You’ve been told a million times to keep your blood glucose levels under control, but why? What are the possible complications of diabetes anyway? Unfortunately, poorly managed diabetes can affect almost every part of the body.
Hearing about these complications may be quite frightening when you’re first diagnosed. However, when armed with knowledge, you can work to minimise or preventing them occurring. So here is a brief overview of the main long-term complications of diabetes.
The complications of diabetes can be loosely divided into two categories, those that affect small blood vessels (microvascular complications of diabetes) and those that affect the large (macrovascular complications of diabetes).
A landmark study, the UKPDS, found that intensive blood-glucose control decreases the risk of microvascular complications, but not macrovascular disease. They also found that blood pressure control contributed more to cardiovascular disease risk reduction (a macrovascular complication), compared to tight blood glucose control. As all complications need to be prevented, a healthy lifestyle, with good control of blood glucose and blood pressure is vital for those with diabetes.
Microvascular Complications of Diabetes
Eye related complications of Diabetes: Diabetic Retinopathy
Long-term hyperglycemia causes damage to the tiny blood vessels in the eyes. According to the World Health Organisation, diabetes is a leading cause of blindness and visual impairment. The majority of these cases are caused by diabetic retinopathy, that is damage to the retina.
Symptoms: You may see floating spots or almost total darkness, be overly sensitive to glare, have problems with balance, reading, watching television, recognising people, or seeing at night. Unfortunately by the time you notice changes the damage may already be severe.
Prevention: Meeting your blood glucose targets and keeping your blood pressure down both help prevent diabetic retinopathy. However, some people with good control who have had diabetes for a long time may still develop retinopathy.
Check-upss: If you have diabetes you should have eye checks regularly, at least every two years.
Nerve complications of Diabetes: Neuropathy
Neuropathy, or nerve damage, is seen in about half of patients with diabetes. Nerve damage can affect many areas of the body.
Peripheral Neuropathy refers to nerve damage in the arms, hands, legs and feet.
Symptoms: May include pain, tingling, or numbness in the hands, arms, feet, and legs. However, not all those with neuropathy have symptoms.
Foot complications of diabetes
Foot problems are a source of major patient suffering and societal costs and the most common reason for hospital admission among people with diabetes! They mostly occur as a result of neuropathy (nerve cell damage). However, they are also associated with ischaemia (restricted blood supply, causing lack of oxygen and glucose) from peripheral vascular disease.
A foot ulcer is serious and needs to be managed immediately.
Check-ups: Even those at low risk of foot complications are recommended have a foot examination at least annually.
Autonomic Neuropathy refers to damage to the nerves that function without you thinking about it – automatically you could say! Diabetic autonomic neuropathy includes resting tachycardia, exercise intolerance, constipation, gastroparesis and erectile dysfunction.
Gastroparesis is when food moves very slowly out of the stomach and into the small intestine.
It happens as a result of damage the vagus nerve, which is responsible for controlling the stomach muscles. This damage occurs as a result of poor blood glucose control and in turn gastroparesis can make controlling blood glucose even more difficult. When food that has been delayed in the stomach finally enters the small intestine, blood glucose levels rise. As gastric emptying is unpredictable with gastroparesis, a person’s blood glucose levels become erratic.
Symptoms: prolonged fullness, bloating, vomiting (antiemetics may assist) and erratic glucose control.
Kidneys complication of Diabetes: Diabetic nephropathy
Diabetes is the leading cause of chronic kidney disease in developed countries. High blood glucose levels damage the nephrons, the filtering units of the in the kidneys. Kidney disease is progressive and can lead to kidney failure including the need for dialysis. High blood pressure is known to contribute to the progression of chronic kidney disease. Nerve damage in the kidneys can also cause bladder dysfunction.
Prevention: Maintaining good blood glucose and blood pressure as well as a healthy lifestyle, including a low salt diet, physical activity, healthy weight and not smoking.
Check ups: Annual blood, urine and blood pressure test should be carried out by your health professional.
Macrovascular Complications of Diabetes
Diabetics have an increased risk of developing cardiovascular disease and it remains the main cause of death. Long term high blood glucose damages blood vessels as it contributes to atherosclerosis, clogging of arteries. This narrowing of arteries can cause decreased blood flow to heart muscle leading to a heart attack or to brain, causing a stroke.
Symptoms: May be some symptoms or they may only present at the time of heart attack or stroke.
Peripheral vascular disease
Peripheral vascular disease refers to the narrowing of the arteries in the legs. As in cardiovascular disease, this is caused by atherosclerosis, clogging of the arteries. This leads to pain and decreased circulation which increases infection rates and healing times. Combined with neuropathy it can lead to foot complications that result in the need for amputations.
Symptoms: leg pain (when walking or exercising), numbness, tingling, or coldness in the lower legs or feet. Sores or infections on your feet or legs that heal slowly.
Prevention: Controlling blood glucose, pressure and cholesterol, not smoking and reducing obesity.
Ps. If you like science and want some more details on why diabetes causes these complication, watch this great video!
The above information on the complications of diabetes is of a general nature only. It should not be taken as medical advice and does not replace that of your qualified health professional. For tailored recommendations please refer directly to your healthcare team.