Secondary Complications

According to the Center for Disease Control and Prevention (CDC), new evidence shows that one in three Americans born in 2000 will develop diabetes sometime during their lifetime.  As you can see diabetes can be a debilitating and deadly disease.  Find out more about about each of these secondary complications by reading below.

Blindness
Complications of Pregnancy
Heart Disease and Stroke
Kidney Disease
Nerve Damage and Amputations
Other Complications

Blindness

Diabetes is the leading cause of new cases of blindness among adults aged 20-74 years.  Diabetic retinopathy causes 12,000 - 24,000 new cases of blindness each year.  However, regular eye exams and timely treatment could prevent up to 90% of diabetes-related blindness.  Unfortunately, in 2002, only 64% of people with diabetes received an annual dilated eye exam.

Over time, high blood sugar levels can damage the blood vessels that feed the retina of the eye.  In the early stages of diabetic eye disease (called background retinopathy), the blood vessels may change.  This change may be throughout the eye or specifically on the macula.  Most likely, you cannot feel any of the early changes and certain changes require immediate treatment.

The most serious event occurs when bleeding and scarring pull on the retina and cause it to detach.  Blindness can occur.  If detected early, some cases of diabetic retinopathy can be treated with laser therapy.  During this procedure, doctors aim a strong beam of light onto the patient's retina to shrink or seal leaking or abnormal vessels.  Laser surgery can not restore vision already lost, so early detection is important.  In some advanced cases, a surgeon may remove the vitreous part of the eye and replace it with a clear solution (called a vitrectomy).  This can improve vision.

People with diabetes should have an annual dilated eye exam to ensure the health of their eyes and to protect their vision.  Most people will not notice a change in their vision until their eye disease is advanced.  A good eye exam is done by an eye care specialist after dilating the pupils.  If eye illness is detected early, there is a better chance that vision loss can be minimized.  If eye illness is not detected early, the vision that is lost can not be restored.  

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Complications of Pregnancy

About 18,000 women with preexisting diabetes and about 135,000 women with gestational diabetes give birth each year.  These women and their babies are at an increased risk for serious complications such as stillbirths, congenital malformations, and the need to cesarian sections.  Women with gestational diabetes and their babies are also at higher risk of becoming obese and developing diabetes later in life.  These risks can be reduced with screenings and diabetes care before, during, and after pregnancy.

Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5-10% of pregnancies and spontaneous abortions in 15-20% of pregnancies.

Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to mother and child.

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Heart Disease and Stroke

Heart disease is the leading cause of death for people with diabetes.  Adults with diabetes are 2-4 times more likely to die from heart disease than adults without diabetes.  Even people with type 2 diabetes who don't have heart disease are at an increased risk of having a heart attack.  People with diabetes also tend to have other risk factors for heart disease, including obesity, high blood pressure, and hardening of the arteries.

People with diabetes are 2-4 times more likely to have a stroke than people without diabetes.

About 65% of deaths among people with diabetes are due to heart disease and stroke.  According to the CDC, these deaths could be reduced by 30% with improved care to control blood pressure, blood glucose, and blood cholesterol levels.

Approximately 73% of adults with diabetes have blood pressure greater than or equal to 130/80 mm Hg or use prescription medications for hypertension.

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Kidney Disease

Over time, high blood sugar levels can damage the kidneys.  Even when medications and diet are able to control diabetes, it can lead to kidney disease (diabetic nephropathy) and kidney failure.

Healthy kidneys filter waste products and extra fluid out of the blood.  Damaged kidneys do not clean the blood well.  As a result, waste products and fluid build up in the blood.

People with kidney failure must either have dialysis treatment to substitute for some of the filtering functions of the kidneys or receive a kidney transplant.

Diabetes is the leading cause of end-stage renal disease, accounting for 44% of new cases.

In 2001, 42,813 people with diabetes began treatment for end-stage renal disease.

