Diabetes ComplicationsUnderstanding and Prevention

Over time, high blood sugar can damage blood vessels and nerves throughout the body, leading to serious complications. The good news: good blood sugar control, along with managing blood pressure and cholesterol, can prevent or significantly delay most diabetes complications.

Why Complications Happen

High blood sugar causes damage through several mechanisms:

  • Damages blood vessel walls - Both large and small vessels
  • Causes inflammation
  • Damages nerves
  • Weakens the immune system
  • Affects wound healing

Complications develop gradually over years—that's why early detection and prevention are so important.

Cardiovascular Disease

Heart and blood vessel disease is the leading cause of death for people with diabetes.

Risks Include

  • Heart attack - 2-4x higher risk than non-diabetics
  • Stroke
  • Peripheral artery disease - Reduced blood flow to legs
  • Heart failure

Prevention

  • Control blood sugar (A1C target usually under 7%)
  • Manage blood pressure (target usually under 130/80)
  • Control cholesterol (statins often recommended)
  • Don't smoke
  • Stay physically active
  • Maintain healthy weight
  • Take aspirin if recommended by doctor

Nerve Damage (Neuropathy)

Affects about 50% of people with diabetes over time.

Types of Neuropathy

Type Affects Symptoms
Peripheral Feet, legs, hands Numbness, tingling, burning, pain
Autonomic Internal organs Digestive issues, bladder problems, sexual dysfunction
Proximal Thighs, hips, buttocks Pain, weakness
Focal Single nerves Sudden weakness or pain in specific area

Prevention and Management

  • Tight blood sugar control (most important)
  • Don't smoke
  • Limit alcohol
  • Check feet daily for injuries
  • Medications can help manage pain

Eye Disease (Retinopathy)

Diabetes is the leading cause of blindness in working-age adults.

Progression

  1. Mild nonproliferative - Small blood vessel changes
  2. Moderate nonproliferative - Blood vessels blocked
  3. Severe nonproliferative - Many vessels blocked
  4. Proliferative - New abnormal vessels grow (can cause bleeding)

Other Eye Problems

  • Diabetic macular edema - Swelling in central vision area
  • Cataracts - More common, occur earlier
  • Glaucoma - Increased eye pressure

Prevention

  • Annual dilated eye exams - Essential for early detection
  • Control blood sugar
  • Control blood pressure
  • Don't smoke
  • Laser treatment and injections can prevent vision loss if caught early

Kidney Disease (Nephropathy)

Diabetes is the leading cause of kidney failure.

Progression

  • Early: Kidneys filter too much blood
  • Later: Protein leaks into urine (microalbuminuria)
  • Advanced: Kidney function declines
  • End-stage: Dialysis or transplant needed

Prevention

  • Control blood sugar
  • Control blood pressure (very important for kidneys)
  • ACE inhibitors or ARBs often prescribed
  • SGLT2 inhibitors have kidney-protective effects
  • Annual urine and blood tests to check kidney function
  • Limit salt intake

Diabetes is the leading cause of non-traumatic amputation.

How Problems Develop

  1. Neuropathy causes loss of sensation
  2. Small injuries go unnoticed
  3. Poor circulation slows healing
  4. Infections develop
  5. Ulcers form
  6. Severe cases may require amputation

Prevention

  • Check feet daily - Look for cuts, blisters, redness
  • Wash and dry feet carefully, especially between toes
  • Never go barefoot
  • Wear comfortable, well-fitting shoes
  • Cut nails carefully - Straight across
  • See a podiatrist regularly
  • Don't smoke - Smoking worsens circulation

Dental Problems

  • Gum disease more common and severe
  • Tooth decay
  • Dry mouth
  • Infections

Prevention

  • Brush twice daily, floss once daily
  • See dentist every 6 months
  • Tell your dentist you have diabetes
  • Control blood sugar (gum disease can raise blood sugar)

Skin Conditions

  • Bacterial infections
  • Fungal infections
  • Itching
  • Diabetic dermopathy - Brown patches on shins
  • Slow wound healing

Prevention Summary

Action Target How Often
A1C test Under 7% (or individualized) Every 3-6 months
Blood pressure check Under 130/80 mmHg Every visit
Cholesterol test LDL under 100 mg/dL Annually
Eye exam (dilated) No retinopathy Annually
Foot exam No ulcers, good sensation Every visit + daily self-check
Kidney tests Normal function Annually
Dental visit Healthy gums Every 6 months

Key Prevention Actions

  1. Control blood sugar - The most important factor
  2. Control blood pressure - Protects heart, kidneys, eyes
  3. Manage cholesterol - Protects heart and blood vessels
  4. Don't smoke - Smoking accelerates all complications
  5. Stay active - Improves circulation and overall health
  6. Get regular checkups - Catch problems early
  7. Take medications as prescribed
Important: Complications are not inevitable. The landmark DCCT and UKPDS studies proved that tight blood sugar control dramatically reduces the risk of all diabetes complications. Early detection through regular screening allows for treatment before complications become serious.