Complications of Diabetes

Diabetes complications and how to prevent them

/ Author:  / Reviewed by: Robert Carlson, M.D

It's hard enough to keep track of your daily responsibilities. It's even harder to plan for events years down the road. But if you have diabetes, you must start taking steps now to possibly avoid complications in the future.

Diabetes is a serious and complex disease that can lead to a number of complications, including blindness and kidney disease. Fortunately, these complications are possibly preventable.

As diabetes-related complications can take decades to develop, you might find it hard to think about them today. But now is the time to make important lifestyle changes.

You have the power to prevent or delay the complications of diabetes by keeping an eye out for certain symptoms, controlling your blood sugar, and maintaining a conversation with your diabetes health care team.

What complications are associated with diabetes?

People can live long, fruitful lives with diabetes. However, if your diabetes is left unchecked, you are at risk for a variety of health problems, including:

  • eye problems
  • foot problems
  • skin problems
  • heart disease
  • high blood pressure
  • kidney disease
  • ketoacidosis, or high levels of blood acids called ketones

This article will give you an explanation of these common complications and provide tips on how to avoid them.

Eye Problems

Eye problems are common in people with diabetes. In fact, according to the American Diabetes Association (ADA), most diabetes patients will get some kind of retinopathy, a disorder of the retina.

Even though people with diabetes have a higher risk of blindness than others, most diabetes patients are faced with only minor eye problems. For those who develop major eye problems, there are treatments that can help.

As with all complications of diabetes, the best way to prevent eye problems is to keep your blood sugar under control. It is also crucial to get a regular eye exam at least once a year.

What eye problems develop in diabetes patients?

Glaucoma

Diabetes patients have a 40 percent higher risk of developing glaucoma, and that risk increases the longer someone has diabetes. Older patients are also more likely to suffer from glaucoma.

The front part of the eye contains a clear fluid called aqueous humor. This fluid is always being made behind the iris (the colored part of the eye). In a healthy eye, the fluid is regularly drained. In glaucoma, however, the aqueous humor cannot drain, which causes a buildup of pressure. This pressure can cause damage to the optic nerve (carrier of messages from the retina to the brain). Over time, a person will lose vision because the retina and optic nerve are damaged.

There are both medical and surgical treatments for glaucoma designed to relieve pressure in the eye.

Cataracts

Cataracts are common among people with and without diabetes alike. However, the eye condition is 60 percent more common in people with diabetes.

In most people, the lens of the eye is clear. Much like a camera lens, it focuses light as it passes to the back of the eye. In people with cataracts, this clear lens becomes clouded, blocking light and reduces vision.

Cataracts usually develop in older people. With diabetes, they tend to form at a younger age and to progress more rapidly.

Patients with mild cataracts often wear protective eyewear like sunglasses or glare-control lenses in their corrective glasses. If cataracts are severe, a doctor may decide to remove the lens of the eye.

Retinopathy

The retina is the part of the eye that records images, and then turns those images into electrical signals to be sent to the brain.

Diabetic retinopathy is a term used to describe all retina disorders caused by diabetes. These disorders can range from mild to severe.

There are two main types of retinopathy: nonproliferative and proliferative.

In nonproliferative retinopathy, capillaries in the back of the eye swell up and form pouches. In many cases, nonproliferative retinopathy does not require treatment. However, when fluid leaks into the macula (the part of the eye where focusing happens), macula edema can occur.

Macula edema causes blurry vision and, in some cases, total vision loss. Patients with macula edema must seek treatment. Fortunately, treatment usually stops or reverses vision loss.

Over time, retinopathy can get worse, eventually leading to proliferative retinopathy. In patients with this form of retinopathy, the blood vessels become completely closed off, causing new vessels to grow. These new vessels are not as strong as the old and tend to leak blood, which can block vision. This condition is called vitreous hemorrhage.

In some cases, the new blood vessels cause scar tissue to develop, which can warp or knock the retina out of place. This condition is called retinal detachment.

One reason eye exams are so important is that people with retinopathy often have no symptoms until it is too late.

How can I prevent eye problems?

Keeping your blood sugar under tight control is the most important step you can take to prevent eye complications. Results from the Diabetes Control and Complications Trial showed that diabetes patients who kept their blood sugar levels close to normal were four times less likely to get retinopathy than patients on standard treatment.

Blood pressure control is also key to maintaining your vision, as high blood pressure intensify your eye problems.

It's probably something you have heard before, but here it is again: quit smoking now! It will help preserve your vision in addition to improving your overall health.

