Alegent; Omaha - Step 11: Long-Term Complications.

Over time, poorly controlled diabetes can lead to a variety of serious health conditions, including heart disease, stroke, blindness, amputations, kidney disease, and nerve damage. Maintaining a healthy lifestyle and regular checkups are important throughout the life of a person with diabetes.

Heart disease and stroke

Over a period of years, diabetes can have a big impact on the heart and blood vessels. The problem needs to be taken seriously -- people with diabetes are at high risk of having a heart attack, stroke, or heart failure. According to the American Diabetes Association, these problems can occur at a younger age than they do in people without diabetes, and they are more deadly. In fact, heart disease and related complications are the leading cause of death in people with diabetes.

There are steps you can take to miminize the risks:

Keep A1C to less than 7 percent
Maintain a healthy blood pressure -- for people with diabetes, this means less than 130/80
Watch cholesterol levels -- have cholesterol tested regularly and take medication to lower it, if needed
Don't smoke
Get enough exercise and eat right

There are many ways to keep your heart healthy and reduce the risk of cardiovascular problems down the road. Talk to your doctor to learn what may benefit your situation.

Nerve damage (neuropathy)

Diabetes can damage the nerves and cause a complication called neuropathy. This generally effects sensation in the fingers and toes. Eventually, the neuropathy moves up the arms or legs. Symptoms to watch out for include:

Tingling
Weakness
Burning sensations
Loss of sensitivity to warmth or cold
Numbness -- if the nerves are damaged enough, the person may be unaware that a blister or minor wound has become infected.
Abnormal blood pressure
Problems with bowel and bladder control
Impotence in men
Bone deformity in foot ("Charcot foot")

The patient may even have a heart attack and not be able to feel any chest pain.

Problems in the feet and legs

People with diabetes are at risk for blood vessel injury, which may be severe enough to cause tissue damage in the legs and feet. If nerve damage is also a problem, then the person may not be aware of the injuries that have occurred in their legs or feet.

At that point, minor infections sometimes develop into deep tissue injuries that can require surgery. In extreme cases, amputation of the foot or limb may be necessary. Foot care is very important to prevent the need for amputation.

If you have any questions about foot care -- loss of sensation, callouses, sores, how to trim nails, which shoes to wear -- call your doctor or diabetes counsellor.
Check the feet each day.
Report any problems immediately to your doctor.

Kidney disease

The kidneys filter and clean blood. Not surprisingly, having too much glucose in the blood puts a strain on them. Over time, this can actually lead to kidney failure. When this happens, dialysis or a kidney transplant are needed.

Kidney disease can be prevented through good control of glucose levels and blood pressure.
Make sure you get a urine test each year (see guidelines) to assess kidney function.
Watch for kidney-related symptoms -- unusually colored urine, urination frequency, back pain, chills, fever.
Finally, find out whether high blood pressure medicine is appropriate for your situation.

Eye problems

Diabetes is the leading cause of blindness in adults. The most common eye disorder in diabetes is retinopathy. This condition is caused by the excessive amount of glucose in the bloodstream, which weakens and damages the blood vessels. A weakened blood vessel may bulge out (aneurysm). The blood vessel may even rupture, leaking blood and fluid into the surrounding tissues (hemorrhage.) Either of these can cause vision problems.

See an eye doctor at least once a year. Even if vision problems have not started, a doctor can see early warning signs.
Notify your eye doctor of any problems -- such as blurred vision, spots, rings around lights.

People with diabetes are also at higher risk for developing cataracts and certain types of glaucoma.

Other possible complications

Gum disease
Respiratory infections
Urinary tract infections
Scaly and hardened skin
Celiac disease (an allergy to gluten, found in barley, wheat, and rye)
Increased risk of colon and rectal cancer
Hearing loss

Review Date: June 14, 2002

Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.

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