An Overview of Diabetes Complications

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Diabetes is a chronic, progressive disease that must be managed daily. Better medicines, additional resources, increased education, and more sophisticated tools have helped people with diabetes to live longer. However, longer lifespans can leave more time to develop complications. That is not to say that all people with diabetes are destined to have complications. Rather, people must continue to take care of their diabetes to prevent issues down the road.

The best way to prevent diabetes complications is to try to keep your blood sugar, blood pressure, and weight within a healthy range. Chronically high blood sugars can cause damage to many organs of the body. Elevated blood pressure and obesity stress the heart and make controlling diabetes harder.

Also, making sure you keep appointments with your physicians—primary doctor, eye doctor, podiatrist, cardiologist—and being aware of any new symptoms can help you to detect and treat complications quickly. In addition, keeping your blood sugars controlled and adopting lifestyle changes can prevent or delay complications of diabetes.

Understanding these types of complications will increase awareness and motivate you to take good care of yourself.

What Type of Complications Are There?

Diabetes complications are identified as either macrovascular (large vessel complications) or microvascular (small vessel complications). Macrovascular complications include cardiovascular diseases such as heart attacks, strokes, and insufficiency in blood flow to the legs (peripheral arterial disease). These types of complications are produced by atherosclerosis (hardening of the arteries). Abnormal blood lipids, an unhealthy diet, being overweight or obese, not exercising, and having high blood pressure can complicate these symptoms. In addition to controlling your blood sugar, you must also address all of these risk factors so that you can prevent strokes and heart attacks.

Microvascular complications include damage to the eyes (retinopathy), damage to the kidneys (nephropathy), and damage to the nerves (neuropathy). These types of complications can be mitigated or prevented by keeping your blood sugars controlled. Discuss your blood sugar targets with your physician and aim to reach those targets daily.

What Should I Know About These Complications?

Kidney disease (nephropathy): Diabetes is a major risk factor for kidney disease. In fact, one in three people with diabetes develop kidney disease, and diabetes is the most common cause of kidney failure. Diabetes can cause damage to the barrier that protects the kidneys and the basement membrane where the filtering process takes place. The kidneys are made up of blood vessels that are responsible for filtering the blood. When the blood vessels become damaged, toxins can build up in the blood. Your physician should check your kidney function each time you get blood work. In addition, urinalysis is done to check for kidney disease in your urine.

To prevent kidney damage he or she may put you on a blood pressure medicine, called an ACE inhibitor. It is important to try to keep your blood pressure controlled. Elevated blood pressure can put stress on your heart and your kidneys, complicating things even further. If you've been prescribed medicine, make sure you take it. If you smoke, try to quit. And if you are salt sensitive, it's best to try to avoid high sodium foods, such as canned goods, deli meat, snack foods, and frozen meals. These types of foods are high in sodium, which can cause blood pressure to rise by putting pressure on your vessels.

There are five stages of kidney disease. The first stage is considered the benign phase and the last stage is end-stage kidney disease, in which treatment consists of dialysis or kidney transplant. Most of the time, people do not feel the symptoms of kidney disease until it has progressed to the very end stages. Therefore, it's important to have a good relationship with your doctor. Become a proactive patient and ask questions, so that you are aware of where your kidney function is and where it should be.

The good news is that keeping your blood sugars, blood pressure, and weight control can help to prevent kidney disease. In addition, getting your kidneys tested regularly is an important way to keep track of the health of your kidneys.

Nerve damage (neuropathy): Neuropathy is most common in the feet and hands, but can also cause damage to nerves in other areas of the body. Autonomic neuropathy develops in the bladder, digestive tract, and the reproductive organs. Peripheral neuropathy affects the hands, feet, and legs. Nerve pain can hurt. It can also cause unusual symptoms. For example, nerve damage to the stomach can cause increased satiety and erratic blood sugars. Peripheral neuropathy is often described as a burning sensation or a numbness and tingling. People who have nerve pain in their extremities may have difficulty detecting foot injuries, such as stepping on a tack, or perhaps the rubbing of a stone against your toe. Undetected foot injuries can lead to serious infections. Coupled with elevated blood sugars, foot injuries can be slow to heal and can lead to amputations.

You are more likely to develop neuropathy if you've had diabetes for an extended period of time, especially if your blood sugars have been chronically high. The best thing you can do to prevent neuropathy is to keep your blood sugars in good range. If you suspect something is wrong, you should contact your physician.

If you've been diagnosed with autonomic neuropathy, you may need to follow certain treatments, such as following a special diet, seeking psychological counseling, or taking certain medicines.

