Complications of diabetes

The complications associated with long-term diabetes afflict a significant proportion of diabetics: approximately 4 in 10 suffer from it, regardless of the type of diabetes.

A rate of glucose blood (or blood sugar) is too high, even periodically, can lead over time to serious health problems.

The earlier diabetes occurs, the greater the risk of complications. However, it is quite possible to delay or prevent the majority of complications by strict control of blood glucose.

Undiagnosed or poorly controlled diabetes can also lead to serious acute complications, which are medical emergencies.

Acute complications of diabetes

Diabetic ketoacidosis
This is a condition that can be fatal. When the body lacks insulin, it replaces glucose with another fuel: fatty acids. This produces ketone bodies which, in turn, increase the acidity of the body.
Symptoms: fruity breath, dehydration, nausea, vomiting and abdominal pain. If no one intervenes, a difficult breathing, a state of confusion, coma and death can occur.
How to detect it: high blood sugar , usually around 20 mmol / l (360 mg / dl) and sometimes more.
What to do: if ketoacidosis is detected, go to the emergency department of a hospital and contact your doctor later to adjust the medication.

Hyperosmolar state
When type 2 diabetes is not treated, hyperglycemic hyperosmolar syndrome may occur. This is a real medical emergency that is fatal in more than 50% of cases.
Symptoms: increased urination , intense thirst and other symptoms of dehydration (weight loss, loss of skin elasticity, dryness of the mucous membranes, increased heart rate and low blood pressure).
How to detect it: A blood glucose level that exceeds 33 mmol / l (600 mg / dl).
What to do: If a hyperosmolar condition is detected, go to the emergency department of a hospital and contact your doctor later to adjust the medication.

Long-term complications

Virtually every part of the body can be affected by poorly controlled diabetes: the heart, blood vessels, kidneys, eyes, nervous system, and so on. As many organs can be affected because, over time, hyperglycemia weakens the walls of small blood vessels that supply all tissues with oxygen and nutrients.

Eye disorders. Diabetes can lead to progressive deterioration of vision. It can also lead to cataracts and glaucoma, even to loss of sight. Eye disorders are the most common complication of diabetes. Virtually everyone with type 1 diabetes develops it, while it affects 60% of type 2 diabetics. The retina is the part of the eye that is most commonly affected, but other parts can be affected as well. .

Neuropathy. Neuropathy is the name given to conditions that affect the nerves and can be quite painful, whatever the cause. It is formed in the first 10 years of diabetes in 40% to 50% of people with type 1 or 2 diabetes. The neuropathy stems from poor blood circulation (and therefore inadequate oxygen supply to the nerves) and low blood pressure. High glucose that alters the structure of the nerves. Most often, the subject feels tingling, loss of sensitivity and pain which first appear at the end of the toes or fingers, then progressively rise along the affected limbs. Neuropathy can also affect the nerves that control digestion, blood pressure, heart rate, sexual organs, and bladder.

Sensitivity to infections. The rise in blood sugar and the fatigue sometimes caused by the disease make diabetics more at risk for periodic infections that are sometimes difficult to cure. It can be infections of the skin, gums, respiratory tract, vagina or bladder. In addition, diabetes can slow down the healing process, which can cause recalcitrant infections in wounds. Foot infections are the most common. Partly due to neuropathy, they can be accompanied by ulcers, and sometimes even require amputation of the foot in case of gangrene .

Nephropathy. The term nephropathy comes from the Greek anaphors = kidney. The kidney tissue is made up of a multitude of tiny blood vessels that form a filter whose role is to eliminate toxins and waste products from the blood. Because diabetes causes vascular disorders, small kidney vessels can be affected to the point of causing progressive kidney deterioration that will manifest itself in a variety of conditions, from kidney failure to irreversible kidney disease. It should be noted that hypertension is also a major contributor to nephropathy.

Cardiovascular diseases. Diabetes contributes to the emergence of cardiovascular diseases. They are 2 to 4 times more common in diabetics than in the general population. A high level of glucose in the blood helps to coagulate the blood. Over time, the risk of obstruction of blood vessels near the heart (infarct) or brain (stroke) increases. The age, the heredity, the hypertension, the overweight and smoking also increase the risk. Type 2 diabetics often have a profile that initially makes them more at risk for this type of disease.

On average, people with type 2 diabetes will die 5 to 10 years earlier than those without diabetes. This is mostly due to cardiovascular disease.

Either of these symptoms may occur.

Eye disorders

Black dots in the visual field, or areas without vision.
Poor color perception and poor vision in the dark.
A dryness of the eyes.
A tangled view.
A loss of visual acuity, which can go as far as blindness. Usually, the loss is done gradually.

Sometimes, there are no symptoms. Consult an ophthalmologist regularly.

