Long-Term Complications of Diabetes
There's probably not much time in your life for wondering what's happening next weekend, let alone time to consider how having diabetes affects your future. But thinking about your diabetes a little bit now — and taking some steps to prevent problems — might make things easier down the road.
You may have wondered why doctors talk so much about keeping blood sugar levels in a healthy range. Here's why: Long-term diabetes problems — or complications — are often linked to higher blood sugar levels over a long period of time. These complications can affect several different parts of the body.
But blood sugar control isn't the only thing that determines a person's risk for diabetes complications. Other factors, like genes, can also play a role.
Many of the complications of diabetes don't show up until after many years — even decades — of having the disease. They usually develop silently and gradually over time, so even if people with diabetes aren't having any signs of complications, they may still eventually develop them.
Talking or thinking about long-term complications can be scary. And, let's be realistic, it can be hard for anyone to make changes in how they live today to decrease the risk of health problems that may not show up for decades. But it's important to start now. Managing your diabetes by eating right, getting regular exercise, and taking your medication under the supervision of your diabetes health care team is the best way to reduce the risk of developing complications.
Where Complications Can Occur
Parts of the body that can be most affected by diabetes complications are the:
- heart and blood vessels
People with diabetes have a greater risk of developing eye problems, including:
- Cataracts: A cataract is a thickening and clouding of the lens of the eye. The lens is the part of the eye that helps you focus on what you see. Cataracts can make a person's vision blurry or make it hard to see at night.
Doctors think that people with diabetes are more likely to develop cataracts if they have high blood sugar levels over a long period of time. If cataracts get in the way of seeing properly, a person can have surgery to remove them.
- Retinopathy: Another eye problem, called diabetic retinopathy (pronounced: reh-tih-NAH-puh-thee), involves changes in the retina, the light-sensitive layer at the back of the eye. These changes happen because of damage or growth problems in the small blood vessels of the retina.
Usually, changes in the retinal blood vessels don't appear before a person has reached puberty and has had diabetes for several years. Retinopathy is more likely to become a problem in people with diabetes if they have high blood sugar levels over a long period of time, if they have high blood pressure, or if they use smoke or chew tobacco.
One reason why teens with diabetes need to have regular yearly eye exams is because people with retinopathy might not have any problems seeing at first. But if the condition gets worse, they can become blind. Someone who develops retinal problems will need to visit the eye doctor more often.
A person with diabetes may be able to slow or reverse the damage caused by retinopathy by improving blood sugar control. If retinopathy becomes more advanced, laser treatment may be needed to help prevent vision loss.
- Glaucoma: People with diabetes also have a greater chance of getting glaucoma. In this disease, pressure builds up inside the eye, which can decrease blood flow to the retina and optic nerve and damage them. At first, a person may not have trouble seeing. But if it's not treated, glaucoma can cause a person to lose vision. The risk increases as a person gets older and has had diabetes longer. People with glaucoma take medications to lower the pressure inside the eye and sometimes need surgery.
Your doctor will probably check your eyes for early signs of these problems during routine exams. He or she may also recommend that you see an ophthalmologist (pronounced: opf-thul-MAH-luh-jist, a doctor who specializes in treating diseases of the eye) or optometrist (pronounced: op-TAH-muh-trist, a person who examines your eyes and tests your vision).
Keeping your blood sugar and blood pressure levels under control and avoiding tobacco may also help you avoid eye problems associated with diabetes.
When blood sugar is high, it can cause damage to the blood vessels in the kidneys, leading to kidney disease. This is sometimes called diabetic nephropathy (pronounced: neh-FRAH-puh-thee).
Kidney disease is more likely to happen in people who haven't controlled their blood sugar levels over a long period of time. Kidney disease can worsen if someone also has high blood pressure or uses tobacco.
In its early stages, kidney disease doesn't cause symptoms. Over time, though, it can cause kidney failure, which means the kidneys stop working. So kidney disease is a serious health problem.
If a person has gone through puberty and has had diabetes for several years, doctors will probably test for kidney disease about once a year. Doctors may do a urine test to measure the amount of protein called albumin (pronounced: al-BYOO-mun) in the urine.
If the amount of protein in the urine increases beyond a certain point, or if there are other signs of kidney disease, doctors may look at a piece of the kidney (a biopsy) under a microscope to make sure someone really has kidney disease.
If doctors detect kidney disease early enough, the damage can sometimes be reversed with proper treatment. Doctors may tell a person with diabetic nephropathy to eat less protein and also might prescribe medications.
If the kidney disease gets worse, a person may develop kidney failure, which requires dialysis (regular use of a machine to clean the blood as the kidneys normally would) or a kidney transplant. The good news is that these days kidney disease is less likely to end up as kidney failure because of earlier detection and better treatment than in the past.
The best way to help prevent diabetic kidney disease is to keep your blood sugar levels under control by following your diabetes treatment plan. It's also important to get regular blood pressure checks and urine albumin tests — your diabetes health care team will tell you when you need these.
In addition, steer clear of smoking, which can increase the risk of kidney problems and other diabetes complications and health problems.
Another complication that people who have had diabetes for a long time might develop is a type of nerve damage called diabetic neuropathy (pronounced: noo-RAH-puh-thee).
Diabetic neuropathy can affect nerves in many different parts of the body. The most common early symptoms of the condition are numbness, tingling, or sharp pains in the feet or lower legs.
If it's not treated, nerve damage can cause a number of problems. For example, because of the numbness, people with nerve damage might not realize that they have a cut, and it could become seriously infected before they discover it.
Because nerve damage can happen anywhere in the body, problems can occur in almost any organ system, including the digestive tract, urinary system, eyes, and heart.
Doctors usually diagnose nerve damage by giving a person a physical exam. A biopsy of nerve tissue or other special tests may also be necessary. The doctor might recommend that the patient see a nerve specialist (neurologist).
Doctors believe nerve damage is linked to high blood sugar levels over time. So controlling blood sugar levels by following a diabetes treatment plan can help reduce a person's risk of developing this complication.
Heart and Blood Vessel Diseases
People with diabetes have a higher risk of developing certain problems with the heart and blood vessels. (These are called cardiovascular diseases.) Some of these problems are:
- heart attack (caused by a blockage of the blood vessels supplying blood to the heart)
- stroke (caused by a blockage of the blood vessels supplying the brain)
- blockage of blood vessels in the legs and feet, which can lead to foot ulcers, infections, and even loss of a toe, foot, or lower leg
How well blood sugar is managed probably plays a role in heart and blood vessel problems, too. And if a person smokes, is obese, has abnormal levels of blood lipids (triglycerides or cholesterol), high blood pressure, or a family history of heart attack or stroke before age 50, he or she definitely has a higher risk of these problems.
One thing you can do to reduce your risk of cardiovascular diseases is to be a healthy weight. If you're overweight, your doctor can suggest ways to help you lose weight and stay there. The doctor may also check your blood lipid levels (cholesterol and triglycerides) and blood pressure regularly to be sure they're in a healthy range.
Following your diabetes meal plan, getting regular exercise, and taking diabetes medications as prescribed may also help prevent or delay the development of heart and blood vessel problems. Also, smoking increases the risk of heart and blood vessel problems, as well as other diabetes complications.
People with diabetes are more likely than others to develop gum disease (also called periodontal disease) because they may have:
- more plaque and less saliva (too much plaque on the teeth and not enough saliva can contribute to tooth decay)
- higher blood sugar levels (a person has more sugar in their mouth, which can also lead to tooth decay)
- some loss of collagen, a protein that's in gum tissue
- poor blood circulation in the gums
All of these factors can contribute to gum disease. Signs and symptoms of gum disease include bleeding, sensitive, and painful gums. The gums may also recede (receding gums no longer cover the root surfaces of teeth) or be discolored. Dentists can diagnose gum disease during regular checkups.
Fortunately, you can prevent gum disease by managing your blood sugar levels, taking good care of your teeth by brushing and flossing daily, and getting regular dental checkups.
Someone who has had diabetes for many years can develop foot problems because of poor blood flow in the feet and nerve damage.
Starting at puberty, your doctor will check your feet for any signs of problems. You should tell your doctor about any foot problems you're having, such as ingrown toenails, calluses, and dry skin. Even if your feet just feel irritated because you've been wearing certain shoes or because you've had a minor sports injury, you should tell your doctor.
To prevent foot problems, wear comfortable shoes that fit properly and keep your toenails trimmed to the shape of the toe. Exercise, which increases blood flow to the feet, can also help keep feet healthy.
Smoking can increase the risk of foot problems or make them worse.
Staying Healthy for the Long Haul
Some complications of diabetes occur after years — even decades — of having the disease, and sometimes people don't even have any noticeable symptoms. That's why it's so important to follow your diabetes management plan and taking an active role in your health by getting regular medical care and checkups with your diabetes health care team. They can detect many diabetes problems before they start causing symptoms and help you get the treatment you need.
Reviewed by: Steven Dowshen, MD
Date reviewed: August 2013
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