates the nerves and the immune system.

Common Diabetes Symptoms in Women

• Increased thirst and hunger
• Frequent urination
• Unexplained weight changes
• Fatigue and weakness
• Blurred vision
• Slow healing of cuts and infections
• Frequent infections like gum, skin, and vaginal infections

Symptoms Specific to Women

• Chronic vaginal yeast infections and oral thrush
• Recurrent UTIs cause painful or burning urination
• Vaginal dryness due to diabetic nerve damage
• Heavier menstrual periods and menstrual irregularities
• Decreased sex drive is linked to the above symptoms

It is good to be diagnosed and treated early based on these symptoms.

Emotional and Hormonal Indicators

Emotional and hormonal signs of diabetes in females are all interconnected and influence the psyche and the control of sugar in the blood.

Emotional Indicators

• Women with diabetes are more likely to suffer anxiety, depression, and diabetes distress (emotional exhaustion with coping with the disease), which may negatively affect quality of life and diabetes self-care.
• Swinging blood sugar levels result in mood swings, irritability, confusion, nervousness, and fatigue.
• The stress in psychological aspects is magnified in women because of societal expectations, caregiving nature, and hormonal changes.
• Depression in women is said to be twice that of men and often puts additional strain on diabetes and exposes them to risks of heart disease.
• Emotions such as anger and frustration towards dealing with diabetes are also common among women with type 2 diabetes.

Hormonal Indicators

• Menstrual changes in hormones, during the menopause and pregnancy states, affect insulin sensitivity significantly.
• Diabetic postmenopausal women have lower estrogen levels, which are associated with insulin resistance and diabetes risk.
• Progesterone influences insulin secretion, although its effect is less definite.
• Hormonal disorders such as polycystic ovary syndrome (PCOS) put a person at risk of having type 2 diabetes as they have unbalanced hormones and insulin insensitivity.
• The estrogen drop caused by menopause worsens glucose metabolism, which makes management of diabetes more difficult at this life stage.

These emotional and hormonal considerations are core to the management of diabetes in females, beyond the management of blood sugar levels.

You may also like to read: Morbid Obesity

Managing and Preventing Diabetes in Women

Lifestyle changes, medical treatment, and routine health checks to manage and prevent diabetes in women are a part of a holistic approach.

Key Management Strategies

• Diabetes Type: It is vital to find out which type, type 1, type 2, or gestational diabetes, to implement appropriate strategies.
• Balanced Diet: Pay more attention to whole foods: fruits, vegetables, legumes, whole grains, lean proteins, and healthy fats. Avoid refined, fatty, and sweet food. Control of carbohydrate consumption is critical to blood sugar levels.
• Regular Physical Activity: At least attempt 150 minutes of moderate-intensity aerobic exercise each week. The exercise enhances insulin sensitivity and prevents weight gain.
• Blood Sugar Monitoring: Regularly monitor blood glucose levels to make informed choices about food, exercise, and drugs.
• Medication adherence: Strictly adhere to medication plans, whether it is oral medication or insulin.
• Stress Management: Stress is a known cause of elevated blood sugar levels; therefore, stress management is an important skill.
• Regular Health Check-ups: This is essential to detect and manage complications on time.
• Foot Care: Routine check-ups and attendance to ensure infections and ulcers do not occur.
• Education and Support: Getting into a diabetes education program and support groups can help both emotionally and pragmatically.

Preventive Measures for Women

• Keep to a healthy weight by following a balanced diet and physical activity.
• Excessive tobacco and alcohol.
• Treat other risk factors like hypertension and cholesterol.
• In gestational diabetes, after delivery, control postpartum glucose testing and lifestyle modification are recommended to help prevent a future risk of type 2 diabetes.

Special Considerations During Pregnancy and Menopause

• For pregnant women with diabetes, tighter glycemic control using physical activity and medical nutrition therapy is warranted.
• Postpartum care involves insulin modifications, supporting breastfeeding, and continued work-ups of diabetes.
• The changes in hormones at the time of menopause need to be handled differently because insulin resistance may aggravate them.

These strategies give women with diabetes the ability to live a quality life and prevent disease progression and complications.

Final Thoughts

Recognizing the early signs of diabetes in women can make a significant difference in overall health and quality of life. Ranging in severity, such minor symptoms as fatigue and constant thirst to severe ones such as frequent infections or delayed menstruation, education is the key to early identification. When these red flags occur, it is important to see a doctor as soon as possible to avoid complications and enable effective management. Early detection and through lifestyle changes and the right medical attention, women can manage to improve their health and prevent the long-term effects of diabetes.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Obesity is one of the most rapidly growing health issues nowadays, and in its most extreme form, it is reckoned as morbid obesity. This disorder does not only influence the physical aspects but wears heavily on overall health, lifestyle, and life expectancy. As cases around the world are resulted increasingly, it is important to know morbid obesity. This article will examine the nature of morbid obesity, its most common causes, the severe complications that it poses, and the effective treatment available to control it.

What Is Morbid Obesity?

Morbid obesity, now more often defined as Class III or severe obesity, is a severe medical condition may be described as abnormally excessive body mass index (BMI). It is said to exist when the BMI is 40 or more, or 35 and more when there are accompanying health issues that are linked to obesity. This situation arises when one is considerably heavier than the ideal body weight is, usually by more than 80 to 100 pounds above ideal weight, and adds risks of a range of serious medical conditions including type 2 diabetes, heart disease, sleep apnea, osteoarthritis, and some cancers. Morbid obesity is a chronic, multi-factorial complex condition with many causes, including genetics, metabolism, behavior control, and environmental conditions, and it also has implications on life expectancy and quality of life.

Morbid obesity has a BMI of 40 and higher whereas 35 and above with related conditions is also categorized as morbid obesity.

Common Causes of Morbid Obesity

The common etiological factors of morbid obesity are a combination of genetic, environmental, behavioral, and medical causes:

Lifestyle and Behavioral Factors

• Overeating: When a person consumes more calories than his/her body is burning. A high intake of calories per portion, including junk food, greasy foods, carbonated drinks, and large servings, can lead to weight gain.
• Lack of exercise: Sitting and not doing exercise would not burn as many calories, thereby leading to store fat. One of such causes is screen time and physical inactivity.
• Poor diets as children adopted: Childhood habits are healthy habits later in life, and many people find it hard to change.
• Stress, anxiety, and lack of sleep: These are all mental effects that have been associated with weight gain because of their effect on solutions that control our weight and hunger.

Genetic and Biological Factors

• Genetics: Genes influence the way the body stores fat, eccpites and burns calories. Inheritance patterns indicate that obesity risk is in the genes, with about 80 percent being inherited.
• Metabolic and hormonal: Diseases such as hypothyroidism, Cushing disease, polycystic ovarian syndrome (PCOS) and metabolic disease may cause and or contribute to weight gain.
• Set point theory: Some research claims that the body has a set body weight towards which it maintains and it is hard to lose weight once one becomes obese.

Medical Causes and Medications

• Some illnesses and syndromes (e.g. Prader-Willi syndrome) may lead to obesity.
• Steroids, some antidepressants, antipsychotics, diabetes medicines and others may cause weight gain because they stimulate appetite or impact metabolism and fat accumulation.

Environmental and Social Factors

• Obesogenic environments such as poor access to healthy foods, availability of fast food and processed food, and inaccessible areas to exercise, and socioeconomic aspects promote the risk of obesity.
• Obesity is also caused through cultural, social, and psychological factors.

Health Risks and Complications of Morbid Obesity

Morbid obesity carries significant health risks and complications that affect various body systems and overall quality of life:

Cardiovascular Risks

• Increased risk of heart disease and stroke, caused by raised blood pressure, abnormal cholesterol levels and inflammation.
• Risk of congestive heart failure and coronary artery disease, which can lead to loss of life expectancy.

Metabolic Disorders

• High correlation with type 2 diabetes based on insulin resistance, which has serious outcomes, such as kidney illness, nerve damage, and eye disorders.
• The danger of metabolic syndrome where one has high blood pressure, high blood sugar, excessive abdominal fat, and abnormal cholesterol/triglyceride levels.

Respiratory Issues

• Greater potential of sleep apnea, in which breathing stops periodically during sleep, leading to daytime fatigue and cardiovascular problems.
• Obesity hypoventilation syndrome, poor breathing and low oxygen levels.

Skeletal and Muscular Problems

• The extra weight exerts pressure on weight-bearing joints, which can lead to osteoarthritis due to pain, swelling, and restricted motion.
• Back pain and other musculoskeletal aching is common.

Other Organ System Complications

• Larger risk of fatty liver disease that can lead to cirrhosis.
• Exposure to a higher risk of gallstones and gallbladder pathologies, triggered by a mismatched cholesterol metabolism.
• More risk of kidney disorder which is mostly found to be associated with diabetes and hypertensions.

