How to Avoid Diabetes Complications
Diabetes Complications: Less Common Today
Having diabetes puts a person at greater risk for heart disease, kidney disease, blindness, loss of limbs, and other unwanted complications.
Fortunately, most diabetes complications can be limited or effectively treated with early detection and proper care as soon as you or your health care provider discovers the complication, says Richard Jackson, M.D., of the Joslin Diabetes Center in Boston. Keeping blood glucose (or blood sugar), blood pressure, and blood lipids (such as cholesterol) on target is also important in preventing and treating complications.
Despite what you may hear, Jackson says, diabetes itself is not a leading cause of blindness or heart disease in the United States. Rather, poorly managed diabetes is a leading cause of these and other serious health problems.
The Good News: "People with diabetes are living longer and healthier lives than ever," Jackson says. "All of the complications are becoming less common due to all the new tools we have for treatment."
You play an important role in prevention and have the ability to live well with diabetes.
Diabetes Complications: Causes
When blood sugar is high, over time it causes blood vessels to become inflamed. High blood sugar accelerates the buildup of a waxy, fatty substance called plaque inside the vessels. Inflammation and plaque narrow and can block the blood vessels that supply blood to the heart, eyes, kidneys, and nerves. This causes damage to the body’s tissues in a slow, gradual process.
Genetics do play a role in the type and severity of complications you might experience, but researchers are still piecing together the exact clues to explain the genetic links.
The Good News: "There's also a lot we can do nowadays to stop the progression of complications once they set in," says Richard Jackson, M.D.
Things you can directly affect, such as healthful eating, physical activity, and blood glucose and blood pressure control, make a big difference.
Diabetes Complications: Body Parts Affected
Complications can show up in various parts of the body. The four main areas are:
- Heart and Blood Vessels: The heart and blood vessels can incur damage in several ways. The effects of damage can dramatically increase the risk of having heart attacks and strokes.
- Eyes: Eye damage includes loss of vision from retinopathy, glaucoma, and cataracts.
- Kidneys: Kidney damage includes kidney disease or nephropathy and kidney failure.
- Feet and Limbs: Nerve damage, or neuropathy, in the feet and lower limbs can lead to loss of sensation and/or development of nerve pain. Lack of sensation, along with poor circulation, increases the risk of infections and foot ulcers. Nerve damage can also affect the digestive system and sexual organs.
The Good News: This scary list is not necessarily a road map for your future with diabetes. "Of course with diabetes you're facing the increased possibility of all this physical damage, but complications are by no means a foregone conclusion," says Richard Jackson, M.D.
What matters most is how well you control your numbers from the moment you are diagnosed with diabetes. You have the power to keep yourself healthy over the years.
Diabetes Complications: Tests & Checks
Diabetes complications can begin with or without obvious symptoms, and you might not be aware of occurring damage. Medical tests or exams can help you learn if you're developing one or more complications, even with no symptoms. Everyone with diabetes, type 1 or type 2, should have these tests once a year and sometimes more, depending on your health:
- A1C: the average blood glucose levels over the past 2–3 months
- Blood pressure check
- Blood lipid levels: fats in the blood (cholesterol and triglycerides)
- Microalbumin in the urine: a measure of kidney health
- Dilated eye exam to assess eye health
The Good News: A number of tests and checks will help you and your health care provider identify if you are developing diabetes complications.
For a comprehensive list of tests and exams, download and print our free Diabetes Checkup Checklist and share it with your provider to ensure you get the necessary tests and checks. Doing this is the best way to detect any problem early and get a jump start on treatment.
Diabetes Complications: Blood Sugar Matters
You can reduce your risk of complications by keeping your blood sugar levels in control. That means staying in your target range (typically 70–130 mg/dl fasting, and at or less than 180 mg/dl one to two hours after eating). Blood glucose measurements give you snapshots of what’s happening with your glucose levels at different times during the day. To see how you are doing overall, get an A1C blood test at least twice a year. An A1C test provides a record and average of all the fluctuations of glucose levels over two to three months. The A1C target for most people is at or under 7 percent. Talk to your provider about what your target should be.