Neuropathy (affections to the nerves)

A decrease in sensitivity to pain, heat and cold in the extremities.
Tingling and burning sensation
Erectile dysfunction.
A slowing of the emptying of the stomach, causing bloating and regurgitation after a meal.
An alternation of diarrhea and constipation if the nerves of the intestine are affected.
Bladder that does not empty completely or sometimes urinary incontinence.
Orthostatic hypotension, which manifests as dizziness when moving from a supine position to a standing position and can cause falls in the elderly.

Sensitivity to infections

Various infections: skin (especially on the feet), gums, respiratory tract, vagina, bladder, vulva, foreskin, etc.

Nephropathy (kidney problems)

Hypertension sometimes announces the beginning of kidney damage.
The presence of albumin in the urine, detected by a laboratory test (normally the urine is free of albumin).

Cardiovascular illnesses

Slow healing.
Chest pain during an effort (angina pectoris).
Calf pain that hinders walking ( intermittent claudication ). These pains disappear after a few minutes of rest.

People at risk

All people with diabetes are at risk for long-term complications.
Hereditary baggage influences the degree of risk.

Risk factors

Have a glucose (glucose) level often above normal.
Suffer from hypertension
Have a high cholesterol level.
Smoking the cigarette.

Basic preventive measures

People with diabetes can prevent or at least slow down the development of diabetes complications by monitoring and controlling 3 factors: blood sugar , blood pressure, and cholesterol .

Control of blood sugar . Achieve and maintain as much as possible an optimal blood glucose level by respecting the treatment protocol set up with the medical team. Extensive studies have demonstrated the importance of controlling blood glucose levels, regardless of the type of diabetes ^1-4 . See our Diabetes fact sheet (overview).
Control of blood pressure . Aim for blood pressure as close to normal as possible and control hypertension. Normal blood pressure helps prevent damage to the eyes, kidneys and cardiovascular system. Check the blood pressure regularly. See our page Hypertension.
Cholesterol control . If necessary, be sure to maintain a blood cholesterol level closest to normal. This contributes to the prevention of cardiovascular disease, a major problem in diabetics. It is recommended to make an annual lipid report, or more often if the doctor deems it necessary. See our Hypercholesterolemia fact sheet.

On a daily basis, some tips to prevent or delay complications

Pass the follow-up medical examinations recommended by the medical team. An annual checkup is imperative as is an eye exam. It is also important to visit the dentist regularly, as diabetics tend to suffer from gum infections.
Respect the diet plan established with the doctor or nutrition specialist.
Exercise at least 30 minutes, ideally every day.
Do not smoke.
Drink plenty of water in case of illness, for example, if you have flu. The lost fluids are thus replaced and diabetic coma can be prevented.
Have good foot hygiene and examine them every day . For example, look at the skin between the toes: look for any changes in color or appearance (redness, scaly skin, vesicles, ulcers, calluses). Inform your doctor of changes noted. Diabetes can cause insensitivity in the feet. As previously mentioned, small, poorly treated problems can escalate into serious infections.
Doctors have long recommended that people with diabetes that are 40 years of age and older take a low dose of aspirin (acetylsalicylic acid) every day to keep the heart and blood vessels healthy. The goal was essentially to reduce the risk of heart attack. Since June 2011, the Canadian Cardiovascular Society recommends aspirin as a preventive , especially for diabetics than non-diabetics . It has been evaluated that taking aspirin daily is not worth it, given its very low efficacy in prevention and the adverse effects that may be associated with it. Indeed, aspirin carries a risk of digestive bleeding and cerebrovascular accident(Hemorrhagic)
if necessary, discuss it with your doctor.
Note that the Canadian Cardiovascular Society continues to recommend the low daily dose of aspirin to people who have had a heart attack or stroke (caused by a blood clot) in the hope of avoiding recurrence.

Medical treatments for complications of diabetes

Eye disorders . The conventional treatment consists of various surgical procedures, usually performed by laser.

Neuropathy (affections to the nerves). To reduce pain, doctors offer no steroidal anti-inflammatory drugs (NSAID) such as acetylsalicylic acid (aspirin) or ibuprofen (Advil, Motrin. Treatment usually includes the administration of a tricyclic antidepressant that can, somehow, help fight the intense pain associated with neuropathy. However, these drugs are not without adverse effects and their use, especially in the elderly, is disputed by some experts. Other types of antidepressant drugs that have fewer side effects may include: selective serotonin reuptake inhibitors (eg, fluoxetine (Prozac) and sertraline (Zoloft) or inhibitors of reuptake of serotonin and norepinephrine (eg, venlafaxine (Effexor).

Anticonvulsants, such as gabapentin (Neurontin) or carbamazepine (Tegretol), or opioid analgesics may come to the rescue in some cases, but they are not free of side effects.

Sensitivity to infections . Infections will usually be controlled with antibiotics or fungicides (which fight fungi), as appropriate.

Nephropathy (kidney problems) . In the first line, the doctor will usually prescribe medication to control blood pressure and will make certain dietary recommendations. In the end, kidney dialysis or transplantation may be unavoidable.

Cardiovascular diseases . See our Cardiovascular Disorders sheet for typical treatments for these diseases.