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Long Term Complications

What are diabetic complications?

Diabetic complications are health problems caused by diabetes. Diabetes causes your blood sugar level to be higher than normal. Over time, high blood sugar levels can damage your blood vessels and nerves. This damage can cause problems in many areas of the body. Keep reading to learn more about some diabetic complications and how to prevent them.

Nerve damage

Nerve damage (also called diabetic neuropathy) makes it hard for your nerves to send messages to the brain and other parts of the body. If you have nerve damage, you may lose feeling in parts of your body or have a painful tingling feeling.

Neuropathy most often affects the feet and legs. If you have neuropathy, you may not be able to feel a sore on your foot. The sore can become infected, and, in serious cases, the foot may have to be amputated (removed). People who have neuropathy may continue walking on a foot that has damaged joints or bones. This can lead to a condition called Charcot foot that causes the injured foot to become deformed. However, this problem can often be avoided.

If you have diabetes, check your feet every day. If you see swelling and redness and feel warmth in your foot, see your doctor immediately. These can be signs of Charcot foot. Your doctor should also check your feet at least once a year.

Warning signs of nerve damage

Call your doctor if you have:

  • Loss of feeling (numbness)
  • Sharp pain or tingling feeling
  • Sores on your feet
  • Muscle weakness
  • Burning feeling
  • Inability to get an erection (in men)

Eye problems

The retina is the part of the eye that is sensitive to light and helps you see. Diabetes can damage and weaken the small blood vessels in the retina. This damage is called diabetic retinopathy.

When the blood vessels are weak, they can leak fluid. This causes swelling in the eye that blurs your vision. If the retinopathy gets worse, it may lead to blindness by causing your retina to break away from the back of the eye.

Laser surgery can often be used to treat or slow down retinopathy, especially if the problem is found early. People who have diabetes should see their eye doctor once a year for an eye exam.

Warning signs of eye problems

Call your doctor if you have:

  • Blurred vision for more than 2 days
  • Sudden loss of vision in 1 or both eyes
  • Black spots, cobwebs or flashing lights in your vision
  • Redness in your eye
  • Pain or pressure in your eye

Kidney damage

Diabetes can also damage the blood vessels in your kidneys so they can't filter out the body's waste. This damage is called diabetic nephropathy. Some people who have nephropathy will eventually need dialysis (a treatment that eliminates waste from the blood) or kidney transplants.

The risk for nephropathy is increased if you have both diabetes and high blood pressure, so it is important to control both of these conditions.

Protein in the urine is usually the first sign of nephropathy. This should be checked yearly. If your doctor notices early signs of this, he or she can put you on medicine that helps protect your kidneys from damage.

Heart disease and stroke

People with diabetes are at greater risk for heart disease and stroke, The risk is even greater for people who have diabetes and smoke, have high blood pressure, have a family history of heart disease or are overweight.

Heart disease is easiest to treat when it is caught early. It is very important to see your doctor on a regular basis. He or she can test for early signs of heart disease or stroke.

The recommended cholesterol level for a person with diabetes is the same as for someone with heart disease. If your cholesterol is higher than the recommended level, your doctor will talk to you about lifestyle changes and medication to help get your cholesterol under control.

What can I do to prevent or delay diabetic complications?

To prevent problems, keep your blood sugar level as close to normal as possible and follow your doctor's instructions. The following are some other tips:

  • Eat a variety of healthy foods. Avoid foods that are high in fat and sugar.
  • Maintain a healthy weight. If you're overweight, your doctor can give you advice on how to lose weight safely.
  • Control your blood pressure and cholesterol levels.
  • Be physically active on a regular basis.
  • Quit smoking.
  • See your doctor regularly, even when you feel fine. Your doctor will check for early signs of complications.

Diabetic Nephropathy

What is diabetic nephropathy?

Diabetes can affect many parts of the body, including the kidneys. In healthy kidneys, many tiny blood vessels remove waste products from your body. These vessels can be damaged if diabetes is not controlled. This damage can cause kidney disease, which is also called nephropathy (say: nef-rah-puh-thee). If the damage is bad enough, your kidneys could stop working.

How do I know if diabetes has hurt my kidneys?

Your doctor will test your urine for protein. This test will tell your doctor if there is a problem with the way your kidneys are working. Your doctor may also want to do a blood test to see how much damage has been done to the kidneys. Your doctor will find out if it is diabetes or something else that is hurting your kidneys.