The Good News: Good control of blood sugar, cholesterol, and blood pressure really helps reduce the risk of diabetes complications. A major type 1 diabetes study called the Diabetes Control and Complications Trial, which ended in 1993, demonstrated the decrease in complications when blood sugar levels are controlled. "This is true for people who've already developed some complications as well. Keeping your glucose levels in range can help stop the progression of all complications and improve quality of life, because you'll feel better, too," says Amparo Gonzalez, RN, CDE, a past president of the American Association of Diabetes Educators (AADE). The trial continues today as an observational study called Epidemiology of Diabetes Interventions and Complications (EDIC).
Diabetes Complications: The Heart
Anyone with central obesity (extra weight around the waist), abnormal cholesterol levels, and high blood pressure is at greater risk for heart and blood vessel diseases. People with diabetes are two to four times more likely to develop atherosclerosis (hardening of the arteries) and five times more likely to have a stroke than people without diabetes, according to the American Diabetes Association (ADA). Yet only 18 percent of people with diabetes are even aware that they're at increased risk, according to a study commissioned by the ADA.
"There's a big gap between what's true and what people who have diabetes are aware of," says Michael Brownlee, M.D., director of the JDRF International Center for Diabetic Complications at Albert Einstein College of Medicine in New York City.
Protect your heart by keeping your blood sugar, cholesterol, and blood pressure in check. Eating heart-healthy foods and keeping your weight under control will also help decrease your risk of heart disease or heart event.
Diabetes Complications: How to Protect Your Heart
What you can do: There are many things you can do to take care of your heart.
- Achieve good blood sugar control. Keeping your blood glucose in control is important for avoiding all complications, including heart problems.
- Eat right and exercise (even a little helps). Eat more fruits and vegetables, lower sodium intake, do aerobic or other continuous physical activity (at least four days a week for 30 minutes each time), and try to reduce stress.
- Snuff out cigarettes. The right level of smoking for a person with diabetes is none at all.
- Improve cholesterol. Research shows that statins, a class of cholesterol-lowering drugs, are beneficial. Statins further reduce risk of heart attack with diabetes by up to 40 percent. Download our free checklist to see if you should be taking a statin.
- Lower blood pressure. Beyond losing weight, eating right, and exercising, prescription medications called ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) can help lower blood pressure. These first-line medications for treating high blood pressure can also help prevent and delay kidney disease.
- Consider taking an aspirin daily. "Because people with diabetes have abnormally sticky platelets that make their blood thick, an aspirin a day might also be prudent" for protecting the heart, says Michael Brownlee, M.D. A children's or baby aspirin (81–125 mg) will do the trick for most adults. Research now shows not everyone should take daily aspirin, so be sure to talk to your doctor first.
Diabetes Complications: The Eyes
Diabetic eye disease refers to three main problems: retinopathy, damage to the blood vessels in the retina in the back of the eye; cataracts, clouding of an eye's lens; and glaucoma, an increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.
Retinopathy is the most common complication and the most likely to lead to blindness. In the eyes' attempt to circulate more blood, additional abnormal and fragile blood vessels develop that eventually break and leak blood and cloudy fluid. Left alone, this process blurs vision and can eventually blot it out.
You can take action right now to protect your eyes.
Diabetes Complications: How to Protect Your Eyes
What you can do: The steps to prevention are familiar: lowering blood sugar, maintaining the recommended blood pressure, and lowering LDL (bad) cholesterol. You should also:
- Get a dilated-eye exam every year. The priority prevention method is an annual examination. Be absolutely sure to schedule an annual full, dilated-eye exam with an ophthalmologist or optometrist. The doctor may take photographs of your retinas to use as a reference point for any later changes.
- Consider ACE inhibitor medications. Research shows that ACE inhibitor drugs, which are prescribed to treat high blood pressure, can also protect your eyes if your blood pressure is kept in good target range.
Diabetes Complications: The Kidneys
Diabetic kidney disease, or nephropathy, stems from damage to the small blood vessels in the body. The clusters of blood vessels (called glomeruli) that make up the kidney begin to be destroyed. The job of the glomeruli is to filter blood and form urine, which drains into the ureter. When the damaged glomeruli begin to thicken, they can no longer do their job, and the kidneys may start allowing more albumin (protein) than normal in the urine, eventually causing chronic kidney failure.
