Diabetes Complications
| Points to Remember
- Diabetes can cause long-term complications such as heart,
kidney, eye, and nerve disease.
- Careful treatment of diabetes and checking for signs of
complications can lower the chances that someone will be troubled
by these conditions.
- An identification bracelet or necklace stating that the wearer
has diabetes can help ensure that friends or strangers won't
ignore symptoms that signal a medical emergency.
|
A key goal of diabetes treatment is to
prevent complications because, over time, diabetes can damage the heart,
blood vessels, eyes, kidneys, and nerves, although the person may not know
damage is taking place. It's important to diagnose and treat diabetes
early, because it can cause damage even before it makes someone feel ill.
How diabetes causes long-term problems is unclear. However, changes in
the small blood vessels and nerves are common. These changes may be the
first step toward many problems that diabetes causes. Scientists can't
predict who among people with diabetes will develop complications, but
complications are most likely to occur in someone who has had diabetes for
many years. However, because a person can have diabetes without knowing
it, a complication may be the first sign.
Heart Disease
Heart disease is
the most common life-threatening disease linked to diabetes, and experts
say diabetes doubles a person's risk of developing heart disease. In heart
disease, deposits of fat and cholesterol build-up in the arteries that
supply the heart with blood. If this buildup blocks blood from getting to
the heart, a potentially fatal heart attack can occur.
Other risk factors include hypertension or high blood pressure,
obesity, high amounts of fats and cholesterol in blood, and cigarette
smoking. Eliminating these risk factors, along with treating diabetes, can
reduce the risk of heart disease. The American Heart Association has
literature that explains what heart disease is and how to prevent it. The
association's address is in the
resources
section of this hypertext.
Kidney Disease
People with
diabetes are also more likely to develop kidney disease than other people.
The kidneys filter waste products from the blood and excrete them in the
form of urine, maintaining proper fluid balance in the body. While people
can live without one kidney, those without both must have special
treatment, called dialysis. Most people with diabetes will never develop
kidney disease, but proper diabetes treatment can further reduce the risk.
High blood pressure also can add to the risk of kidney disease. Therefore,
regular blood pressure checks and early treatment of the disorder can help
prevent kidney disease.
Urinary tract infections are also a cause of kidney problems. Diabetes
can affect the nerves that control the bladder, making it difficult for a
person to empty his or her bladder completely. Bacteria can form in the
unemptied bladder and the tubes leading from it, eventually causing
infection. The symptoms of a urinary tract infection include frequent,
painful urination, blood in the urine, and pain in the lower abdomen and
back. Without prompt examination and treatment by a doctor, the infection
can reach the kidneys, causing pain, fever, and possibly kidney damage. A
doctor may prescribe antibiotics to treat the infection and may suggest
that the person drink large amounts of water.
Kidney problems are one cause of water retention, or edema, a condition
in which fluid collects in the body, causing swelling, often in the legs
and hands. A doctor can decide if swelling or water retention relates to
kidney function.
A nephrologist, a doctor specially trained to diagnose and treat kidney
problems, can identify the cause of problems and recommend ways to reduce
the risk of kidney disease.
Eye Problems
Diabetes can
affect the eyes in several ways. Frequently, the effects are temporary and
can be corrected with better diabetes control. However, long-term diabetes
can cause changes in the eyes that threaten vision. Stable blood glucose
levels and yearly eye examinations can help reduce the risk of serious eye
damage.
Blurred vision is one effect diabetes can have on the eyes. The reason
may be that changing levels of glucose in blood also can affect the
balance of fluid in the lens of the eye, which works like a flexible
camera lens to focus images. If the lens absorbs more water than normal
and swells, its focusing power changes. Diabetes also may affect the
function of nerves that control eyesight, causing blurred vision.
Cataract and glaucoma are eye diseases that occur more frequently in
people with diabetes. Cataract is a clouding of the normally clear lens of
the eye. Glaucoma is a condition in which pressure within the eye can
damage the optic nerve that transmits visual images to the brain. Early
diagnosis and treatment of cataract and glaucoma can reduce the severity
of these disorders.
Diabetic Retinopathy
Retinopathy, a disease of the retina, the light sensing tissue at the
back of the eye, is a common concern among people with diabetes. Diabetic
retinopathy damages the tiny vessels that supply the retina with blood.
The blood vessels may swell and leak fluid. When retinopathy is more
severe, new blood vessels may grow from the back of the eye and bleed into
the clear gel that fills the eye, the vitreous.
While most people with diabetes may never develop serious eye problems,
people who have had diabetes for 25 years are more likely to develop
retinopathy. Experts think high blood pressure may contribute to diabetic
retinopathy, and that smoking can cause the condition to worsen. If
someone experiences blurred vision that lasts longer than a day or so,
sudden loss of vision in either eye, or black spots, lines, or flashing
lights in the field of vision, a doctor should be alerted right away.
