Diabetes complications

• Alternative Names

  Complications of diabetes

• Causes, incidence, and risk factors

  Insulin is a hormone made by the pancreas, an organ located behind the stomach. Insulin is needed to move glucose (blood sugar) into cells, where it is stored and later used for energy.

  Diabetes is caused by a problem in the way your body makes or uses insulin. There are several types of diabetes. This article discusses the possible complications related to diabetes.

• Signs and tests

  If you have diabetes, you should see your health care provider every 3 months. At these visits you can expect the health care provider to:

  • Check your blood pressure
  • Check the sensation (feeling) on your feet
  • Check the skin and bones of your feet and legs
  • Examine the back part of your eyes with a lighted instrument called an ophthalmoscope
• Support Groups

  For additional information, see: Diabetes resources.

• Complications

  After many years, diabetes can lead to serious problems throughout your body, including your eyes, kidneys, and nerves.

  EYE PROBLEMS

  Diabetes can also damage blood vessels in the eyes, causing vision problems or blindness. Conditions may include:

  • Cataracts
  • Diabetic retinopathy
  • Glaucoma
  • Macular edema

  FOOT AND SKIN PROBLEMS

  People with diabetes are more likely to have foot problems because of nerve and blood vessel damage. Small sores or breaks in the skin may turn into deep skin ulcers if not treated properly. If these skin ulcers do not improve, or become larger or go deeper, amputation of the affected limb may be needed. (See: Diabetes foot care.)

  HEART AND BLOOD VESSELS

  If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack. Other problem with the heart and blood vessels include:

  • Damage to blood vessels that supply the legs and feet (peripheral vascular disease)
  • High blood pressure (hypertension)
  • High cholesterol
  • Stroke

  NERVE PROBLEMS

  Diabetes can damage nerves, which means you may not feel an injury until a large sore or infection develops. Nerve damage causes pain and numbness in the feet, as well as a number of other problems with the stomach and intestines, heart, and other organs. (See: Diabetic neuropathy.)

  OTHER COMPLICATIONS

  • Infections of the female genital tract, the skin, or the urinary tract
  • Kidney disease and kidney failure (diabetic nephropathy)
  • Problems attaining or maintaining an erection (impotence)
• Calling your health care provider

  Call your health care provider if you have:

  • Numbness, tingling, or pain in your feet or legs
  • Problems with your eyesight
  • Sores or infections on your feet
  • Symptoms of high blood sugar (being very thirsty, having blurry vision, having dry skin, feeling weak or tired, needing to urinate a lot)
  • Symptoms of low blood sugar (weakness or tiredness, trembling, sweating, feeling irritable, unclear thinking, fast heartbeat, double or blurry vfision, feeling uneasy)
• Prevention

  You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:

  • How to handle sick days
  • How to recognize and treat low and high blood sugar
  • How to take medications, if needed
  • How to test and record your blood sugar level (See: blood glucose monitoring.)
  • What to eat and when
  • Where to buy diabetes supplies and how to store them

  It may take several months to learn the basic skills. Always continue to education yourself about the disease and its complications. Learn how to control and live with diabetes. Over time, stay current on new research and treatment. (See: Diabetes education.)

  The American Diabetes Assocation recommends keeping blood sugar levels in the range of:

  • 80 - 120 mg/dL before meals
  • 100 - 140 mg/dL at bedtime

  EXERCISE

  Regular exercise is important for everyone, but especially if you have diabetes. Regular aerobic exercise lowers blood sugar without medication and helps burn excess calories and fat so you can mange your weight.

  Exercise can help your overall health by improving blood flow and blood pressure. Exercise also improves your ability to handle stress.

  The following are important for preventing complications of diabetes:

  • Get yearly tests to be sure your kidneys are working well (microalbuminuria and serum creatinine)
  • Have your blood pressure checked at least every year (pressure should bve 130/80 mm/Hg or lower)
  • Have your cholesterol and triglyceride levels checked yearly (LDL levels should be 100 mg/dL or below)
  • Have your glycosulated hemoglobin (HbA1c) check every 6 months if your diabetes is well controlled or every 3 months if it's not
  • See the dentist every 6 months for a thorough cleaning and exam. Make sure your dentist and hygienist know you have diabetes
  • Visit your ophthalmologist at least once a year -- more often if you have signs of diabetic retinopathy

  FOOT CARE

  To prevent problems with your feet, you should:

  • Check and care for your feet EVERY DAY, especially if you already have known nerve or blood vessel damage or current foot problems. Follow the instructions below.
  • Get a foot exam by your health care provider at lesat twice a year and learn whether you have nerve damage
  • Improve control of your blood sugar
  • Make sure you are wearing the right kind of shoes
  • Stop smoking if you smoke

  (See: Diabetes foot care.)

  MEDICATIONS TO PREVENT COMPLICATIONS

  Since those with diabetes have a much higher chance of developing heart disease, kidney disease, and other medical problems, they may need to take certain medicines to treat or prevent these problems.

  An ACE inhibitor (or ARB) is often recommeded:

  • As the first choice medicine for treating high blood pressure
  • For those who have signs of early kidney disesae (microalbuminuria)
  • ACE inhibitors include captopril (Capoten), enalapril (Vasotec), quinapril (Accupril), benazaeprl (Lotensin), ramipril (Altace), perindopril (Aceon), and lisinopril (Prinivil, Zestril)

  Statin drugs are usually the first choice to treat an abnormal cholesterol level. Aim for LDL cholesterol level less than 100 mg/dL. (See: High cholesterol and triglycerides.)

  To prevent heart disease, aspirin is recommended most often for people with diabetes. Ask your doctor if aspirin is right for you.

• References

  American Diabetes Association. Standards of medical care in diabetes -- 2009. Diabetes Care. 2009;32:S13-S61.

  Buchwald H, Estok R, Rahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248-256.e5. Review

  Eisenbarth GS, Polonsky KS, Buse JB. Type 1 Diabetes Mellitus. In: Kronenberg HM, Melmed, S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 31.

  In the clinic. Type 2 diabetes. Ann Intern Med. 2007;146:ITC-1-15.

  U.S. Preventive Services Task Force. Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148(11):846-54.

Review Date: 5/20/2009

Reviewed By: Deborah Wexler, MD, Assistant Professor of Medicine, Harvard Medical School, Endocrinologist, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.