People with diabetes are 20 times more likely to develop kidney failure than the general population. About 30 percent of those affected are people with type 1 diabetes, and 10–40 percent are people with type 2, according to the National Kidney Foundation (NKF).
In addition to good diabetes management, there are two specific things you can do to protect your kidneys: Get a microalbumin test, and seek early treatment if it detects abnormal levels.
Diabetes Complications: How to Protect Your Kidneys
What you can do: Yes, once again, lowering blood sugar, maintaining the recommended blood pressure, and lowering LDL (bad) cholesterol help your kidneys do their job. You should also:
- Get a microalbumin test once a year. The ultrasensitive microalbumin test is a urine test that gauges the "leakiness" of the filtration function of your kidneys. It shows changes a full 10–20 years earlier than older tests could. "One of the biggest advances in diabetes care is early detection of kidney disease. We can now detect it even before it develops. Yet sadly, the microalbumin test is one of the most neglected in patients with diabetes," says Richard Jackson, M.D.. All you have to do is pee in a cup, and you don’t have to fast before the test. If your health care provider finds that you have an abnormal microalbumin test, they may refer you to a nephrologist, or kidney specialist.
- Seek early treatment. Numerous clinical studies show that when increases in microalbumin are identified early, a variety of treatments can successfully decrease or even eliminate your chance of developing kidney disease. These interventions include aggressive control of blood pressure, improvement of glucose control, and taking blood pressure medications such as ACE inhibitors and ARBs, which are also proven to protect kidney function.
Diabetes Complications: The Feet
Nerve Damage (Neuropathy): The feet and lower limbs of people with uncontrolled diabetes can be damaged by diabetic nerve disease, or neuropathy. Neuropathy is an umbrella term for a family of nerve disorders caused by diabetes over time. When small blood vessels are damaged, nerve tissue may be destroyed throughout the body.
The most common type is peripheral neuropathy, which leads to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. "One of the most common problems is damage to your feet that goes unnoticed because you've lost sensation in the nerves there," says Richard Jackson, M.D. "People may burn or otherwise injure their feet without noticing. Untreated, these injuries can become infected and do not heal properly. In the worst-case scenario, some people can lose a leg this way." An estimated 5 percent of people with diabetes eventually require toe or foot amputation.
An estimated 60–70 percent of people with diabetes have some form of neuropathy, but not all of them have symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
You can start protecting your feet right now.
Diabetes Complications: Protect Your Feet
What you can do: There are specific steps you can take to prevent damage to your feet.
- Inspect your feet regularly. Look for blisters or other small injuries that need immediate attention—even if you believe the nerves in your feet still function well. Also check for hot and cold spots and discoloration. If you find any changes, tell your health care provider or podiatrist.
- Wear shoes. Walking around barefoot is highly discouraged, especially if you already have neuropathy. It's just too easy to injure your feet this way or pick up tiny splinters that you don't notice until they cause big problems.
- Select quality footwear. Experts suggest you wear moisture-resistant socks and well-fitting shoes with flexible soles and soft leather tops that allow your feet to breathe. To prevent pressure sores on your feet, make sure your socks don't bunch or wrinkle inside your shoes.
- Get a vibration-sensitivity test. Your health care provider should check your feet at least once a year with a tuning fork or monofilament. They should also feel for hot or cold spots. If you don't feel the tuning fork or monofilament, this is an early indication that you may be losing sensation in your feet. National Institutes of Health data show that comprehensive foot exams can reduce amputation rates by 45–85 percent.
Diabetes Complications: Other Issues
In addition to major complications of the heart, eyes, kidneys, and nerves, diabetes can affect other areas, too. A few other common conditions are infections that won't heal, gum disease (gingivitis and periodontitis), problems with joint mobility (diabetic cheiroarthropathy), and depression.
The Good News: The steps you take to protect your heart, eyes, kidneys, and feet also help reduce your risk of other problems. Monitoring your blood glucose is basic. In addition, what you eat, how often you are active, maintaining a healthy body weight, and taking all your medications to control blood sugar, blood pressure, and cholesterol will all work together to help you prevent and/or delay complications. Improved treatments also can help lessen the severity of any complications that people with diabetes develop.