How to Avoid 5 Serious Diabetes Complications

A diabetes diagnosis comes with a host of worries beyond controlling blood sugar levels and watching your diet. Potential diabetes complications include heart trouble, blindness, nerve damage, foot problems and kidney failure. Experts explain what people with diabetes can do to sidestep these risks... 

Even if you’re the healthiest of diabetics, you’re probably still worried about the long-term complications of the metabolic disease.

“The major concern with diabetes is that it really affects every organ in the body,” says Christopher Gibbons, M.D., an assistant professor of neurology at Harvard Medical School and director of the Neuropathy Clinic at Joslin Diabetes Center, a Harvard-affiliated research and clinical care center.

That includes eyes, heart, kidneys and toes – people with diabetes face higher risk of blindness, nerve damage, foot amputations from infections, cardiovascular disease and kidney failure.

But such complications aren’t inevitable, top endocrinologists say. People with diabetes can do a lot to prevent or at least delay them.

Here are the top five diabetes complications to watch for and steps you can take to avoid them.

Diabetes Complications #1: Heart Disease
People with diabetes face double the risk of having a heart attack or stroke. About 2 out of 3 die from heart disease, according to the American Diabetes Association (ADA).

That’s because diabetes affects cholesterol levels, raising levels of LDL, or bad, cholesterol and lowering HDL, or good, cholesterol. That increases a diabetic’s risk of atherosclerosis, caused when arteries are narrowed by a build-up of fatty materials.

This deposit, also known as plaque, can be caused by high blood sugar levels, says Shaista Malik, M.D., a cardiologist and director of UC Irvine Healthcare’s Preventive Cardiology Program.

Plaque clogs or ruptures arteries, which can deprive the heart of oxygen-rich blood flow and trigger a heart attack.

See your doctor or call 911 if you have any of the following signs, Dr. Malik advises:

• Chest pain
  
• Shortness of breath, particularly during exertion or stress
  
• Pain or discomfort in the arms, back, jaw or neck
  
• Sweating
  
• Nausea with exertion

“Usually [heart attack] pain goes away when you rest, so it kind of comes and goes,” Dr. Malik says. “The problem is that a lot of times diabetics won’t [feel] the symptoms due to [nerve damage].”

Diabetes Prevention Program:

• Monitor and keep blood glucose levels under control.
  
• Stop smoking. “Diabetics who keep down their weight, cholesterol and blood sugar – and who don’t smoke – are much less likely to suffer eye disease,” says endocrinologist Richard Berkson, M.D., a clinical professor of medicine at UCLA Medical School.
  
• Maintain a healthy weight for your height.
  
• Exercise or move enough to get your heart rate elevated, Dr. Gibbons advises. About 30 minutes 3-4 times a week will boost circulation and help the body better use insulin.
  
• Keep blood pressure readings under 130/80 mm Hg, Dr. Malik says.
  
• Monitor and control cholesterol levels. LDL, or “bad” cholesterol, should be less than 100 mg/DL.
  
• Limit your consumption of saturated fats in red meat, whole milk and other dairy products.

“If you do all this – and get [annual] checkups, an EKG [electrocardiogram], stress test and an echocardiogram – you’re far less likely to have heart problems,” Dr. Berkson says.

Diabetes Complication #2: NeuropathyAlmost half of people with diabetes have some kind of nerve damage, according to the ADA. It’s a complication that builds over time as high blood glucose levels damage capillaries, the tiny blood vessels that feed nerves.

With neuropathy, nerves send corrupted signals for pain, touch and temperature to the brain. The condition causes loss of sensation, making it easy to injure yourself without noticing.

Poor circulation and neuropathy also reduce your body’s ability to fight off infection and slows wound healing.

Symptoms of neuropathy include tingling, numbness, burning, shooting pains or cold pains, typically in fingers or toes and feet, Dr. Gibbons says.

The pain can be extreme, and sometimes everyday actions, such as rubbing against bed sheets, can trigger it. With some patients, foot pain can feel like a hot plate, or ants crawling, Dr. Gibbons says.

