Tight control of diabetes can significantly delay the onset of complications by decades.  

Because it's possible to have high blood glucose levels and feel no symptoms, diabetes is often called a silent disease. But, even though it may be silent, it's always serious, with potential for dangerous short- and long-term effects if it isn't properly controlled.

Serious short-term complications from uncontrolled blood glucose levels can be fatal.

• Very high blood sugar.  Blood sugar can becomes so high that it actually becomes thick and syrupy.  Symptoms include excessive thirst, increased urination, weakness, leg cramps, confusion, convulsions and coma.  
  
• Very low blood sugar.  This is most common in people taking insulin, but people taking oral medications that enhance the release of insulin are also at risk.  Symptoms include slurred speech, drowsiness, confusion and coma.
  
• Diabetic ketoacidosis.  When blood glucose levels are persistently high, your cells become starved for energy and your body begins to break down fat.  This produces toxic acids (ketones).  Left untreated, it can lead to coma and even death. 

The long term complications of diabetes are equally dangerous.  The good news is that numerous studies very clearly show that when people with diabetes keep their blood glucose levels close to the normal, non-diabetic range the long term complications of diabetes can be significantly delayed.  According to a study described in the February, 2003 issue of The New England Journal of Medicine, the most serious complications of Type 2 diabetes can be reduced up to 50%.

Because diabetes can damage nerves, blood vessels and organs found everywhere in your body, the long-term complications from uncontrolled blood glucose levels are many.    

• Heart disease and stroke are two to four times more common in those with diabetes.
  
• Diabetics with poor blood sugar control and high blood pressure are at greatest risk of severe kidney disease, including kidney failure.
  
• Diabetes can cause a variety of eye problems and may lead to blindness. 
  
• Diabetes can damage the sensory nerves in your legs and sometimes your arms.  This becomes most dangerous when, in addition to nerve damage, blood flow is poor.  Gangrene can develop, requiring amputation. 
  
• Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation.
  
• High blood sugar impairs your immune system and increases your risk of infections.

The signs and symptoms of long term complications develop slowly and by the time they're evident you may have already sustained a great deal of damage.  But, by taking the right steps, and taking them early, you can make a big difference in your prognosis.

• Step 1.  Set ambitious treatment goals and stick to them. 
  
• Step 2.   Optimize your overall health including weight, blood pressure, cholesterol levels and blood glucose levels.  If you smoke, stop.
  
• Step 3.  Talk to your primary care physician about specialists who should be on your health care team.  For instance, if you're at high risk for heart disease, consider annual checkups with a cardiologist.  Make sure you get annual eye exams – timely treatment and appropriate follow-up eye care can reduce the risk of blindness by 90 percent.  

It's all about looking ahead and making a decision.  It's tempting to ignore the specter of future complications and continue to live your life exactly as you did before.  That choice virtually guarantees some pretty grim consequences.  Or, you can take the disease seriously and choose to make changes.  When you do, you can look forward to a longer and more productive life, even with diabetes.