Cancer Risks

• Increased rates of many other cancers, such as breast, colon, endometrial, esophageal, pancreatic and kidney cancer with obesity.

Mental Health and Quality of Life

• Depression, anxiety, social isolation, low self-esteem and discrimination often come together affecting emotional well-being and social functioning.
• Obesity leads to physical restrictions in other daily activities, which decrease the quality life of living.

Additional Health Concerns

• High chances of having pregnancy complications such as gestational diabetes and pre-eclampsia.
• An increased severity of infections such as COVID-19, increase in hospitalizations, and complications.

You may also like to read: Benefits of Mindfulness-Based Interventions for Diabetes

Effective Treatment and Management Options

Morbid obesity can be managed and treated efficiently through a classic, multidisciplinary approach that suits the individual. The principal possibilities are:

Lifestyle Interventions

• Current and early interventions involve behavior change, restrictive caloric intake with a balance of 500-750 kcal day-1, and enhanced physical exercise (150 minutes/week to maintain, and 300 minutes /week to lose).
• Lifestyle changes ONLY can cause 4-8% weight loss in the first year and largely have improved health outcome like blood pressure and blood glucose.

Pharmacotherapy

• Newer drugs such as incretin-based treatments (GLP-1 receptor agonists: liraglutide, semaglutide; dual GLP-1/GIP agent: tirzepatide) are useful in patients with A1C 0.75% greater or with comorbidities.
• These medications encourage significant weight loss (as much as 21%) and enhance diabetes, blood pressure, and cholesterol levels.
• To avoid weight regain, long-term usage is desired.

Endoscopic Procedures

• ESG is endoscopically performed and involves reduction of the volume of the stomach.
• At one year, SG leads to 13-16 percent weight loss and amelioration of diabetes, blood pressure, and cholesterol in many patients.

Bariatric Surgery

• Bariatric or metabolic surgery (including sleeve gastrectomy and Roux-en-Y gastric bypass) is the most effective therapy in morbid being .
• Surgery: surgery induces 25-30 percent total weight loss sustained by long term loss.
• It causes high percentages of remission/ improvement in diabetes type 2, blood pressure, and cholesterol, and dramatically reduces cardiovascular risks.
• Operation is risky and demands a continuous follow-up of the diets.

Living with Morbid Obesity: Coping and Support

Living with morbid obesity presents significant physical, emotional, and social challenges that impact daily life in multiple ways:

Physical and Daily Life Challenges

• Most morbidly obese people have challenges in walking, climbing stairs, and even standing long. Excessive weight causes chronic joint and back pains.
• Breathing difficulties (breathlessness and sleep apnea) cause even routine activities to be exhausting and distort sleep.
• These physical symptoms add to slowed mobility, a less active lifestyle, which further contributes to obesity and other health problems.

Emotional and Mental Health Impact

• Severe obesity also tends to result in depression, anxiety, poor self-esteem, and body image issues caused by social disapproval and discrimination as well as internalized shame.
• This creates isolation and emotional distress as many people isolate themselves to avoid judgment or embarrassment in society.
• Frustration and body discontent also can elicit ineffective coping responses, such as emotional eating or binge eating, which complicates diet attempts.

Social and Relationship Effects

• Obesity may interfere with relations with family members, friends and romantic partners because of health-related limitations and emotional overload.
• Morbid obesity in the workplace can relegate an individual to discrimination or bias in their professional career and in their relationships with other professionals.
• Social activities may be hard due to physical pain, trouble locating suitable seating and embarrassment or stigma in social places, adding to a state of social isolation.

Coping and Support Strategies

• Medical support by a team of professionals including dieticians, psychologists, Physiotherapists, etc is imperative to control both body and spirit.
• Mental health, motivation, and isolation can be made better by joining support groups or getting counseling.
• Individual strategies of coping might involve realistic goals, developing healthy eating and physical activity pattern, and emphasis on gradual progress.
• Even environmental modifications to improve living conditions, e.g. good seating arrangements and accessible toilets etc.

Bottom Line

Morbid obesity is not just a weight concern but a serious health problem that predisposes people to life threatening diseases and affects their quality of life. It has numerous reasons that run from heredity to life preferences, but it is an issue that can be controlled through proper treatment and support. It is never too late to take back control of our health because there are ways to help, including lifestyle modifications, drugs, and even bariatric surgery as one of the last resorts. By creating awareness, early prevention and compassionate care, we can play our part in the fight against morbid obesity. Making modest, gradual changes toward a healthier lifestyle can become permanent and result in a healthier life.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

It is never easy to live with diabetes, and the condition demands vigilance in terms of diet and exercise, medicines and emotional health. Though there is conventional care on how to keep sugar levels in check, most are resorting to natural methods of keeping healthy. Mindfulness is one of such processes; it is all about living in this moment. Recent studies highlight the benefits of mindfulness-based interventions for diabetes, showing that they can help reduce stress, improve emotional balance, and even support better blood sugar control. By integrating mindfulness into daily routines, individuals with diabetes may find new ways to manage their condition more effectively and enhance their quality of life.

Understanding Mindfulness-Based Interventions

Mindfulness-Based Interventions (MBIs) is a sort of treatment method which uses the practice of mindfulness to encourage both mental and physical well-being. The concept of mindfulness suggests conscious present attention in a non-judgmental, accepting and objective way.

Key Components of MBIs:

• Presence: Being fully aware of the present, of thoughts and feelings, of body and surroundings.
• Non-judgement and acceptance: Perceiving situations without judgment or attempting to alter them and being accepting of thoughts and emotions.
• Self-regulation of attention: Train the power to remain focused and shift attention onto the present-focus without distractions.
• Emotional regulation: Learning to have a new attitude to their thoughts and their distressing feelings: openness and acceptance.
• Practices of mindfulness meditation include: Sitting meditation, body scan, mindful movement (i.e., walking meditation or gentler yoga), and breathing exercises.
• Informal mindfulness: A daily use of mindfulness as in mindful eating or mindful brushing of teeth.

Common Forms of MBIs:

• Mindfulness Based Stress Reduction (MBSR): An eight-week inpatient group session that focuses on meditation and mindfulness activities to mitigate stress.
• Mindfulness-Based Cognitive Therapy (MBCT): Derived out of MBSR but with some inclusions of cognitive therapy based on preventing relapse in cases of depression.
• Dialectical Behavior Therapy (DBT): Uses mindfulness as an element of a comprehensive therapy that focuses on emotional control.
• Acceptance and Commitment Therapy (ACT): Is a larger approach to behavioral change of which mindfulness is a module.

How MBIs Are Delivered:

·       Comprises guided meditation practice, homework practice, and group discussions of experiences.

·       In general, structured group sessions occur 2-2.5 hours a week over 8 weeks.

·       Comprises guided meditation practice, homework practice, and group discussions of experiences.

·       Practices such as body scans gradually lead the attention to various parts of the body.

·       Places greatly focus on experience and developing meta-awareness (being aware of being aware).

MBIsassist a person in achieving the mindful state that helps individuals better manage their emotions, ruminate less, and deal with stress and mental disorders. They are valid across health care, educational, and work environments and can be applied to most populations and situations.

Psychological Benefits of Mindfulness in Diabetes

The psychological benefits of mindfulness in diabetes management are notable and multifaceted. Here are the key points:

• Minimizing stress: Carrying the emotional baggage and stress that comes with dealing with diabetes is reduced with mindfulness. Mindfulness can reduce stress levels, which have been shown to adversely affect the blood glucose levels.
• Better Emotional Regulation: Mindfulness leads to enhanced control of emotions thus patients can control anxiety, depression and diabetes-related distress more easily. This results in a better mood and more consistent diabetes control.
• Improved Self-Care and Adherence: Mindfulness interventions lead to improved self-management of diabetes and adherence behaviors like medication compliance, healthy eating habits, and physical exercise by creating greater self-insight and self-motivation.
• Decrease in Diabetes Distress: Diabetes distress, one of the emotional demands of managing diabetes, decreases by mindfulness practice, which enhances quality of life.
• Positive Thinking and Psychological Well-being: Practicing mindfulness can help enhance positive thinking and psychological well-being during the disease.
• Potential gains in the levels of Depression and Anxiety: Research shows that mindfulness decreases levels of depression and anxiety in a person with diabetes, which also adds to mental well-being.
• Promotion of Glycemic Control through Psychological Process: When stress and emotional changes are minimized through mindfulness this improves blood glucose levels leading to improved diabetes management overall.

