Diabetes is a condition with multiple causes. It is characterized by the abnormal breakdown of sugars, starches and proteins that results in high blood sugar levels.

Type 1 Diabetes is an autoimmune disorder that destroys Beta-cells in the pancreas. This disorder usually occurs before age 25, with sudden onset. In Type 1 Diabetes, the pancreas makes very little or no insulin. The body uses fat or muscle as a fuel source. This breakdown of fat or muscle produces ketones in the bloodstream. If not treated, excessive ketones can cause death. Insulin must be used to treat Type 1 Diabetes.

Type 2 Diabetes occurs in older adults that are usually overweight or have a family history of diabetes. There is a combination of insulin resistance and compensating insulin secretion. Initially, symptoms may be mild and undetectable. Treatment may include a combination dietary changes, oral medication, insulin and an exercise routine.

According to the U.S Department of Health and Human Services-Office of Minority Health, African Americans are almost two times as likely to be diagnosed with diabetes than non-Hispanic whites. African-Americans are more likely to suffer complications. In 2013, African-Americans were two times more likely than non-Hispanic whites to die from diabetes.

The incidence of diabetes increases with age. The likelihood of becoming diabetic doubles with each decade of life. Studies have shown that up to 20% of persons older than seventy have problems with blood sugar regulation.  The longer an individual has diabetes without blood sugar control, the greater the risk of complications.

Long term complications of uncontrolled diabetes include macrovascular damage to the large blood vessels. These changes cause damage to the heart, brain and legs Microvascular changes to the small blood vessels causes damage to the eyes, kidneys, feet and nerves

Complications involving the eyes, called retinopathy, causes vision loss or blindness. Peripheral neuropathy can cause foot ulcers or amputation. Neuropathy causes injury to the walls of blood vessel capillaries. These capillaries nourish the nerves in the extremities. Symptoms of neuropathy may include tingling, numbness, burning or pain. The pain usually begins in the fingertips and toes. Nerve damage in the feet increases the risk of healing complications. Cuts and blisters on the feet can lead to infection and poor healing. Ultimately, there may be a need for toe, foot or leg amputation.

Autonomic neuropathy results when there is damage to the nerves that control internal bodily functions. The digestive and urinary tract, cardiac and sexual function may be affected.

Atherosclerotic vascular changes cause increased incidence of heart attack, stroke and peripheral vascular disease.  An uncontrolled diabetic’s risk of heart attack and stroke is double that of a non-diabetic. Uncontrolled diabetes can cause angina or chest pain.

High blood pressure, dental disease, hearing loss and Alzheimer’s Disease are possible with uncontrolled diabetes. The higher the blood sugar the greater the risk of Alzheimer’s Disease. There are multiple theories about the connection between high blood sugars and Alzheimer’s Disease. However, none of these theories have been proven.

Nephropathy or kidney damage results in kidney failure. Tiny blood vessel clusters in the kidneys filter waste. Damage to these clusters leads to kidney failure or irreversible end stage kidney disease. End stage kidney disease requires dialysis or transplant.

Diabetes is a progressive and incurable condition. Left uncontrolled, diabetes causes irreversible complications and death. Following a prescribed treatment plan and avoiding consistently high blood sugars can help prevent the irreversible complications of diabetes.

Marcia Jackson is a retired RN and educator based in Baltimore.