The good news is that not everyone with diabetes suffers neuropathy, Dr. Gibbons says. It’s rarely seen within 10 years after diagnosis, and some people will only have mild symptoms.

Diabetes Prevention Program:

• Control blood glucose levels.
  
• Report symptoms to your doctor.

Diabetes Complications #3: RetinopathyPeople with diabetes have a higher risk of eye troubles than those without the disease. One cause: The capillaries in the eye become fragile and break, leaking into other parts of the eye, according to the ADA.

On average, retinopathy, or damage to the blood vessels in the back of the eye, takes seven years to appear.

Symptoms include:

• Black smudges or “floaters,” which are streaks of blood leaked by retinal blood vessels
  
• Blurred vision
  
• Sudden loss of vision in one eye
  
• Seeing rings around lights
  
• Dark spots
  
• Flashing lights

Diabetes Prevention Program:Diabetics who take good care of their health generally don’t develop eye disease, Dr. Berkson says.

Follow these tips:

• Carefully manage blood glucose levels. If blood sugar levels remain over 180 mg/dl for three days in a row, insulin or oral medication dosages may need adjusting, according to the University of Michigan’s W.K. Kellogg Eye Center.
  
• Have yearly eye exams by a retina specialist or ophthalmologist to spot and treat problems early.
  
• Report any vision changes to your eye doctor.
  
• If you smoke, stop. About 23% of all diabetics smoke, Dr. Berkson says. But if they don’t smoke, and keep down their weight, cholesterol and blood sugar, “they’re unlikely to suffer eye disease.”

Diabetes Complications #4: Foot InfectionsFor a person without diabetes, a blister is no cause for alarm. But that’s not the case for people with diabetes, who run a higher risk that the injury will heal so slowly that it becomes infected.

Blame nerve damage and poor circulation caused by high blood glucose levels, says Dr. Gibbons. Infections may even spread to the bone, leading to amputation, he warns.

Diabetes Prevention Program:

• If you notice an ulcer or any other injury on your feet, keep it clean and sterile.
  
  Also, see your doctor immediately, preferably the same day, but definitely within two days, Dr. Gibbons says. Go to the emergency room if your doctor isn’t available, he advises.
  
• Keep feet infection-free by properly trimming toenails and wearing comfortable, non-irritating shoes.
  
• Schedule regular checkups with a podiatrist, who can safely help with calluses and other foot pressure problems.
  
• Get special shoes if you have foot problems. (They’re covered by Medicare.)

Diabetes Complications #5: Kidney FailureDiabetes is the most common cause of kidney failure, where the organs fail to rid the body of waste, according to the National Institutes of Health (NIH).

It’s a slow-growing problem, usually taking 15 years for symptoms to show up. In fact, pronounced symptoms may not appear until the kidneys have been damaged, according to the National Kidney Foundation.

Watch for the following red flags:

• A frequent need to urinate, especially at night
  
• Fatigue or lack of energy
  
• Muscle cramping at night
  
• Swollen feet or ankles
  
• Lack of concentration
  
• Lack of appetite
  
• Sleep trouble
  
• Eye puffiness, especially in the morning

Diabetes Prevention Program:

• Get tests to monitor kidney function twice a year, Dr. Malik advises. One examines urine for microalbumin, a protein that spills into the urine if kidneys aren’t functioning well. A second screens blood for levels of creatinine, a compound that helps supply energy to cells. With impaired kidney function, creatinine in the blood rises. (Normal is 1.2 mg/dL or less, Dr. Berkson says.)
  
• Consider a low-protein diet, which can slow the onset of kidney disease, according to the NIH.
  
• Maintain intensive control of blood glucose levels.
  
• Monitor and control blood pressure to keep readings under 130/80 mm Hg.
  
• Monitor and control LDL and HDL cholesterol.

As with everything else in the treatment of diabetes, being aware and prepared are key to avoiding immediate and long-term problems.

“I’m amazed at how many 90-year-olds [there are] who have diabetes,” Dr. Berkson says. “They aren’t obese and they take care of themselves. It’s possible to do.”