Impact on Glycemic Control and Physical Health

Mindfulness-based interventions have demonstrated a positive impact on glycemic control and physical health in people with diabetes. Key findings include:

• Glycemic Control: Mindfulness has been demonstrated to produce a large reduction in an important measure of long-term control of blood glucose levels, hemoglobin A1c (HbA1c). Meta-analyses show decreases in HbA1c of approximately 0.25-0.3 per cent. One trial showed similar effects to that of first line diabetes treatment metformin. This is an advancement in improved overall blood sugar control.
• Physiological Effects: Mindfulness triggers an increase in the activity of the parasympathetic nervous system and decreases sympathetic tone and anxiety hormones such as cortisol and markers of inflammation. These modifications improve insulin resistance and autonomic health along with cardiovascular health, which promotes diabetes prevention and management.
• Stress and Emotional Regulation: Mindfulness reduces stress and enhances emotional self- control; hence, reducing stress-developed glucose variations in blood. This causes more balance in blood sugar levels.
• Physical Health Advantages: Mindfulness meditation plus physical activity has resulted in small changes in body weight, blood pressure, and other metabolic indicators that are relevant to the care of diabetes.
• Self-Management: Enhances self-care behavior to diabetes, like medication adherence, proper diet, and physical exercise, all of which result in improved quality of life and glycemic control.

Mindful Eating and Lifestyle Habits

Mindful eating and lifestyle habits play a crucial role in managing diabetes effectively. Here are the main points on how mindful eating contributes to diabetes management and supports healthier lifestyle habits:

Mindful Eating in Diabetes

• Receptivity to the Eating Experience: Mindful eating is being in touch with the full sensory experience of eating: taste, texture, smell, appearance, as well as internal hunger and satiation.
• Emotional Awareness: It will assist them in understanding whether they are eating out of hunger or emotions such as stress, boredom, or habit and will help curb emotional or stress eating.
• Better Blood Glucose Levels: Mindful eating enhances balanced meals, portion control, and slowing down which can help prevent blood glucose spikes and control blood glucose levels.
• Non-Restrictive Focus: Mindful eating involves not just counting calories or carbohydrates but an amicable approach to food that can be sustained with less effort in the long term.

Lifestyle Habits Related to Mindful Eating

• Preventing Meaningless Eating: Awareness of unique sensory experiences and recognition of satiation cues leads to the reduction of meaningless eating that is also relevant in the management of diabetes.
• Analysis: Greater attention while eating helps in making decisions that are healthier towards the control of diabetes, e.g., incorporating non-starchy vegetables, lean proteins, and quality carbohydrates.
• Environmental Changes: To prevent distraction during meals (turn the TV, turning off electronics) to be able to concentrate on eating mindfully.
• Meal Timing and Nutrient Sequencing: Dinner (or the food we eat at the end of the day) is particularly noteworthy because what we eat and when we eat can have a moderate effect on blood glucose.
• Combining with physical activity: Mindful eating is more effective combined with regular physical activity in promoting good overall metabolic health and diabetes prevention and management.

You may also like to read: Role of Exercise in Diabetes Management

Long-Term Outcomes and Limitations

• Emotional well-being Sustained psychological benefits: Long-term studies report significant effects of MBIs on the emotional well-being including reductions in depression, anxiety, and diabetes-related distress. These psychological advantages are effective in the long term, which leads to a better quality of life among individuals with type 2 diabetes.
• Glycemic Control: Multiple meta-analyses revealed that MBIs have the potential of decreasing hemoglobin A1c (HbA1c) by an average of 0.3 percent; this is considered clinically significant. In some studies, these glycemic improvements have been maintained long-term. Although there is no definite evidence of a large effect on long-term fasting blood glucose or HbA1c levels. Such variability can be the result of a variety of study design, population differences, intervention type, or adherence.
• Physical Health Outcomes: MBIs are connected to decreasing body weight, stress, blood pressure, and depressive and anxiety symptoms. These enhancements apply to cardiovascular health, which is worse in diabetes. Nevertheless, the durability of physical health measures is low and inconclusive.
• Implications on Diabetes Self-Management: MBIs improve attention control, emotion regulation and self-awareness and these factors align with positive lifestyle choices in diabetes management like medication adherence, diet and exercising. These high rates can increase long-term control of the disease and fewer complications.

Limitations and Challenges

• Heterogeneity of Interventions: The nature of mindfulness interventions is vastly diverse, drawing a conclusion across assessment of several studies can be difficult.
• Quality of Studies and Design: The methods of the studies are flawed because the sample size is modest, the follow-up is too brief, or the availability of the control.
• Cultural and Contextual factors: Effectiveness can be influenced by cultural, social, and individual differences not captured in the current research.
• Long-Term Follow-Up: Most studies rely on short- and intermediate-term outcomes; long-term follow-up research is required to provide more information on long-term effects and mechanisms.
• Unreliable Changes in Physical Markers: Psychological ones are more evident, but the biomarkers (fasting glucose and cholesterol levels) do not change reliably.

