Many people with diabetes are anxious about their blood sugar numbers but have no concept of complications. What they don’t realize is that short-term blood sugar fluctuations make you feel uncomfortable, while long-term high blood sugar is the real culprit behind organ damage.
Diabetes itself is not directly fatal—complications are. And the occurrence of complications is directly related to "how long blood sugar has been high." For every 1% increase in HbA1c, the risk of microvascular complications increases by about 35%.
Complications fall into two categories, with completely different attack pathways
Category 1: Microvascular complications—the "precision strike" of glucotoxicity
Diabetic retinopathy: For those with diabetes for more than 10 years, the incidence rate exceeds 50%. Early symptoms are just blurred vision; late-stage can lead to blindness. An annual eye exam is more life-saving than measuring blood sugar.
Diabetic nephropathy: Early signs include microalbuminuria, at which point kidney function is still reversible; if it progresses to massive proteinuria and elevated serum creatinine, it enters an irreversible stage. Diabetes is the leading cause of end-stage renal disease.
Diabetic neuropathy: Numbness, tingling, and pain in the hands and feet, like wearing gloves and socks, worsening at night. Once pain sensation diminishes, foot injuries can go unnoticed, laying the groundwork for diabetic foot.
Category 2: Macrovascular complications—the "death pathway" shared with the general population
The risk of cardiovascular and cerebrovascular diseases in people with diabetes is 2-4 times that of the general population. Myocardial infarction, stroke, peripheral artery occlusion—high blood sugar accelerates atherosclerosis, aging blood vessels by 20 years ahead of time.
A critically underestimated complication: sarcopenia
Long-term high blood sugar + disordered protein metabolism + chronic inflammation lead to accelerated muscle mass loss. The less muscle you have, the harder it is to control blood sugar, creating a vicious cycle. Many elderly individuals with diabetes ultimately do not die from diabetes itself, but from complications following a fall.
Three essential screenings you must do
- Annual fundus photography
- Annual urine microalbumin-to-creatinine ratio (UACR) test
- Foot examination every 6 months (including 10-gram monofilament tactile test)
💡 The essence of blood sugar control is "protecting organs"
Blood sugar numbers are just the surface; the real battleground lies in the blood vessels, nerves, kidneys, and retina behind them.
⚠️ Note
This article is for health science popularization. If you experience any symptoms, please visit a regular hospital for consultation in the relevant department.
