Diabetes: Long Term Complications

Diabetes, unfortunately, is a disease capable of affecting almost every part of your body and especially if it’s poorly managed. Certain conditions related to diabetes can create the potential for a myriad of complications that have long term and serious effects. It’s important to understand what the most common long term complications are and how to prevent them from happening.

Diabetic Retinopathy

Diabetic retinopathy is a disease involving the retina in the eye. The blood vessels in the retina are damaged or become blocked. The disease affects both type 1 (T1D) and type 2 (T2D) diabetics. It is a progressive disease that goes through various stages and over a period of time affects your ability to see well and can even lead to partial or full blindness.  In fact, 99% of those who have had T1D for more than 20 years are at high risk of developing diabetic retinopathy. The figure is 60% for those who have T2D.[1]  Half of all diabetics will develop some stage of retinopathy in their lifetimes according to the National Eye Institute.

Retinopathy stages are defined as follows:[2]

  • Mild nonproliferative
  • Moderate nonproliferative
  • Severe nonproliferative
  • Proliferative

At the proliferative stage, there is abnormal blood vessel growth. Diabetics also have a higher risk of developing glaucoma and cataracts.

Neuropathy

The root words for neuropathy – neuro and path – mean “distressed nerves.”  There are three types of neuropathy common to diabetics:

  • Peripheral Neuropathy – nerve damage in the nerve system transmitting information from peripheral nervous system found in the arms and legs to the central nervous system made up of the brain and spinal cord
  • Autonomic Neuropathy – nerve damage in the nerves that control the involuntary nervous system managing biological activities like blood pressure and bladder function
  • Cardiovascular Autonomic Neuropathy (CAN) – nerve damage in the nerves controlling the blood vessels and heart

Each of these types of neuropathy common to diabetics has various sub-categories. Neuropathy signifies that at least one nerve running from the brain and the spinal cord into the body is damaged. The nerve affected determines the outward sign of the complication.

  • Distal symmetric polyneuropathy – The most common type, it involves the feet and legs
  • Charcot foot or joint or neuropathic arthropathy – It has its greatest and most common effect on the feet
  • Cranial neuropathy – Impacts the nerves accountable for hearing, eye movement, taste and sight
  • Autonomic neuropathy[3] –The product of distress to the nerves of the heart blood vessels, bladder, lungs, intestines stomach, and sex organs
  • Compression neuropathy – This occurs when a single nerve becomes injured

If you are affected by distal symmetric polyneuropathy, your first physical indications will be a tingling sensation in either your hands and/or feet. Early signs have been compared to an electric shock.[4]  The symptoms progress until the feet or hands suffer from a variety of symptoms including:

  • A burning sensation
  • Stabbing pains
  • Piercing  sensations in one specific portion of the foot or hand
  • Crawling skin
  • A very high sensitivity of touch – even the sensation of a bed sheet can result in pain
  • An overall “pins-and-needles” feeling[5]

Kidney Disease

Diabetic kidney diseases are formally referred to as Diabetic Nephropathy. Among diabetics, nephropathy is one of the most common causes of death. Diabetes is the number one cause of kidney failure leading to dialysis. Early indications that kidney disease exists may not be obvious, but the disease is progressive. Some people don’t discover they have kidney disease until renal failure occurs. An annual screening may detect the presence of microalbumin in the urine, a potential indicator of the individual being at a high risk for kidney disease.[6]

Heart and Cardiovascular Issues

When fat or cholesterol (lipids) are not managed and clog your arteries, atherosclerosis develops. Commonly referred to as “hardening of the arteries”, blood flow is restricted due to the cholesterol buildup. Chest pains are the earliest symptom when you develop coronary artery atherosclerosis. Known as angina pectoris, the intensity of the pain can be quite relentless. However, many people develop coronary heart disease with no or very mild symptoms until an artery is almost blocked leading to stroke or heart attack. Diabetic patients have the same risk of having a heart attack as somone who has already had a heart attack.

The risks of developing heart failure and atherosclerosis are reminders that any time you spend controlling your diabetes may equate to time you have in your lifetime without cardiovascular issues.

Peripheral Vascular Disease

Peripheral vascular disease involves atherosclerosis also, but it’s the extremities that are affected.  Once again, it is the result of the fatty degeneration of the middle coat of the arterial wall when cholesterol collects within the arteries. Blocked arteries cause poor circulation to the legs, feet or hands causing a number of problems. The lack of blood causes numbness, sores, leg cramps and cold limbs. This can often make it difficult to walk due to pain, even distances as short as to your mailbox.

Strokes

Another name for a stroke is a cerebro-vascular accident (CVA). There are several types including the following:

  • Ischemic stroke – an artery leading to the brain is blocked
  • Transient ischemic attack (TIA) – temporary interruption in the blood flow to a section of the brain
  • Hemorrhagic stroke – blood vessel in the brain either leaks or breaks; most frequent cause is high blood pressure

The immediate cause of any stroke is the disruption of the blood supply to the brain. The root cause, however, may actually be atherosclerosis which has advanced more rapidly due to diabetes and hypertension (high blood pressure).

Skin Disease

Diabetes can affect your skin in several ways. It may manifest any of a number of problems by being dry or overly moist. There may be blisters, erosions (loss of dermis), ulcers and hemorrhage. Your skin will feel itchy and even flaky. These are indications of poor diabetes management.

Skin conditions are common among diabetics. They include bacterial and fungal infections, Acanthosis Nigricans (darkening of the skin on the back of your neck), and diabetic dermopathy.

Sexual Dysfunction

Dryness of the vagina and erectile dysfunction are complications of diabetes. Worry about being diabetic and the effort it takes to manage the disease can also lead to actual physical and emotional problems that impact sexual functioning.

 Conclusion

There are many long term complications associated with diabetes. That is yet another reason why you should carefully manage this disease. The long term complications are serious and can shorten your lifespan. The good news is that keeping your blood glucose levels within normal range can prevent most of the problems associated with diabetes.

References

[1] David J. Browning, DJ (2010) “Diabetic Macular Edema” in Diabetic Retinopathy Browning, DJ (ed). New York: Springer, p 141-202.

[2] American Diabetes Association (2009). Type 2 Diabetes. Your Healthy Living Guide. Alexandria, VA: ADA.

[3] Masharani, U (2008). Diabetes DeMYSTiFieD. New York: McGraw Hill.

[4] Levin, ME; and Pfeiffer, MA (editors) (2009). The Uncomplicated Guide to Diabetes Complications, 3rd ed. Alexandria, VA: ADA.

[5] Stanley, K (2009). 50 Things You Need To Know About Diabetes. Alexandria, VA: ADA.

[6] Tesch, GH (2010). “Macrophages and Diabetic Nephropathy.” Seminars in Nephrology, 30(3): 290-301.

[7] This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.