Practical Tips for Patients

Here are practical mindfulness-based tips for patients with diabetes to help manage their condition effectively:

• Begin Small with Mindfulness Practice: Start with minimal time of mindfulness meditation, such as 5-10 minutes a day and then take it forward as you get increasingly comfortable with the practice.
• Breath Awareness: Pay simple attention to breath. When cravings or stress occur bring your attention back to breath.
• Eat Mindfully: Eat slowly, savor and enjoy every bite and pay attention to the experience of what you are eating, the taste, feel, smell. Listen to your hunger and fullness volumes before meals and during meals.
• Set Up an Eating Free environment: This means no screens and multitasking during mealtimes to help stay present and make food choices aware.
• Body Scan Meditation: Practicing body scan meditation will help improve body recognition, lower stress and improve connection to physical cues like hunger or satiety.
• Practice Mindfulness to Cope with Stress: Putting stress into perspective with mindfulness can help curb feelings of overwhelm and help to address blood sugar and stress levels.
• Incorporate Mindful Movement: Participate in body movements that are light with awareness like walking yoga or tai chi to promote mental state and physical fitness.
• Remain consistent with self-care: Apply mindfulness to develop a humane approach to diabetes treatment practices such as taking medication, blood sugar measurement, and physical activity.
• Find Support: Join mindfulness groups or diabetes education programs that also apply mindfulness to acquire more advice and social support.
• Be Patient and Judgmental- Mindful progress is a gradual process. Handle setbacks with compassion and wonder and instead of judgment.

Final Thoughts

In summary, mindfulness-based interventions have positive effects on diabetes, going beyond reducing stress, to instead providing substantial benefit to mental and physical health. Specifically, mindfulness can be used as a tool to reduce anxiety levels and enhance emotional sturdiness, along with healthier lifestyle choices and better blood sugar levels. Although it should not be a substitute to medical care, making practices, such as meditations, mindful eating, or stress awareness, a part of daily life can help people become more in control of their health. Incorporating mindfulness as a holistic practice, individuals with diabetes can live better and develop enduring equilibrium.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes is a very prevalent chronic disease globally with millions of people of all ages being victims of this condition. One of the main ways to treat the disease is with the use of medications and diet; however, changes in lifestyle are also instrumental in keeping the condition under control. Of all of these, exercise works as a potent and yet natural measure to control blood sugar and help heart health as well as overall wellbeing. Knowledge of how exercise helps in the management of diabetes may help people to be more proactive in combating diabetes and minimizing complications of the disease.

Why Exercise Matters for People with Diabetes

Exercise is very important for people with diabetes because it helps control blood sugar levels and reduces the risk of severe health complications associated with diabetes. Here are the key reasons why exercise matters for people with diabetes:

• Enhances blood sugar regulation: Exercise aids muscles in utilizing blood sugar (glucose) more accurately, which increases insulin sensitivity and reduces blood sugar levels. It has been reported that regular exercise regimes can lower blood sugar to same extent as diabetes drugs. This is possible up to 2 days after exercising.
• Increases muscle mass and muscle energy use: The larger the muscle mass, the easier the body uses blood sugar as energy, thereby assisting with sugar management. Resistance regular exercise develops muscle and enhances insulin sensitivity which are especially useful in type 2 diabetes.
• Lowers Blood Pressure: The regularity of exercising lowers blood pressure by promoting a longer stroke volume which in turn increases blood flow. This shields individuals with diabetes against heart disease that is a standard complication.
• Aids in Weight Management: Exercise and particularly when added to healthy eating aids in weight loss and weight maintenance. This lowers insulin resistance and can even bring diabetics with type 2 diabetes to remission.
• Means to Enhance Overall Well-being: Exercise helps to boost energy, mood, sleep and mental well-being because it releases endorphins. It also aids flexibility of joints and stress reduction thus leading to higher quality of life.
• Various Kinds of Exercise Are Advantageous: Aerobic (e.g. walking, cycling, swimming) and resistance training (e.g. weightlifting, bodyweight exercises) are both beneficial. Combining both types has maximum benefits, but any regular exercise will be beneficial HIIT is effective as well.
• Considerations Regarding Safety: Patients with diabetes must measure their blood glucose before and after their workout to prevent hypoglycemia, especially when taking insulin or other blood sugar decreasing drugs.