In 2001, a total of 142,963 people with end-stage renal disease due to diabetes were living on chronic dialysis or with a kidney transplant.

According to the Center for Disease Control and Prevention, treatment to better control blood pressure and blood glucose levels could reduce diabetes-related kidney failure by about 50%.

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Nerve Damage and Amputations

About 60-70% of people with diabetes have mild to severe forms of nervous system damage.  The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.

People with diabetes need to take special care of their feet.  They are at risk for foot injuries due to numbness caused by nerve damage (diabetic neuropathy) and low blood flow to the legs and feet.

If people know they have loss of protective sensation (LOPS) and decreased circulation, they can learn how to prevent diabetic foot ulcers.  Once a person has a foot ulcer, they may use dressings, skin substitutes, or other treatments to protect and heal their skin.  Unfortunately, diabetic foot ulcers are at very high risk of becoming infected and sometimes can not be healed.  Foot ulcers that can not be healed are a frequent cause of amputation in people with diabetes. 

Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.  More than 60% of nontraumatic lower-limb amputations occur among people with diabetes.  About 82,000 people have diabetes-related leg, foot, or toe amputations each year.  According to the Center for Disease Control, foot care programs that include regular examinations and patient education could prevent up to 85% of these amputations.

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Other Complications

Uncontrolled diabetes often leads to biochemical imbalances than can cause acute life-threatening events.  One of the most serious acute events for people with type 1 diabetes is diabetic ketoacidosis (DKA).  When a person has high blood sugar (hyperglycemia) and there is not enough insulin to handle it, fat is used as fuel instead of glucose.  This produces ketones which flood the bloodstream.  High blood sugar causes the person to urinate more frequently, become dehydrated and lose important chemicals.  If not treated, all of these imbalances can eventually lead to coma and death.  Another serious acute event is hyperosmolar hyperglycemic state (HHS).  HHS is similar to DKA in that the person experiencing it starts with an even higher blood sugar which develops over a longer time.  HHS occurs most often in people with type 2 diabetes.  There is insufficient insulin to handle the high sugar which leads to frequent urination and severe dehydration.  Due to extreme dehydration, HHS can be life-threatening.

Another complication that people with uncontrolled diabetes experience is susceptibility to illnesses and, once they acquire the illness, the severity with which illness can affect them.  Each year, 10,000 - 30,000 people with diabetes die of complications from flu or pneumonia.  They are about three times more likely to die of these complications than people without diabetes.  According to the CDC, people with diabetes need to ensure they receive their annual flu shot.  Currently, only 55% of people with diabetes receive this shot each year.

The most common trigger for a hyperglycemic crisis is an infection, such as pneumonia, strep throat, an intestinal virus, a urinary tract infection, or an infected foot ulcer.  Other triggers include heart attack, stroke, trauma, alcohol abuse, certain corticosteroids, certain blood pressure medications, and skipping or lowering your insulin dose.  Infections can result in DKA or HHS when the infection is not adequately treated.

The best way to prevent DKA and HHS is to keep high blood sugars from happening in the first place.  Stick to your diabetes regimen, monitor your blood glucose levels regularly, know your target glucoses, and learn to adjust your insulin dose properly, if you use insulin.

Be aware of the signs of infection (such as high blood sugar) and seek treatment promptly.  When you're sick, it's especially important to take your usual doses of insulin or diabetes pills (in fact, you may need more even when you are not eating as usual), monitor your blood sugar levels frequently, take your temperature, drink fluids, and test your urine for ketones.  Stay in close contact with your provider until sugar levels, fever or ketones are under control.

Be aware of the signs of high blood sugar, which include: thirst, increased appetite, frequent urination, weight loss, and dehydration.  You will know if you are severely dehydrated if you notice that your mouth is dry, your lips are cracked, your eyes are sunken, you lose weight, or you have flushed, dry skin.  As you get more and more dehydrated, you may experience vomiting, weakness, confusion, and even coma.

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