If you have been diagnosed with peripheral neuropathy or suspect that you may have it, you should have your physician conduct a thorough foot exam to determine your sense of sensation with either a tuning fork or monofilament test. If you have diminished sensation, foot abnormalities, such as fungal infections or nails, deformities, dry cracked skin, wounds or cuts, you likely will be sent to a podiatrist for further work up. If you do not see a podiatrist, make sure you take your socks and shoes off at each physician visit. When you are home it is important to check your feet regularly and practice good foot hygiene. Make sure you:

  • Change your socks daily and wear clean, dry socks.
  • Apply emollient creams to cracked soles (avoid lotion between the toes).
  • Dry well between your toes (too much moisture can cause the development of fungal infections).

It's also important never to walk around barefoot, always shake out your shoes before putting them on, and wear shoes that fit and are comfortable.

Retinopathy (eye damage): Elevated blood sugars can cause damage to the small vessels behind the eye, which can cause them to bleed or leak fluid. People with diabetes are at increased risk of developing eye conditions, such as retinopathy, diabetic macular edema (DME), cataract, and glaucoma. If not properly treated, these eye conditions can lead to vision loss and even blindness. People with diabetes should have a dilated eye exam upon diagnosis of diabetes. Damage to the eye can begin before diabetes is diagnosed. Therefore, being proactive is very important for preventing complications. If you have diabetes, you should get your eyes examined at least once every two years if you have no evidence of retinopathy and once per year if you have existing eye issues. Controlling diabetes—by taking medications as prescribed, staying physically active, and maintaining a healthy diet—can prevent or delay vision loss. In addition, early detection and appropriate follow-up care can protect vision loss.

High blood pressure and heart disease: People with diabetes are at increased risk of developing high blood pressure. People with diabetes are also two times more likely to have heart attacks and strokes than those who do not have diabetes. It is important to think of diabetes, not only as a disease of blood sugar but as a cardiovascular disease. Doing so can help prevent or delay the development of heart disease. Therefore, it is important to keep blood sugar, blood pressure, cholesterol, and weight within healthy ranges. In addition, if you smoke, you should try to stop. Smoking cessation can reduce your risk of stroke and lower both blood sugar and blood pressure.

Typically, there are no symptoms of elevated blood pressure, which is why it is often referred to as the "silent killer." Some people walk around with their pressure being high or borderline high without even knowing it. If you do experience symptoms, you may develop headaches or feel lighted. To maintain normal blood pressure, you should make sure your blood pressure is checked at every doctor's visit. Know your numbers and what a normal blood pressure is.

According to the American Heart Association, a normal blood pressure is less than or equal to 120/80 mm/Hg. The top number, systolic blood pressure, is the measurement of pressure in the arteries when the heart beats (or is at work). And the lower number, diastolic pressure, measures the pressure between beats when the heart is resting. If you have been prescribed blood pressure medicine, make sure you take it. If you have been given a blood pressure machine to monitor your pressure at home, you should do so. Notify your physician if your pressure is higher than it should be. Lastly, changing your diet can help to lower your blood pressure. Foods that are rich in sodium can elevate blood pressure. Avoid adding salt to your foods and try to avoid processed foods—foods that are in a can, bag, or box. Many people with elevated blood pressure benefit from following a DASH diet. 

If you have a family history of heart disease, you are at increased risk of developing it, especially if you have diabetes. But you can try to reduce the risk by keeping your blood sugar and lipids at goal (HDL and LDL cholesterol and triglycerides), your body mass index at a healthy range, your waist circumference within normal limits, and increasing your physical activity.

Discuss your specific goals with your physician. Most people benefit from these numbers:

  • Hemoglobin A1c 7 percent or less
  • Total cholesterol: <200 mg/dL
  • LDL <100 mg/dL
  • HDL > 40 mg/dL for men and >50 mg/dL for women
  • Triglycerides <150 mg/dL
  • Waist circumference: Men <40 inches, women <35 inches
  • Body Mass Index: 18.5-24.4kg/m2
  • Exercise: Aim for 150 minutes per week of moderate physical activity

Preventing These Complications

High glucose levels produce changes in the blood vessels themselves, as well as in blood cells that impair blood flow to various organs. Making aggressive lifestyle changes can help to lower blood sugars and prevent diabetes complications. It is never too late to take action. Even if you've had diabetes for a long time, you can still make changes to better your health.

Keep your blood sugars in target range: Make sure you have a clear understanding of what your blood sugar targets are. Blood sugars that are too high (hyperglycemia) and too low (hypoglycemia) can be dangerous. Keeping your blood sugars at your desired goal can help you to prevent the large and small vessels from becoming damaged. Don't get upset if you have an occasional high blood sugar. But take action when you notice a pattern of high blood sugars. Contact your doctor if you are doing everything the same and your blood sugars are high—you may need a medication adjustment. Because diabetes is a progressive disease, sometimes we need to make changes, even when we are doing everything right.

