Complications of Diabetes

Diabetes Complications

Complications may occur in people with diabetes, usually after a prolonged period of elevated blood glucose levels. Other factors contributing to complications are elevated blood fats such as cholesterol and triglycerides, being overweight and/or inactive, and cigarette smoking.

The opportunity to prevent complications has improved markedly with the availability of:

Technology such as glucose meters, allowing people to know their own blood glucose levels and participate as partners in their own care.
Specialised diabetes health care teams to provide information and assistance to clients on areas such as healthy eating and making lifestyle changes, glucose monitoring, and improving diabetes control.
Simple, but effective complication screening methods.

How can people with diabetes help to prevent diabetes complications

Attend your doctor on a regular basis to have checks on your diabetes control and blood pressure.
Attend your local diabetes service in NRAH have the diabetes educator explain the ideal testing times for you and also to explain how to test your own blood glucose levels, and what action to take if your glucose control is not satisfactory
Keep you weight within the healthy weight range. Diabetes services provide can provide access for you to see a dietitian and be advised on healthy eating.
Exercise regularly.
Have regular complication screening tests ie on eyes, kidneys, blood fats etc, as outlined below.
Do not smoke.

Adult complication screening recommendations for health professionals

Assess diabetes control by measuring HbA1c (test estimating average blood glucose, it is useful in assessing overall diabetes control). This test is recommended 3-6 monthly for insulin treated people, or 6-12 monthly for non-insulin treated people.
Eye examination. In people whose diabetes started at age 30 years or more an eye test should be done at diagnosis and then every 1-2 years. In people whose diabetes started at less than 30 years of age an eye test should be done within 5 years of diagnosis and then every 1-2 years.
Measure weight and height on initial visit then weight every 3 months. Measure weight more frequently if person is on weight reduction program.
Measure blood pressure every visit.
Examine feet every 6 months or at every visit if high risk foot problems exist. Refer to specialist experienced in care of the diabetic foot if infection of ulceration is present. Enure that people with high-risk foot problems receive appropriate care from specialists and podiatrists.
Measure blood fats (lipids) - total cholesterol, triglycerides and HDL cholesterol every 1-2 years if normal, or every 3-6 months if abnormal or on treatment.
Test to determine the amount of protein in the urine. The presence of more than a trace of protein in the urine may suggest that the kidneys have been damaged. This test should be done at diagnosis and then every 12 months for people with type 2 diabetes (mature onset diabetes); In people with type 1 diabetes (juvenile onset diabetes) this test should be done 5 years after diagnosis and then every 12 months.

Source: NSW Health Department. Principles of Diabetes Care and Guidelines for the Clinical Management of Diabetes Mellitus in Adults. 1996.

Complications of diabetes include increased risk of heart disease and stroke, blindness, kidney failure, limb amputation and erectile dysfunction in men.

Diabetes and eye disease

Diabetic eye disease (retinopathy) is the leading cause of blindness in Australians aged less than 60. The development of retinopathy is strongly related to the length of time diabetes has been present and the degree of blood glucose control. Cataracts are also more common in people with diabetes. Regular checks can determine the presence of cataracts and eye disease. Treatment by an eye specialist can help prevent or reduce the likelihood of blindness caused by eye disease.

Diabetes and kidney disease

The work of the kidneys is to filter blood allowing the body to keep valuable nutrients etc, and to help get rid of waste products the body does not want. Diabetes damage to the kidneys (nephropathy) is often caused by changes in small blood vessels that lead to the filter systems in the kidney. Diabetes kidney disease can be detected by a simple urine test for albumin (protein), and by blood tests that can be ordered by your doctor. Diabetes is the second most common causes of end stage renal disease (ESRD). In 2001 Type 1 and Type 2 diabetes accounted for 25% (Type 1: 4%, Type 2: 21%) of all new cases of ESRD diagnosed in Australia.

Diabetes and lower limbs

Nerve disease of the lower limbs (peripheral neuropathy) is one of the most debilitating of the diabetes complications. Problems such as high blood glucose levels over a period of time, can cause nerve damage. Nerve damage can cause numbness, pins and needles sensations in the feet, and burning pains in the feet and legs especially at night. Special care is required for people with painful nerve problems, or numbness of their feet to prevent injury.
Vascular(blood vessel) damage is another major problem that may affect the lower limbs. Smoking will make this worse. This problem combined with the nerve problem may lead to leg or foot ulcers, unrecognised infections and serious foot problems from which limb amputation may result.

Diabetes and heart disease/stroke

Diabetes is also often associated with high blood pressure ie 69% of people with type 2 diabetes, and high blood fats (cholesterol 51% and triglycerides 43%). These problems contribute to large blood vessel disease (macro vascular disease). Narrowing of the blood vessels that nourish important organs like the heart and brain causes large blood vessel disease. As the lining of the vessels thicken, the flow of blood through the vessels is reduced and the muscle that is nourished by the vessel is deprived of oxygen. People with diabetes are at an increased risk of heart attack and stroke. The likelihood of diabetes with heart disease is increased two times in men and four times in women. Blood vessel blockages to the brain are four times more likely in people with diabetes.

Diabetes can also cause many other less common complications e.g. problems with stomach and/or urinary bladder emptying, erectile dysfunction, skin problems, and cataracts etc. Seek advice from your general practitioner, medical specialist, or diabetes educator if you are experiencing problems.

Important to remember - complications are not a necessary part of having diabetes.

As a partner in your own care be proactive in seeking the recommended regular screening tests, and follow the recommendations listed above.

Developed by Judy Reinhardt, NCAHS.