Treatment for diabetic retinopathy can help prevent loss of vision and
can sometimes restore vision lost because of the disease. A yearly eye
examination with dilated pupils makes it possible for an ophthalmologist,
an eye doctor, to notice changes before the illness becomes harder to
treat. Scientists are testing new means of treating diabetic retinopathy.
For more information on eye complications of diabetes and the treatment of
these conditions, see the resource list at the end of this hypertext
document.
Legs and Feet
Leg and foot
problems can arise in people with diabetes due to changes in blood vessels
and nerves in these areas. Peripheral vascular disease is a condition in
which blood vessels become narrowed by fatty deposits, reducing blood
supply to the legs and feet. Diabetes also can dull the sensitivity of
nerves. Someone with this condition, called peripheral neuropathy, might
not notice a sore spot caused by tight shoes or pressure from walking. If
ignored, the sore can become infected, and because blood circulation is
poor, the area may take longer to heal.
Proper foot care and regular visits to a doctor can prevent foot and
leg sores and ensure that any that do appear don't become infected and
painful. Helpful measures include inspecting the feet daily for cuts or
sore spots. Blisters and sore spots are not as likely when shoes fit well
and socks or stockings aren't tight. A doctor also may suggest washing
feet daily, with warm, not hot water; filing thick calluses; and using
lotions that keep the feet from getting too dry. Shoe inserts or special
shoes can be used to prevent pressure on the foot.
Diabetic neuropathy, or nerve disease, dulls the nerves and can be
extremely painful. A person with neuropathy also may be depressed.
Scientists aren't sure whether the depression is an effect of neuropathy,
or if it's simply a response to pain. Treatment, aimed at relieving pain
and depression, may include aspirin and other pain-killing drugs.
Any sore on the foot or leg, whether or not it's painful, requires a
doctor's immediate attention. Treatment can help sores heal and prevent
new ones from developing. Problems with the feet and legs can cause
life-threatening problems that require amputation-surgical removal of
limbs if not treated early.
Other Effects of Diabetic Neuropathy
Nerves provide
muscle tone and feeling and help control functions like digestion and
blood pressure. Diabetes can cause changes in these nerves and the
functions they control. These changes are most frequent in people who have
had other complications of diabetes, like problems with their feet.
Someone who has had diabetes for some years and has other complications,
may find that spells of indigestion or diarrhea are common. A doctor may
prescribe drugs to relieve these symptoms. Diabetes also can affect the
nerves that control penile erection in men, which can cause impotence that
shows up gradually, without any loss of desire for sex. A doctor can find
out whether impotence is the result of physical changes, such as diabetes,
or emotional changes, and suggest treatment or counseling.
Skin and Oral Infections
People with
diabetes are more likely to develop infections, like boils and ulcers,
than the average person. Women with diabetes may develop vaginal
infections more often than other women. Checking for infections, treating
them early, and following a doctor's advice can help ensure that
infections are mild and infrequent. Infections also can affect the teeth
and gums, making people with diabetes more susceptible to periodontal
disease, an inflammation of tissue surrounding and supporting the teeth.
An important cause of periodontal disease is bacterial growth on the teeth
and gums. Treating diabetes and following a dentist's advice on dental
care can help prevent periodontal disease.
Emergencies
Very high blood glucose levels cause symptoms that are hard to ignore:
frequent urination and excessive thirst. However, in someone who is
elderly or in poor health these symptoms may go unnoticed. Without
treatment, a person with high blood glucose or hyperglycemia can lose
fluids, become weak, confused, and even unconscious. Breathing will be
shallow and the pulse rapid. The person's lips and tongue will be dry, and
his or her hands and feet will be cool. A doctor should be called
immediately.
The opposite of high blood glucose, very low blood glucose or
hypoglycemia, is also dangerous. Hypoglycemia can occur when someone
hasn't eaten enough to balance the effects of insulin or oral medicine.
Prolonged, strenuous exercise in someone taking oral diabetes drugs or
insulin also can cause hypoglycemia, as can alcohol.
Someone whose blood glucose has become too low may feel nervous, shaky,
and weak. The person may sweat, feel hungry, and have a headache. Severe
hypoglycemia can cause loss of consciousness. A person with hypoglycemia
who begins to feel weak and shaky should eat or drink something with sugar
in it immediately, like orange juice. If the person is unconscious, he or
she should be taken to a hospital emergency room right away. An
identification bracelet or necklace that states that the wearer has
diabetes will let friends know that these symptoms are a warning of
illness that requires urgent medical help.