Complications of Diabetes

We have talked about the different types of diabetes over the past few weeks.  Today we will talk about the complications that can develop in people with diabetes.  The risk of long-term complications gets higher the longer you have diabetes, but how well diabetes is controlled is also an important factor in your risk of developing complications.  

What are the short-term complications of diabetes?

Short-term complications of diabetes are complications that happen acutely, even in patients that have only had diabetes for a short time.  They can be quickly remedied without lasting problems if they are recognized early.  These include:

• Diabetic ketoacidosis - Results from increased levels of ketones in the blood.  Blood sugar will be dangerously high as well.  It happens due to lack of insulin and is more common in type 1 diabetes.  It can be dangerous, even life-threatening, if not treated appropriately and early.  Symptoms include excessive thirst, frequent urination, fatigue, vomiting, weakness, rapid breathing, confusion, and a fruity breath smell.
• Hypoglycemia - Low blood sugar, which can be the result of diabetes medications or not eating when taking diabetes medications.  Can result in death if not recognized and treated quickly.  Symptoms include excessive sweating, dizziness, fatigue, sudden feeling of hunger, irritability, confusion, and fast heart rate or palpitations.
• Diabetic coma - An unconscious state resulting from either dangerously high, or dangerously low blood sugar.  Symptoms that happen before developing diabetic coma will either be the same as those of ketoacidosis or those of hypoglycemia that I listed above.

What are the long-term complications of diabetes?

All types of diabetes can affect many body organs and systems.  Long-term complications usually develop gradually.  In type 2 diabetes, some complications may even start developing before you know you have diabetes.  Here are some of the long-term complications of diabetes:

• Nerve damage (also called neuropathy, or diabetic nerve pain) - Can cause tingling, numbness, burning, or pain.  It usually starts in the tips of your toes and later fingers, and gradually spreads upwards, like a stocking or glove.  It is the result of damage to the capillaries that nourish your nerves caused by high sugar levels in the blood.  If not treated, you can lose the feeling in your feet and hands completely.  Damage to the nerves in the abdomen can cause problems with digestion.  It can also cause erectile dysfunction in men.
• Cardiovascular disease - This includes coronary artery disease and peripheral artery disease (hardening of the arteries outside the heart).  It causes a high risk of stroke, heart attack, and loss of circulation to various parts of the body.  For this reason, it is even more important for people with diabetes to work with their doctor to maintain good cholesterol and triglyceride levels to keep heart disease risk in check.
• Kidney damage - High blood sugar damages the delicate filtering system within the kidneys.  It can lead to kidney failure resulting in the need for dialysis or kidney transplant.
• Eye damage - High blood sugar damages the blood vessels in the retina at the back of the eye, which can lead to blindness.  Diabetes also increases the risk of glaucoma and cataracts.  90% of blindness caused by diabetes is preventable with timely diagnosis of diabetes, good blood sugar control with treatment, and regular eye exams to recognize and treat eye damage early.
• Skin problems - High blood sugar levels make the skin more prone to infection and poor healing of cuts or scrapes. 
• Foot problems - The feet can be seriously affected by cardiovascular, nerve, and skin complications noted above.  Damage in the feet is a common problem in diabetes.  A simple blister on the foot of a diabetic, if not treated properly, can lead to serious infection that may not heal easily.  This may lead to amputation of a toe, foot, or even the leg below or above the knee.  Diabetics can also have changes in the structure of their feet due to neuropathy, with fallen arches and worse, even leading to fractures in the feet without any trauma.  A person with diabetes should check their feet every day to look for cuts, scrapes, or blisters that need attention.  They should wear good quality shoes that are supportive and do not put undue pressure on any one place.  Your doctor should regularly check your feet as well.  
• Dementia - Type 2 diabetes increases your risk of developing dementia, including Alzheimer's disease.  The risk is greater with blood sugar that is poorly controlled.  
• Hearing problems - Are more common in people with diabetes.
• Depression - Is common in people with all types of diabetes.  When a person is depressed, it can be harder to manage blood sugar levels for several reasons, leading to more complications.

If you have diabetes, good blood sugar control is an important part of preventing complications from developing.  It is important to work closely with your doctor to manage your diabetes and maintain good control of your blood sugar.    

Next week, we will finish our series on diabetes with a discussion of nutritional considerations in diabetes by one of our dieticians. 

If you have any questions about diabetes, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor