Preventing long-term complications – What are common long-term complications?
Type 2 diabetes can be easy to ignore, especially in the early stages when you’re feeling fine. However, diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can help prevent complications.
Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include:
Heart and blood vessel disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure. The risk of stroke is two to four times higher for people with diabetes, and the death rate from heart disease is two to four times higher for people with diabetes than for people without the disease, according to the American Heart Association.
Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.
Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
At first, diabetic retinopathy may not cause symptoms or might only cause mild vision problems. Eventually, however, diabetic retinopathy can result in blindness.
Diabetic retinopathy can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes, and the less controlled your blood sugar is, the more likely you are to develop diabetic retinopathy.
To protect your vision, take prevention seriously. Start by carefully controlling your blood sugar level and scheduling yearly eye exams.
Symptoms of Diabetic Retinopathy
It’s possible to have diabetic retinopathy and not know it. In fact, it’s uncommon to have symptoms in the early stages of diabetic retinopathy.
As the condition progresses, diabetic retinopathy symptoms may include:
- Spots or dark strings floating in your vision (floaters)
- Blurred vision
- Fluctuating vision
- Dark or empty areas in your vision
- Vision loss
- Difficulty with color perception
Diabetic retinopathy usually affects both eyes. It may be classified as early or advanced, depending on your signs and symptoms.
Early diabetic retinopathy. This type of diabetic retinopathy is called nonproliferative diabetic retinopathy (NPDR). It’s called that because at this point, new blood vessels aren’t growing (proliferating). NPDR can be described as mild, moderate or severe. When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges (called microaneurysms) protrude from the vessel walls, sometimes leaking or oozing fluid and blood into the retina. As the condition progresses, the smaller vessels may close and the larger retinal vessels may begin to dilate and become irregular in diameter. Nerve fibers in the retina may begin to swell. Sometimes the central part of the retina (macula) begins to swell, too. This is known as macular edema.
Advanced diabetic retinopathy. Proliferative diabetic retinopathy (PDR) is the most severe type of diabetic retinopathy. It’s called proliferative because at this stage, new blood vessels begin to grow in the retina. These new blood vessels are abnormal. They may grow or leak into the clear, jelly-like substance that fills the center of your eye (vitreous). Eventually, scar tissue stimulated by the growth of new blood vessels may cause the retina to detach from the back of If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure may build up in the eyeball, causing glaucoma. This can damage the nerve that carries images from your eye to your brain (optic nerve).
When to see a doctor
Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly dilated eye exam — even if your vision seems fine — because it’s important to detect diabetic retinopathy in the early stages. If you become pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy, because pregnancy can sometimes worsen diabetic retinopathy.
Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy.
Causes of Diabetic Retinopathy
Too much sugar in your blood can damage the tiny blood vessels that nourish the retina. It may even block them completely. As more and more blood vessels become blocked, the blood supply to the retina is increasingly cut off. This can result in vision loss. In response to the lack of blood supply, the eye attempts to grow new blood vessels. But, these new blood vessels don’t develop properly and can leak easily. Leaking blood vessels can cause a loss of vision. Scar tissue may also form, which can pull on the retina. Sometimes, this can cause the retina to detach.
Elevated blood sugar levels can also affect the eyes’ lenses. With high levels of sugar over long periods of time, the lenses can swell, providing another cause of blurred vision.
Diabetic retinopathy can happen to anyone who has diabetes. These factors can increase your risk:
- Duration of diabetes — the longer you have diabetes, the greater your risk of diabetic retinopathy
- Poor control of your blood sugar level
- High blood pressure
- High cholesterol
- Tobacco use
Preparing for your appointment
People with type 1 or type 2 diabetes should have a dilated eye exam performed by an eye doctor (optometrist) every year. It is recommended that anyone older than 10 with type 1 diabetes have his or her first eye exam within five years of being diagnosed with diabetes. For people with type 2 diabetes, it is important to get the initial eye exam soon after you’ve been diagnosed with diabetes, because you may have had diabetes for some time without knowing it.
After the initial exam, it is recommends that people with either type 1 or type 2 diabetes get an annual eye exam. Some people who have had repeated normal exams may be able to extend the time between exams to two to three years. Ask your eye doctor what he or she recommends.
Women with diabetes who become pregnant need to have an eye exam during the first trimester of pregnancy and possibly again later in the pregnancy, depending on the results of the first exam. The reason for this is that pregnancy can sometimes worsen diabetic retinopathy.
Because appointments can be brief, and there’s often a lot of ground to cover, it’s a good idea to arrive prepared.
Tests and diagnosis
Diabetic retinopathy is best diagnosed with a dilated eye exam. For this exam, your eye doctor will place drops in your eyes that make your pupils open widely. This allows your doctor to get a better view inside your eye. The drops may cause your close vision to be blurry until they wear off several hours later.
Treatments and drugs
Treatment depends largely on the type of diabetic retinopathy you have. Your treatment will also be affected by how severe your retinopathy is, and how it has responded to previous treatments.
Early diabetic retinopathy
If you have non-proliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine if you need treatment.
It may also be helpful to work with your diabetes doctor (endocrinologist) to find out if there are any additional steps you can take to improve your diabetes management.
Advanced diabetic retinopathy
If you have proliferative diabetic retinopathy, you’ll need prompt surgical treatment. Sometimes surgery is also recommended for severe nonproliferative diabetic retinopathy.
- Pay attention to vision changes. Yearly dilated eye exams are an important part of your diabetes treatment plan. Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy.
Remember, diabetes doesn’t necessarily lead to poor vision. Taking an active role in diabetes management can go a long way toward preventing complications.
- Foot damage. As a person with diabetes, you are more vulnerable to foot problems because diabetes can damage your nerves and reduce blood flow to your feet making it harder to heal an injury or resist infection. Because of these problems, you may not notice a pebble in your shoe, so you could develop a blister, then a sore, then a stubborn infection that might cause you to lose a foot or leg to amputation.
- Skin and mouth conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.
- Osteoporosis. Diabetes may lead to lower than normal bone mineral density, increasing your risk of osteoporosis.
- Alzheimer’s disease. Type 2 diabetes may increase the risk of Alzheimer’s disease and vascular dementia. The poorer your blood sugar control, the greater the risk appears to be. So what connects the two conditions? One theory is that cardiovascular problems caused by diabetes could contribute to dementia by blocking blood flow to the brain or causing strokes. Other possibilities are that too much insulin in the blood leads to brain-damaging inflammation, or lack of insulin in the brain deprives brain cells of glucose.
- Hearing problems. Diabetes can also lead to hearing impairment.