Get regular checkups from an eye care professional at least once a year. It may be time to see an eye specialist now if you have:

  • blurry vision
  • difficulty reading books or street signs
  • double vision
  • pain in one or both of your eyes
  • redness in your eyes that does not go away
  • pressure in your eyes
  • spots in your vision
  • trouble seeing straight lines as straight
  • trouble seeing things to your side

Foot Problems

Diabetes-related foot complications come in many forms. Nerve damage, or neuropathy, is the most common cause of foot problems in people with diabetes. Problems also can be caused by poor blood flow or changes in the shape of your feet.

What foot problems develop in diabetes patients?

Neuropathy

For some people, diabetic nerve damage can hurt. Most often, it makes it harder to feel pain or temperature. Since you cannot feel, you might not notice if you have hurt your foot. You could have an open wound all day that, if left ignored, could get infected.

Neuropathy can also cause your feet and toes to change shape. If this happens to you, your doctor may recommend special shoes.

Poor Blood Flow

Diabetes can cause the blood vessels in your legs and feet to harden and narrow, leading to poor circulation. If you have poor blood flow, your feet are more prone to infection and less able to heal.

There are a few things you can do on your own to prevent poor blood flow. First, quit smoking. Smoking makes your arteries harden faster. Keeping your blood pressure and cholesterol under control also can improve your circulation.

Foot Ulcers

Some people with diabetes develop foot ulcers, or wounds or open sores that do not heal or keep coming back. In most cases, diabetes patients get ulcers on the ball of the foot or bottom of the big toe.

Not every ulcer will hurt. But even if there is no pain, you should get every ulcer checked by your doctor. If left untreated, ulcers can lead to infection and possibly amputation.

If you have a foot ulcer, let it heal. Stay off your feet as much as possible. Your doctor may even recommend you wear a special shoe or other device.

Amputation

You might have heard that people with diabetes have a higher risk than others of foot and leg amputations. Unfortunately, that is true.

So, why are diabetes patients more likely to have an amputation?

For one, many diabetes patients have artery disease, which makes it hard for blood to flow to the feet. Another reason is nerve damage, which makes it harder to feel pain or any problems in the feet and legs.

The good news is that amputations, and all other diabetes-related foot complications, are possibly avoidable.

How can I prevent foot problems?

Anyone with diabetes should get a complete foot exam at least once a year. If you already have foot problems, you should get your feet checked even more often.

If you injure your foot, get care from your doctor as soon as possible. You should always let your doctor know if you have cut or broken the skin of your foot, even if it is just an ingrown toenail. It is also important to tell your doctor if you see in changes to the color or shape of your foot.

There are a number of ways to prevent foot complications and to maintain healthy feet, including:

  • keeping your blood sugar under control
  • checking your feet daily for spots, cuts, swelling, or blisters
  • staying active
  • wearing special therapeutic shoes
  • washing your feet every day
  • using lotion to keep the skin of your feet soft and smooth
  • trimming your toenails
  • protecting your feet with socks and shoes
  • protecting your feet from extreme heat and cold, as you might not be able to feel temperature
  • keeping your blood flowing to your feet by putting your feet up while sitting, moving your toes and ankles multiple times a day
  • quitting smoking

Skin Problems

According to the ADA, about 33 percent of people will have a diabetes-related skin problem at some point in their lives. Some of these skin problems can happen to anyone, while others mainly affect only those with diabetes.

Bacterial Infections

People with diabetes have a higher risk for a number of general skin conditions. Examples of bacterial infections affecting diabetes patients include:

  • styes, or infections of eyelid glands
  • boils
  • folliculitis, or hair follicle infections
  • carbuncles, or deep tissue skin infections
  • infections around the nails

Fungal Infections

People with diabetes are also at risk of fungal infections. In most cases, fungal infections are caused by Candida albicans, a yeast-like fungus that can lead to itchy, red, and moist rashes, small blisters and scaly skin.

