There is little doubt that diabetes is a serious disease. There is also little doubt that people with diabetes can live long, healthy, happy lives, if they keep their diabetes under control. But do you know that how well you manage your disease on a day-to-day basis can have a dramatic impact on your degree of risk for the complications of diabetes?
What Are the Complications of Type 2 Diabetes?
The complications of
are both numerous and serious. They include:
Two out of three people with diabetes die from heart disease and stroke. In fact, diabetes, along with cigarette smoking,
high blood pressure
, and lack of exercise is considered a major, modifiable risk factor for heart disease and stroke.
Diabetes can change your blood, causing blood vessels throughout your body to become narrowed or to clog completely. If this occurs in your heart, you may have a
. If it occurs in a blood vessel in your brain, you could have a stroke.
This means that people with diabetes must work to keep not only their blood sugar under control, but their blood pressure and cholesterol levels as well.
While it’s true that people with diabetes have a higher risk of blindness than people who do not have the disease, most people who have diabetes experience only minor eye disorders. These vision problems are generally the result of persistent high levels of sugar in the blood, which damage the tiny blood vessels in your eyes.
In general, people with type 2 diabetes are at increased risk for three types of vision problems:
, and diabetic retinopathy (a general term for all disorders of the retina caused by diabetes). Fortunately, most diabetes-related vision problems can be slowed or stopped if caught early and can be prevented with good blood sugar control.
High levels of blood sugar make the kidneys filter too much blood. Eventually, the kidneys begin to leak, causing needed protein to be lost in the urine and waste products to build up in the blood. If diagnosed early, there are several treatments that may keep your kidney disease from getting worse. If caught later,
end-stage renal disease
(ESRD), usually follows. People with ESRD may need to have their blood filtered by machine (
) or may require a kidney transplant.
Diabetic neuropathies are a family of nerve disorders caused by diabetes. Neuropathy is the most common complication of diabetes and can be both painful and disabling. Over time, diabetes can damage the nerves throughout the body. This may lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. It may also affect other organ systems, such as the digestive tract, the vascular system, and the sex organs.
The most common manifestation of diabetic neuropathy is a small injury to the foot. When the nerves of your foot are damaged, you may not notice small sores or cuts on your foot and therefore not treat them appropriately. It may also take these injuries longer to heal. Both situations leave you at risk for infection, which in serious cases can lead to
Researchers do not yet know what causes diabetic neuropathy, however, glucose control seems to play a role. This means that the longer a person has diabetes, the greater their risk of developing diabetic neuropathy, particularly if they have difficulty controlling their glucose, cholesterol, and blood pressure levels. Fortunately, maintaining good blood sugar control seems to help prevent diabetic neuropathy and help relieve it once it occurs.
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder affects about 20% of people with diabetes, compared with 5% of people without diabetes. A frozen shoulder, technically known as adhesive capsulitis, often begins as tenderness or soreness in the shoulder joint, usually following a bout with another musculoskeletal condition such as
. As the shoulder becomes stiffer and more painful, people tend to use it less and less. Unfortunately, this eventually only adds to the stiffness and pain, creating a vicious cycle in which the shoulder’s range of motion decreases while the pain and stiffness increases.
Researchers aren’t sure exactly why diabetes is a risk factor for frozen shoulder. One theory is that high (uncontrolled) levels of glucose in the blood may contribute to abnormal deposits of collagen (a major part of the ligaments that hold the bones together in a joint) in the cartilage and tendons of the shoulder. This buildup can cause the affected shoulder to stiffen.
People with diabetes are also prone to skin conditions. It is so common, in fact, that as many as one third of people with diabetes will have some type of skin disorder during their lifetime.
Indeed, skin problems such as infections and itching are sometimes the first indication that a person has diabetes. Other types of skin disorders common in people with diabetes include dermopathy, necrobiosis lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis. Fortunately, most of these skin conditions can be either prevented or easily treated if caught early.
Gum Disease (Gingivitis)
If you have diabetes, you are at higher risk for gum disease than people who do not have the disease. This is because diabetes may weaken your mouth's ability to fight germs. And while it’s true that anyone can get gum disease, having diabetes can make it worse and make it more difficult to control.
When blood glucose levels are out of the normal range, they cause complications. These include the following:
Careful control of your blood sugar can
lower your chances
of developing these complications. Also, ask your doctor if there are specific medications you can take to decrease the risk of developing these complications.
is low blood sugar. Sometimes it is called an "insulin reaction." It is more common in people who take insulin to control their blood sugar, though it can also occur in people who take oral medication, most commonly sulfonylureas. It can be caused by any of the following:
Taking too much insulin or oral diabetes medication
Skipping or delaying a meal, or eating a smaller meal than usual
Exercising harder or longer than your usual pattern
Hypoglycemia can be managed fairly easily if you recognize the symptoms and treat them right away. The symptoms of hypoglycemia include:
Pale skin color
Sudden moodiness or behavior change, such as crying for no apparent reason
Clumsy or jerky movements
Confusion or difficulty paying attention
Tingling sensations around the mouth
If you think you are hypoglycemic, test your blood with your blood glucose monitor. If your blood glucose level is below the range your doctor said was safe, then treat the hypoglycemia. (If you don't know what your safe blood sugar range is, ask your doctor) Or if you recognize the symptoms of low blood sugar, you may want to treat it immediately, without waiting to test. Safety ranges for blood glucose will vary by individual and are based on your age and other medical conditions.