Key Benefits of Exercise in Diabetes Management

Key benefits of exercise in diabetes management include:

• Enhances Blood Sugar Control: Exercise improves insulin sensitivity and uptake of glucose by muscles thus ensuring lower blood sugar levels and controlling glucose up to 24-48 hours after exercise. This is critical in controlling diabetes type 1 and diabetes type 2.
• Creates Insulin sensitivity: Exercise leads to insulin sensitivity, which is the fundamental issue in diabetes type 2 since it helps the body to respond positively to insulin.
• Reduces HbA1c: The interval average of blood glucose (HbA1c) level is reduced by about 0.67 percent through regular exercise, equating to some diabetes drugs.
• Facilitates Weight Control: Physical activity aids in weight loss and weight maintenance and decreases metabolic demands to provide greater control of diabetes. It also decreases central fat that is affiliated with metabolic risk.
• Enhances Vascular Health: Exercise reduces blood pressure, improves HDL and LDL cholesterol and blood triglyceride levels, and reduces the risk of cardiovascular disease, which is elevated in individuals with diabetes.
• Develops Muscle Mass and Strength: Weight based exercising increases the mass of muscles, which also has a positive outcome in insulin resistance as well as glucose metabolism.
• Boosts Mental Health and Well-being: Through the release of endorphins, exercise lessens stress levels, enhances mood, induces sleep, and diminishes signs of anxiety and depression.
• Aids in Prevention of Diabetes: In people who have pre-diabetes and those who are at risk, physical exercise is very effective in reducing the chances of developing diabetes type 2. Diets with regular exercise can help lower incidence by up to 74-46 percent in clinical trials.
• Varied Types of Exercise: It is best to combine aerobic work (walking, cycling, swimming), athletic training, and even dancing or walking sports. The routine is made sustainable by consistency and fun.

Overall, exercise is a cornerstone of diabetes management for its multifaceted benefits on glucose control, cardiovascular health, weight management, and overall quality of life.

Types of Exercise Recommended for Diabetes

The best exercises suggested to those with diabetes are a collection of aerobics, resistance, flexibility, and balance exercises. The most significant ones are the following categories and examples:

1. Aerobic Exercise
   • Walking (brisk walking is especially beneficial)
   • Cycling
   • Swimming and water aerobics (low impact on joints)
   • Running or jogging (if appropriate)
   • Aerobic dance or fitness classes (e.g., Zumba)
   • Team sports like basketball, soccer, tennis
     Aerobic exercises improve cardiovascular health, lower blood sugar, and help with weight management.
2. Resistance Training (Strength Training)
   • Weightlifting with free weights or machines
   • Resistance band exercises
   • Bodyweight exercises (push-ups, squats)
     Resistance training builds muscle mass, which improves glucose uptake and insulin sensitivity. It complements aerobic exercise in diabetes control.
3. Flexibility and Balance Exercises
   • Yoga
   • Tai Chi
   • Pilates
     These improve flexibility, balance, and stress reduction, helping especially older adults with diabetes avoid falls and better manage blood sugar.
4. Low-Impact and Seated Exercises
   • Aquatic exercises are good for joint issues or neuropathy
   • Specific calf muscle exercises (like soleus push-ups) can help lower blood sugar even when seated.
5. High-Intensity Interval Training (HIIT)
   • Alternating periods of high- and low-intensity exercise (e.g., sprinting and walking)
     HIIT can be effective in improving blood sugar and fitness in people with type 2 diabetes.

General guidelines indicate that one should exercise at least 150 minutes weekly of moderate-intensity aerobics, performed on most days, and added two or three sessions of resistance training. Balance training and flexibility exercise are advised regularly, particularly those at old age.

You may also like to read: Importance of Carbohydrate Counting in Diabetes

Best Times to Exercise for Blood Sugar Control

The best times to exercise for blood sugar control in people with diabetes are generally:

• Afternoon and Evening: Afternoon or evening exercise has shown to provide greater benefit in insulin resistance and blood sugar regulation. In a study by Anderson, the work conducted moderately vigorous physical activity at noon to midnight cutting down insulin resistance and hepatic fat content significantly as compared to earlier in the day. Midday and evening exercise regimens performed better than a morning or all-day strategy at reducing insulin resistance with an 18 and 25 per cent lower rate of reduction respectively.
• Three to Dosto Hours After Eating (Post-Meal): This is an ideal time to work out as the glucose level is elevated and ready to be burnt. Exercise after meals may be able to reduce after-meal blood sugar spikes, as well as long-term cardiovascular risks. This schedule is viable in the control of glucose levels after a meal.
• Morning Exercise: This is not an advantage, but morning exercise may be appropriate to those who want to work out in the morning or must attend other activities in the daytime. It is reported that fast exercise in morning can enhance insulin sensitivity of a day, helping to manage weight and decrease food consumption. In the case of individuals with type 1 diabetes, training in the morning may enhance risks of hypoglycemia less than training later in the day.
• Timing Should Accommodate Personal Routine and Chronotype: A consistent time schedule is the most important thing to adhere to in long-term equivalents. The chronotype (being a morning or an evening person) also has an impact on exercise preference and metabolic reactions. Selecting a time that suits one better helps to sustain physical activity.
• Safety precautions: Insulin users or users of blood sugar-lowering drugs should measure their blood sugar before any exercise to avoid hypoglycemia, irrespective of the time of exercise.

Precautions and Safety Tips

Here are important precautions and safety tips for exercising with diabetes:

• Medical Approval: Seek doctor approval before commencing and changing an exercise regime especially when you have heart disease, neuropathy, retinopathy, kidney problems, or you use insulin or a drug that can cause hypoglycemia. Your physician can prescribe exercise advice and can modify the drugs.
• Start at Low Pace: When starting or after a hiatus, start at low and slow pace to prevent injury and over-fatigue yourself.
• Monitoring Blood Sugar: Monitor blood sugar levels before, during (long instance only), and after exercise especially in cases where you are taking insulin or other medications that reduce blood sugar as this could result in hypoglycemia. Use quick-energy carbohydrates to correct low blood sugar.
• Hydrate: Before, during and after physical activity, drink lots of water to avoid dehydration.
• Use Good Quality Footwear and Care: Wear proper shoes that fit your feet well and have good support. Wear socks made of moisture-absorbing materials to keep your feet and feet dry. Check feet daily, it you have neuropathy.
• Warm Up: Cool Down: 5-10 minutes warm up and cool down to gear up the muscles and minimize the chances of injury.
• Sporting in Safe Areas: Never sport in areas with extreme climate conditions, sport either indoors in the slightest weather extremes.
• Wear a medical ID bracelet or tag indicates you have diabetes in case of an emergency.
• Take Note of Your Body: Do not exercise when you are in pain, dizzy, lacking breath or weak. Remedy any strange symptoms with your doctor.
• Practice Constantly: The benefits will persist with regular physical activities over time and at the same time.

By taking these precautions, exercise becomes safe and effective in management of diabetes.

Would it also help to give some specific advice on how to manage blood sugar before/during/after what types of exercise? The key precautions and safety tips of exercising with diabetes are as follows:

• Check with your physician before undertaking or modifying an exercise program, particularly when you have heart disease, neuropathy, retinopathy, kidney problems, or are on insulin or some medications that may cause low blood sugar. Your doctor can recommend certain changes or exams
• To avoid injuries, start the exercise gradually in case you are new or returning after long absence. Start with activities such as walking that have low impact.
• Pre-check and post-check sugar levels to avoid hypoglycemia, especially during long exercise sessions in case of insulin or lowering of glucose medications. Respond to low blood sugar with carbohydrate snacks.
• Avoid dehydration before, during and after exercise.
• Use well-fitting shoes and socks that are moisture-wicking. Check your feet each day especially in case you have nerve damage (neuropathy).
• Before exercise, warm up properly and after exercise cool down to prepare your muscles to reduce injury.
• When the weather is too cold or hot, avoid exercising in extreme temperatures, consider an indoor exercise.
• Wear a medical ID bracelet or tag when you have diabetes to identify you in case of emergency.
• Stop exercising at any time when you feel any pain, dizziness, shortness of breath, or faintness. Check with your medical expert about unusual symptoms.
• It is best to have consistent exercise schedules to remain beneficial and safe.

Making these precautions will make exercise an effective and safe part of diabetes and complications management.

Bottom Line

Exercise is much more than a fitness workout it is a component of effective diabetes management. Exercise has many benefits, which include but are not limited to better control of blood sugar levels, increased insulin sensitivity, healthy cardiac functioning and robust mental health maintenance. The solution is to make it safe and fun and tailor exercise plans to health requirements. Regularly exercising will allow people to take more control of their condition and minimize their chances of developing complications and create a healthier future.