Other common fungal infections include:

  • athlete's foot
  • jock itch
  • ringworm
  • vaginal infection

Diabetes-specific Skin Conditions

Some skin conditions are mostly or only seen in people with diabetes. These include:

  • diabetic dermopathy - changes in small blood vessels that cause light brown, scaly patches most often on the front of the legs
  • necrobiosis lipoidica diabeticorum - changes in blood vessels that cause spots that look like those of diabetic dermopathy, but bigger, deeper, and fewer
  • atherosclerosis - a hardening of the blood vessels that can make the skin hairless, thin, cool, and shiny, and can make it hard for sores to heal
  • eruptive xanthomatosis - a condition that causes hard, yellow, itchy growths on the back, hands, feet, arms, legs, and buttocks
  • digital sclerosis - the development of tight, thick, waxy skin on the back of the hands, toes, forehead
  • disseminated granuloma annular - raised rings or arcs usually occurring on parts of the body away from the trunk, such as fingers or ears
  • acanthosis nigricans - tan or brown raised areas of skin on the neck, armpits, and groin that usually occur in people who are overweight
How can I prevent skin problems?

Diabetes-related skin conditions can be irritating and, sometimes, very dangerous. Luckily, most of them are both preventable and treatable.

Carefully managing your diabetes is the most important part of preventing skin conditions associated with diabetes. By following your doctor's instructions about diet, exercise, and medications, you can keep your blood sugar down and control your weight. Doing these things will help you avoid most diabetes-related skin problems. You should also take care of your skin by avoiding too much sun and using lotions approved by your doctor.

Heart Disease

People with diabetes have a higher risk of having heart-related problems, compared to people without diabetes. In fact, heart disease is one of the leading causes of death in diabetes patients.

It is certainly scary to think about the possibility of suffering a heart attack or stroke. But if you take the proper steps, you can protect yourself from these potentially deadly complications.

How can I prevent heart disease?

Getting your diabetes under control is crucial in preventing heart disease. Your blood sugar, blood pressure, and cholesterol all play a role in the development and prevention of heart disease.

In order to lessen heart disease risk, you must first get your blood sugar under control. Your doctor likely has given you a target goal for your levels of HbA1C, a measure of blood sugar over three months. Carefully managing your blood sugar to reach that goal is key in the management of heart disease risk. Generally, people with diabetes should aim for an HbA1C of seven percent or less. Your doctor will advise you of your personal goal.

Secondly, you should keep an eye on your blood pressure. It is recommended that most diabetes patients aim for a blood pressure level below 130/80 mm Hg. Make sure your doctor checks your blood pressure at every regular appointment.

Lastly, it is important to watch your cholesterol. Basically, you want to reduce your levels of LDL, or "bad" cholesterol and increase your levels of HDL, or "good" cholesterol.

Kidney Disease

Your kidneys are amazing filter systems. When we eat and digest, our bodies create waste. While useful substances like proteins stay in our blood, these waste products our filter out through the kidneys into our urine.

Diabetes can put a strain on our kidneys. High blood sugar levels make our kidneys filter too much blood. Over time, a diabetes patient can start to lose useful proteins in the urine. Small levels of protein in the urine is called microalbuminuria.

Microalbuminuria are an early sign of kidney disease. If your doctor can spot kidney disease early, there are treatments that can keep it from getting worse. If you already have high levels of protein in your urine (macroalbuminuria), you may develop kidney failure and need dialysis.

How can I prevent kidney disease?

Tight blood sugar control is your key to avoiding kidney disease. Studies have shown that diabetes patients who practice tight control of blood sugar may lower their risk of kidney disease by as much as one third. Some research has suggested that tight blood sugar control may even reverse microalbuminuria.

Ketoacidosis

Another serious complication of diabetes is called diabetic ketoacidosis, a condition that occurs when your body makes very high levels of blood acids called ketones.

Toxic ketones may enter your blood stream when you have too little insulin in your body. This may eventually lead to diabetic ketoacidosis.

If you are suffering from ketoacidosis, you may experience:

  • excessive thirst
  • frequent urination
  • nausea
  • vomiting
  • abdominal pain
  • loss of appetite
  • fatigue
  • confusion
  • shortness of breath
  • breath that smells like fruit
How can I prevent diabetic ketoacidosis?

Controlling your blood sugar and managing your insulin levels are key to preventing diabetic ketoacidosis. Carefully monitor your blood sugar levels throughout the day. You may need to change your insulin dosage. Based on your diet, level of exercise, and other health conditions, ask your doctor what insulin dosage is right for you.

Plan for Your Future

It's not easy to hear your doctor give you a diagnosis of diabetes. But don't freak out. It's not the end of the world. You can live a long, relatively healthy life with the condition. For some people, it even may be possible to reverse the disease.

Follow your health care provider's instructions about diet, regular exercise, and drug treatments. Controlling blood sugar, losing weight, and quitting smoking will help you avoid complications.

Reviewed by: 
Review Date: 
May 3, 2012