The goal of treating hypoglycemia is to quickly raise your blood glucose level to within your safe range. Ask your doctor what the best method of quickly treating hypoglycemia is for you. Common methods of self-treating hypoglycemia include eating or drinking some form of sugar, such as:
½ cup of fruit juice
5-6 pieces of hard candy
You should always have some type of sugar with you, so you are prepared to immediately treat hypoglycemia.
Wait 15-20 minutes after eating the sugar, and then retest your blood glucose. If it is still too low, repeat the treatment.
If you pass out from hypoglycemia, you will need immediate, emergency treatment. People who have type 1 diabetes may become prone to hypoglycemic episodes with few warning symptoms. Doctors may give these patients an injectable hormone, glucagon, to use in emergencies.
People with type 2 diabetes usually have warning signs of low blood sugars. If you experience symptoms or episodes of hypoglycemia, you should discuss the events around the episode with your doctor. You should review your current medication regimen to see if it needs adjusting, and you should also strategize about how you can prevent further episodes.
Hyperglycemia is high blood sugar. Long-term hyperglycemia is the major cause of many of the complications that occur in people with diabetes. Hyperglycemia occurs when you do not have enough insulin to remove the glucose in your body, or when your body does not use insulin properly. It can be caused by any of the following:
Taking too little insulin or oral medication
Eating a larger meal than usual
Stress from an illness, such as a cold or flu; or stress from factors in your daily life
Hyperglycemia should be treated immediately to avoid further complications. The signs and symptoms include:
High blood sugar—Ask your doctor how often you should check your blood sugar.
High levels of sugar in your urine—Ask your doctor if you should be monitoring your urine.
Frequent urination (polyuria)
Increased thirst (polydipsia)
If hyperglycemia is not promptly treated, it can lead to ketoacidosis, which is also known as diabetic coma. This is rare in people with type 2 diabetes patients. When blood sugar levels are so high that very little sugar is available in the cells for energy, the body starts breaking down stored fat for energy. The by-products of fat breakdown are ketone bodies, which are acids that build up in the blood and cause ketoacidosis.
Chronic high blood sugar as well as high blood pressure can damage tiny blood vessels in the retina of the eye. This damage, called diabetic retinopathy, can occur over a long period of time.
(two other eye conditions) occur almost twice as often and at a younger age in people with type 2 diabetes than in people without this disease. Signs of eye damage include:
Blurry or double vision
Rings, flashing lights, or blank spots
Dark or floating spots
Pain or pressure in one or both of your eyes
Trouble seeing things out of the corners of your eyes
Some people do not have any symptoms until the damage is significant. Therefore, it is essential to see your eye doctor regularly. Diabetic retinopathy can be treated with laser therapy, called photocoagulation, or surgery.
Quitting smoking and controlling your blood pressure are important preventive measures. According to the National Eye Institute, 90% of blindness in people with diabetes is preventable.
A cataract is a cloud over the lens of your eye. Your lens, which is usually clear, focuses light onto the retina. A cataract makes your vision cloudy. Cataracts are removed with surgery.
Glaucoma is a group of eye diseases caused by a clogging or drainage problem of the fluid in the eye. Eventually there is damage to your eye's main nerve—the optic nerve. The damage first causes you to lose sight from the corners or sides of your eyes. Without treatment, you can go blind. Glaucoma can be treated with special eye drops or laser surgery.
Between 30% and 40% of people with diabetes develop diabetic nephropathy after 20 years, a form of kidney damage.
High blood sugar and high blood pressure damage the kidneys’ small blood vessels (capillaries), which are responsible for filtering waste out of the blood. This damage allows protein to leak out of the blood, and causes wastes that should be excreted with the urine to build up in your blood. Having small amounts of protein in the urine is called microalbuminuria.
As damage continues, more protein is leaked and more wastes build up. Having larger amounts of protein in the urine is called proteinuria or macroalbuminuria. This damage can eventually progress to
People with type 2 diabetes are more likely to have heart disease and to die from heart disease than people without diabetes. Microalbuminuria is a known risk factor for vascular disease especially coronary artery disease. Yearly urine screen for protein is recommended. In type 2 diabetes, high triglycerides and low HDL cholesterol levels are also quite common. These are known risk factors for heart disease.