Lose weight: Weight loss is one of the most powerful ways of reducing blood sugars. In addition, losing weight takes stress off the heart and can reduce the risk of heart disease. Establishing a healthy weight can help reduce insulin resistance and allow your body to use the insulin it is making. This takes stress off the pancreas and can preserve beta cells (the cells used to make insulin). Losing 10 percent of your body weight can greatly improve your overall health. If you've been trying to lose weight for a long time and continue your struggle, you may benefit from a meal replacement. Meal replacements are calorie- and carbohydrate-controlled. They can serve to eliminate a food choice during the day, which can make it easier for you to reduce your calorie intake. Being accountable for your food choices can also help you to stick to a healthy eating plan. Increase your accountability and gain a coach by setting up a meeting with a registered dietitian or certified diabetes educator. 

Follow a healthy diet: What you eat greatly impacts your diabetes control. Carbohydrates are the nutrient that raises blood sugars the most. Foods such as bread, rice, pasta, beans, fruit, milk, and yogurt all contain carbohydrates. People with diabetes benefit from eating a modified, carbohydrate-controlled diet. Many people find that their blood sugars are better controlled when they eat a lower carbohydrate diet. If your diet is high in carbohydrates, the best thing you can do is try to cut back.

Eliminate sweetened beverages, reduce sweets and limit your carbohydrates at your meals to no more than 1 cup. Once you've done that, try to choose better sources of carbohydrates: whole grains, legumes, and starchy vegetables are some better carbohydrate choices. In addition to reducing carbohydrates, it's best to reduce intake of processed and fried foods, such as cured meats, deli meats, and French fries, to name a few. These types of foods are rich in calories, saturated, and trans fat, and can increase bad cholesterol, which is a contributing factor to atherosclerosis. Lastly, increase your fiber intake. Foods rich in fiber, whole grains, fruits, vegetables, nuts, and seeds can help you to feel full, stabilize blood sugars and lower cholesterol. It is beneficial to eat about 25-38g of fiber daily. 

Move more: It might be easier said than done, but exercise really helps to lower blood sugar by utilizing insulin. In addition, exercise can help to build muscle, increase energy, and improve sleep and mood. Ultimately, you should aim to hit about 150 minutes per week of moderate physical activity (spread over at least three days). When possible, you also should include two days per week of resistance exercise. If you've never exercised before, make sure you get medical clearance before starting a new routine.

Receive diabetes self-management education: Everyone with diabetes should receive diabetes self-management education at diagnosis and should continue to receive education throughout the various stages of diabetes. Even if you've had diabetes for a long time, you can benefit from getting a refresher course. Diabetes self-management education focuses on self-care behaviors, such as healthy eating, physical activity, blood sugar monitoring, problem-solving, reducing risks, and healthy coping. You can choose to do one-on-one sessions or group sessions. Ask your physician about getting started.

Assemble a team of doctors: A great way to reduce risk and complications is to establish a good relationship with your primary care physician. Typically, she will refer you to other physicians: the eye doctor, the foot doctor, the cardiologist, the endocrinologist, etc. Receiving healthy checkups can help to take preventative action in reducing diabetes complications. Having a baseline evaluation can help you to identify changes. The faster you identify changes the better chance you have of treating an issue quickly and preventing further complications.

Take your diabetes seriously: Oftentimes, people with diabetes report that they don't feel as though their blood sugars are high. As a result, they decide not to treat their diabetes. This is extremely dangerous. Diabetes that is left untreated can result in dangerously high blood sugars, which can cause complications that may not be reversible. It's important to take diabetes seriously from the start. Sometimes aggressive lifestyle modifications, weight loss, diet, and exercise can help to lower blood sugars so much that they are no longer in the diabetes range. It is possible to do this if you adjust your behaviors as soon as you know about your diabetes. Take action today—you can do it.

A Word From Verywell

Diabetes is a disease that can cause many types of complications. But, the good news is that if you make aggressive lifestyle changes you can reduce or delay your risk of developing these complications. The best way to reduce your risk is to keep your blood sugar, blood pressure, weight, and cholesterol as close to normal as you can. Don't wait. Make sure you are meeting with the right types of doctors and that you are being proactive in your diabetes care. You can live a healthy, long life with diabetes, but you must work at it.

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Article Sources

  • American Diabetes Association. Standards of Medical Care 2016.
  • American Heart Association. Understanding Blood Pressure Readings.
  • National Eye Institute. Facts About Diabetic Eye Disease.
  • National Kidney Foundation. Diabetes.
  • Power, et. al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American diabetes association, the American association of diabetes educators, and the academy of nutrition and dietetics.Diabetes Care.