Unless the damage is severe, you probably will not have any symptoms. If your kidneys stop working, your feet and ankles may swell. You also might feel weak or not want to eat.

What can I do to slow down the damage? The following are some of the most important things you can do to protect your kidneys:

  • Keep your blood pressure lower than 130 over 80. Your doctor may give you medicine to help lower your blood pressure.
  • Check your blood sugar level (also called your A1C level) often. Keep your A1C level below 7 percent. Your doctor may give you medicine to help lower your blood sugar level.
  • Stick to your diet. Ask your doctor how many calories and carbohydrates and how much protein you should eat.
  • Be physically active every day.
  • Take the medicines your doctor prescribes for you. Check with your doctor before taking any new medicines. This includes vitamins, herbal medicines and over-the-counter medicines.
  • Keep all of your doctor appointments.
  • Stop smoking.


  • What happens if my kidneys stop working?

    Even with the right treatments, diabetic nephropathy can get worse over time. Your kidneys could stop working. This is called kidney failure. If this happens, waste products build up in your body. This can cause vomiting, weakness, confusion and coma.

    If you have kidney failure, your doctor will refer you for dialysis (say: die-al-uh-sis). In dialysis, a machine is used to take waste products out of the blood. One kind of dialysis has to be done in a clinic. For another kind of dialysis, the machine is so small it can be strapped to your body while you go about your daily activities.

    Diabetic Ketoacidosis

    Diabetic ketoacidosis (say: key-toe-acid-oh-sis), or DKA for short, happens when your body has high blood sugar (also called glucose) and a build-up of acids called ketones. If it isn't treated, it can lead to coma and even death. It mainly affects people who have type 1 diabetes. However, it can also happen with other types of diabetes, including type 2 diabetes and diabetes during pregnancy.

    What causes DKA?

    The main cause of DKA is not having enough insulin (a hormone produced by the pancreas). This raises your body's blood glucose levels, but stops the body from using the glucose for energy. To get energy, the body starts to burn fat. This causes a build-up of ketones in your body. Ketones can poison the body.

    For people who don't realize they have diabetes, DKA may be the first sign of their illness. For others, DKA can be caused by missing an insulin dose, eating poorly or feeling stressed. Infections, surgery or heart attacks can also lead to DKA.

    What are the warning signs of DKA?

    DKA is a very serious condition. If you have diabetes, you should contact your doctor right away if you experience any of the following:
  • Vomiting more than once
  • Stomach pain
  • Diarrhea 5 or more times in 6 hours
  • 2 blood glucose level tests higher than 300 mg per dL
  • A blood glucose level less than 70 mg per dL more than once, or symptoms of low blood sugar
  • Trouble breathing
  • Moderate or high ketones if you are using urine test strips
  • High beta-hydroxybutyrate levels if you are using blood test strips
  • A high level of blood glucose can also cause you to urinate often, which leads to a lack of fluids in the body (dehydration).


  • If you have signs of infection, including fever, cough, sore throat, or pain when you go to the bathroom, contact your doctor to make sure you are getting the right treatment.

    How can I prevent DKA?

    When you are sick, you need to watch your blood glucose very closely so that it doesn't get too high or too low. Ask your doctor what your critical blood glucose level is. Most patients should watch their glucose levels closely when they are higher than 250 mg per dL.

    When you're sick, you should check your blood glucose level every 3 to 4 hours. If your blood glucose reaches a critical level, check it every 1 to 2 hours. Test your blood glucose levels at least every 4 hours during the night.

    You should talk to your doctor to develop a plan if your blood glucose level gets too high. Make sure that you know how to reach your doctor in an emergency.

    You should also test your urine for ketones or your blood for beta-hydroxybutyrate every 4 hours or if your blood glucose is over 250 mg per dL.

    Should I keep taking insulin when I'm sick?

    Yes, you should keep taking your insulin, even if you are too sick to eat. Your body needs insulin even if you are not eating. Ask your doctor whether it is necessary to adjust your insulin dose or take extra insulin.

    If you are on an insulin pump, make sure that you have short-acting insulin, long-acting insulin and needles in case your pump is not working right. You also should have an emergency phone number to call for help with your pump.

    What else should I do?

    When you're sick, drink lots of sugar-free, caffeine-free liquids. Sip small amounts every few minutes if you are feeling sick to your stomach.

    If your blood glucose is more than 250 mg per dL, do not eat or drink foods that are high in carbohydrates.


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