Having diabetes can cause your blood cholesterol levels to rise, leading to clogged, narrowed arteries—a condition called
. Clogged arteries make it more difficult for blood to carry oxygen and other essential nutrients to vital organs and tissues such as you heart, and can cause:
Chest pain (
)—This pain or pressure typically starts in your chest and radiates to your arms (especially the left). This type of pain may appear when you exercise or after eating a large meal, and get better when you rest.
Heart attack—This is caused by the blockage of a blood vessel in or near your heart. As a result, part of your heart muscle doesn't receive oxygen and the essential nutrients it needs to function, so it stops working. Symptoms of a heart attack include chest pain, pressure feeling, nausea, indigestion, extreme weakness, and sweating.
Cardiomyopathy—This is a general weakening of the heart muscle caused by narrowed, small blood vessels that decrease the blood flow through the heart.
Type 2 diabetes makes you more likely to have a
. A stroke is caused by a blockage of blood flow to the brain usually from emboli arising from the heart or carotid artery or due to brain hemorrhage. The effects of a stroke depend on the part of your brain that is damaged, and may include:
Sudden weakness or numbness of your face, arm, or leg on one side of your body
Sudden confusion, trouble talking, or trouble understanding
Sudden dizziness, loss of balance, or trouble walking
Sudden trouble seeing in one or both eyes or sudden double vision
Sudden severe headache
Diabetes can also cause mild to severe nerve damage, called diabetic neuropathy. Having high blood sugar for many years can damage the blood vessels that bring oxygen to the nerves. High blood sugar can also hurt the covering on the nerves. Damaged nerves may stop sending messages. Or they may send messages too slowly or at the wrong times. This can lead to symptoms that range from pain or tingling, to numbness and loss of feeling. The longest nerves in the body are often affected first, leaving the hands and feet most susceptible to neuropathy.
The combination of repeated injury, poor blood flow, and poor healing, leads to a greater risk of foot infections that are difficult to treat. In severe cases, when circulation is poor and antibiotics fail to cure the infection,
foot and leg amputations
Your feet are especially vulnerable to the complications of type 2 diabetes. Damage to the peripheral nerves—which go to the arms, hands, legs, and feet—can impair your experience of sensations such as pain, heat, and cold. In addition to nerve damage, type 2 diabetes can also cause a decrease in blood flow. Therefore, if you have a
or sore on your foot, you may not feel it because of neuropathy. And then, because of lack of sensation, this area on your foot may be continually re-injured. Therefore, it is essential to wash and examine your feet daily.
Lower Your Chances of Complications
Take these steps to promote your health:
Have regular checkups even if you feel fine; your doctor can often spot early signs of complications.
Strive to keep your blood sugar under control. Work with your doctor to find appropriate blood sugar goals for you.
Keep your blood pressure and cholesterol under good control.
Don't smoke; if you smoke, quit.
Keep your influenza and pneumococal immunization up-to-date.
Exercise regularly (e.g., aerobic exercise three to five times a week for 20-60 minutes each time).
Keep a close to normal weight.
Tell your doctor if you have any of these warning signs:
Vision problems, such as blurriness or spots
Numbness or tingling feelings in hands or feet
Repeated infections or slow healing of wounds
Cuts or blisters on your feet
Ask your doctor if there are any medications that you should take to prevent complications
Gross JL, de Azevedo, Silveviro SP, et al: Diabetic nephropathy: diagnosis, prevention, and treatment.
Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomized placebo-controlled trial.
Kendall DM, Riddle MC, Rosenstock J, et al. Effects of Exenatide (Exendin-4) on glycemic control over 30 weeks in patients with type 2 diabetes treated with metformin and a sulfonylurea.
Kris-Etherton PM, Harris WS, Appel LJ for the AHA Nutrition committee:Omega-3 Fatty Acids and Cardiovascular Disease. Arteriosclerosis, Thrombosis, and Vascular Biology 2003; 23:151-52.
Link for life: an interactive program on diabetes and heart disease. American Diabetes Association website. Available at:
. Accessed October 13, 2003.
Lipid control in the management of type 2 diabetes mellitus: a clinical guideline from the American College of Physicians.
Annals Internal Med
. 2004; 140:644-9.
Skyler JS, Bergenstal R, Bonow RO et al: Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials.
2/7/2008 DynaMed Systematic Literature Surveillance
: Armstrong DG, Holtz-Neiderer K, Wendel C, Mohler MJ, Kimbriel HR, Lavery LA. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients.
Am J Med.
2/7/2008 DynaMed Systematic Literature Surveillance
: Lavery LA, Higgins KR, Lanctot DR, et al. Home monitoring of foot skin temperatures to prevent ulceration.
4/10/2008 DynaMed Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance
: The ONTARGET investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events.
N Engl J Med.
2008 Mar 31 [Epub ahead of print].
6/18/2008 DynaMed Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance
: ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
N Engl J Med.
2008;358:2560-2572. Epub 2008 Jun 6.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a