Diabetes Complications


The following content was adapted from American Diabetes Association: Type 2 Diabetes Complications.
www.diabetes.org/living-with-diabetes/complications/

Complications are very common in diabetes, and usually develop when blood sugar levels are not controlled over a long period of time. High blood sugar levels damage blood vessels, which can affect eyes, feet, kidneys, nerves, and skin.


Eye Complications

Diabetic Retinopathy
Diabetic retinopathy is a serious disorder of the eyes that can lead to blindness. High blood sugar causes damage to the blood vessels that supply blood and nutrients to the retina. There are two types of retinopathy: non-proliferative and proliferative.

Non-proliferative retinopathy is the most common type of retinopathy. It occurs when blood vessels in the retina are blocked by swollen capillaries. Usually no vision loss occurs at this stage.

Proliferative retinopathy is more serious than non-proliferative retinopathy and can cause vision loss. Proliferative retinopathy occurs when small blood vessels grow on the surface of the retina. These vessels are very weak and can leak blood into the retina, causing vision to be blocked. Scar tissue can also form causing the retina to be distorted or pulled out of place.

Warning signs Diabetic retinopathy can develop with no warning signs or changes in vision, however, some people experience blurred vision, vision changes, trouble reading, seeing rings around lights, dark spots or flashing lights. Having yearly eye exams is important because a doctor can detect and treat any problems and prevent the worsening of the condition.

Preventing and Delaying Diabetic RetinopathyThe risk of developing diabetic retinopathy increases the longer a person has had diabetes, however, keeping blood sugar levels in the target range, and maintaining blood pressure at or below 130/80mm/hg are two ways to prevent or delay the onset of diabetic retinopathy.


Glaucoma
Glaucoma is a serious disorder of the eye that can cause blindness. People with diabetes are 2 times more likely to suffer from glaucoma than someone without diabetes. Glaucoma is caused when the drainage of fluid from the front chamber of the eye is reduced or blocked. The pressure pinches the blood vessels that supply blood and nutrients to the retina and puts pressure on the optic nerve. The damage caused by the loss of blood and nutrients to the retina and continued pressure on the optic nerve cause vision to be gradually lost.

Treatment Medications and surgery designed to relieve the pressure in the eye, and restore the blood flow to the retina are two methods of treatment. Early detection of glaucoma can slow and reverse the damage to the eye and preserve vision.


Cataracts
Cataracts occur in many people, however, people with diabetes are 60% more likely to develop cataracts than someone without diabetes. Cataracts occur when the lens of the eye becomes cloudy blocking light and vision.

Treatment Cataracts are treated by surgery that removes the cloudy lens of the eye and replaces it with a new clear lens. It is important for people with diabetes to work closely with their primary care provider and optometrist to slow and delay the progression of these diseases.

For more information visit the American Diabetes Association. Eye Complications.
www.diabetes.org/living-with-diabetes/complications/eye-complications/



Nerve damage

Nerve damage or diabetic neuropathy is common among people with long standing diabetes. It is more common with people who have high blood glucose levels or problems controlling their blood sugar.

Signs and Symptoms Diabetic neuropathy can cause many signs and symptoms including pain, burning, tingling or loss of feeling in hands and feet, abnormal sweating, or light-headed feeling when standing up. It can also make it difficult to tell when blood glucose is low. Nerve damage can cause other problems including difficulty swallowing, bowel problems, difficulty urinating and dribbling, bladder and kidney infections, and erectile dysfunction.

Prevent and Control Diabetic Neuropathy Ensuring that blood glucose levels are as close to normal range as possible can delay and prevent the onset of neuropathy. Once neuropathy has been diagnosed in the diabetic it is still important to control blood glucose levels in order to make sure the nerve damage does not get worse.

For more information visit the American Diabetes Association. Diabetic Neuropathy and Diabetes.
www.diabetes.org/living-with-diabetes/complications/neuropathy/


Foot Problems

Many people who have diabetes also suffer from foot problems as a result of diabetic neuropathy (nerve damage), or circulation (blood flow) problems. Foot problems in people with diabetes are very serious because if not cared for properly they can result in amputation.

What's the Problem? Nerve damage can cause loss of feeling in feet making it more difficult to feel blisters, splinters, ulcers or other injuries to the feet. Poor circulation can make the healing of sores and ulcers slow and difficult, which can lead to infection. If proper care is not taken of feet, or if sores on feet are not treated infection can set in which can lead to foot amputation.

What can I do? While foot problems and amputation are a serious concern for people with diabetes, the good news is that you can do a lot to protect yourself against foot problems. Controlling your blood glucose is very important to maintain the health of nerves and to protect against the hardening of the vessels of the feet and legs. Taking care of the feet by having regular exams and checking them each night can minimize your chances of having major foot problems.

Foot Care

  1. Keep blood glucose in normal range.
  2. Examine feet every day for cuts, sores, blisters, red spots, swelling or anything abnormal, be sure to check bottoms of feet and between toes. If you cannot see the bottom of your feet, use a mirror.
  3. Make a physical activity plan with your doctor.
  4. Ask your doctor about Medicare coverage for special shoes.
  5. Every day wash feet and dry carefully, paying special attention to the skin in between toes.
  6. Put lotion on the tops and bottoms of feet to keep them soft and smooth. Don't put lotion between toes because it can help bacteria grow.
  7. Trim your toenails straight across.
  8. Always wear socks and shoes that fit well, even when you are inside. Before putting on shoes check to make sure the inside is smooth and there are no objects that will irritate feet.
  9. Protect your feet from extreme temperatures. Never go barefoot. Test water before placing feet into it, don't use hot pads, water bottles, electric blankets or ice packs.
  10. Keep blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two to three times a day. Don't cross your legs for long periods of time. Don't smoke.

For more information visit the American Diabetes Association. Foot Complications.
www.diabetes.org/living-with-diabetes/complications/foot-complications/


Dental Complications

High blood glucose over a long period of time can cause dental problems. You should get your teeth cleaned and your mouth checked every 6 months.

Signs and Symptoms Sore, red, or swollen gums or gums that bleed when you brush your teeth, trouble chewing, bad breath, a bad taste in your mouth, or sore or loose teeth are all signs that you might have a problem. You should make an appointment and see your dentist as soon as you can.

Preventing Problems Brush your teeth at least twice a day, using a soft bristled toothbrush and toothpaste with fluoride. Make sure that you always brush before you go to bed at night, floss your teeth each day and see your dentist twice a year. Also, keeping your blood glucose normal or close to normal is very important to preventing or delaying dental problems.



Kidney Disease

Kidney Disease or nephropathy is a serious complication in people with diabetes. The kidneys function to filter the blood and take out waste products. Each kidney has millions of filters that allow only waste materials to pass through. Once through the kidneys, waste products are excreted through the urine. Over time damage to the kidneys, from high blood sugar, allows these filters to become enlarged and leaky, which allows things we need in our body, like protein, to escape.

Microalbuminuria - A small amount of protein found in the urine is called microalbuminuria. This is a sign of the beginning stages of kidney disease. There are treatments that can be done to prevent or delay further kidney damage.

Macroalbuminuria - A large amount of protein is found in the urine. This is a sign that the kidneys have lost most of their filtering ability, as a result, there is a build-up of waste products in the blood. In most patients with macroalbuminuria, end stage renal disease follows. End stage renal disease is the failure of the kidneys to filter the blood, and it becomes necessary to have a kidney transplant or be on dialysis.

Preventing Kidney Disease There are several ways to maintain the health of kidneys. Maintaining blood glucose at normal levels can help to delay or prevent the risk of developing microalbuminuria, and can reduce the risk of developing macroalbuminuria if microalbuminuria already exists. Blood pressure, 130/80 mm/hg or higher, can quickly make kidney disease worse. It is important to control blood pressure to prevent or delay the onset of kidney disease. There are several ways to lower blood pressure: avoid salt, lose weight (if you are overweight), avoid alcohol and tobacco, and exercise regularly.

Dialysis is a method of cleaning the blood if the kidneys are no longer functioning. There are two types of dialysis: hemodialysis and peritoneal dialysis.

  • Hemodialysis is usually done 2-3 times per week, blood travels through a machine where it is cleaned, and returned to body.
  • Peritonial dialysis is done several times each day and uses the lining inside the abdomen as the filter. A tube is surgically inserted into the abdomen and cleansing fluid is put in and drained out several times each day to cleanse the blood.

For more information visit the American Diabetes Association. Kidney Disease.
www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html