LONG TERM COMPLICATIONS

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LONG TERM COMPLICATIONS

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Complications is a word that strikes fear in the hearts of most people living with diabetes, as diabetes has the potential to affect the metabolism of most cells in the body. Some of the complications happen over a long period of time and can lead to wide range of life-threatening and disabling problems. The complications may have no obvious symptoms and can go undetected without regular medical follow-up and screening.

Not all people with diabetes will develop the complications of diabetes. It is known that avoiding complications is directly linked to lifestyle modifications including:

quitting smoking,

controlling blood glucose,

controlling blood pressure

controlling cholesterol (blood fats)

Studies have shown that the best way to reduce or delay complications is to stay as healthy as possible. This means following a diabetes self-care plan that includes healthy eating, physical activity, and possibly medication.

A, B, C,'s of avoiding complications.
A is for A1C - target is an A1C of 7% or less
B is for Blood Pressure – target is 130/80 or less
C is for Cholesterol – targets are:
LDL – less than 2.0 mmol/L

TC/HDL ratio – less than 4.0 (a word about cholesterol)

Major Complications of Diabetes
Unfortunately diabetes affects the body's blood supply in an unhealthy way. Damage to both the large and small blood vessels can result. The large blood vessels of the heart and those leading to the brain, legs, and sometimes the kidney become clogged with cholesterol rich deposits. The deposits may continue to build until the blood flow is completely blocked.

1. Cardiovascular (Heart) Disease and Stroke

A heart attack can result if the large blood vessels that nourish the heart muscle become clogged. Other large blood vessels can also be affected, resulting in a stroke or poor circulation to the extremities.
To decrease your risk of blood vessel (vascular) disease and stroke it is important you control you blood pressure, cholesterol levels and stop smoking.

BLOOD PRESSURE (Hypertension)
Hypertension, which can damage blood vessels, occurs frequently in people with Type 2 diabetes. High blood pressure along with elevated cholesterol and glucose levels increases the risk for heart attack, stroke and heart failure.
If you are on a medication for hypertension it is important that you take it faithfully. You may also be told to follow a low salt (sodium) diet and increase your activity level. The blood pressure target for people with diabetes is 130/80 or lower.

HIGH CHOLESTEROL
It is common for people with diabetes to have high levels of fat in the blood. Two common types of blood fats are cholesterol and triglycerides.


Terms to know:

Total Cholesterol = The total amount of cholesterol in your blood.

LDL Cholesterol = Low Density Lipoprotein (LDL), often known as “bad” cholesterol. High levels in the blood can increase your risk of heart disease.

HDL Cholesterol = High Density Lipoprotein (HDL), often known as “good” cholesterol. High levels in your blood can decrease your risk of heart disease.

Triglycerides = another blood fat, often associated with high blood glucose levels.


Having good blood glucose control helps control cholesterol and triglyceride levels. For more information see “A Word about Cholesterol”, and www.heartandstroke.ca

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2. Kidney Disease (nephropathy)
Normally, kidneys filter waste products from blood through a network of tiny blood vessels called glomeruli. The purified blood returns to the body while the waste is removed in the urine.

High blood glucose and high blood pressure damage the kidney’s glomeruli. When the small vessels in the kidneys are damaged, the filtering process is affected. As a result, the kidneys may “leak”, meaning that they will allow some useful protiens to escape into the urine, and fail to filter out some of the waste products. If this progresses, kidney damage can become kidney failure, also known as renal disease. ( see The Kidney Foundation of Canada )

All people with diabetes should have a kidney function check annually.

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3. Eyes Diseases
People with diabetes face several eye problems more often than people without diabetes. It has been found that up to one fifth of people with Type 2 diabetes will have some retinopathy at the time of diagnosis. The more common problems are:

- Diabetic retinopathy
- Glaucoma
- Cataracts


DIABETIC RETINOPATHY – is the leading cause of vision loss in working age adults in Canada.
The retina is the light sensitive membrane, made up of blood vessels and nerve endings, that lines the inside back of the eye. It changes light into messages that are sent to the brain where they are converted to the pictures we see.

Diabetic retinopathy is a term used for all abnormalities of the small blood vessels of the retina caused by diabetes, such as weakening of blood vessel walls or leakage from blood vessels.

Weak blood vessel walls will bulge and may break which causes bleeding in the back of the eye. Other blood vessels may become plugged completely by fatty deposits. If the retina is not getting enough oxygen and nutrients to function properly, it tries to grow new blood vessels to replace the damaged ones. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina. This could cause partial loss of vision or complete blindness. Vision loss may develop slowly or occur suddenly, and both of your eyes may not have the same amount of damage.

Diabetic retinopathy often has no early warning signs. Detection is the key to saving your eyesight because timely treatment is essential. Retinopathy can be treated with laser surgery and vision loss can be prevented if the damage is caught early enough. This is why it is advised that all people with diabetes have a yearly eye exam through dilated pupils.

With laser surgery, a light beam is aimed at the lining of the eye to seal off blood vessels that are leaking. The laser beam can also be scattered around the eye to stop new blood vessel growth. Many laser treatments may be needed to get the desired results, but if performed at the right time, severe vision loss can be reduced.

If you have high blood glucose, high blood pressure, kidney disease or elevated cholesterol, you may be advised to see your eye specialist more than once a year.

Diabetic retinopathy may not always be prevented, but with regular screening, early detection and treatment, you can reduce the risk of developing severe visual loss.

For information regarding appropriate exercise for people with diabetes related eye disease, please click here.

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GLAUCOMA – This condition is caused by increased pressure inside of the eye. If fluid in the eye is not able to drain as required, it will build up putting pressure on the retina and optic nerve. If untreated, it can lead to blindness.

Yearly screening for glaucoma is important as it is usually painless and may take years to develop. Once you have the signs of glaucoma (rings around lights and a decrease in your side vision) you may already have some permanent vision loss.

Although not directly caused by elevated blood glucose levels, this condition may be worsened when good control is not maintained. Referral to an eye specialist is important for appropriate treatment. Eye drops are usually prescribed but a pill may also be prescribed if the drops don’t work. If all treatments are unsuccessful, laser surgery to reduce the pressure may be prescribed.

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CATARACTS - A cataract is the clouding over and thickening of the lens of the eye.Some vision is lost and may be blurred as the cloudy lens blocks light from coming into the eye. Cataracts may occur in both eyes.

Blood glucose levels that are high for a number of years may speed up the growth of some cataracts. Studies have shown that people with diabetes are twice as likely to develop cataracts.

If vision loss is great, the cataract may have to be surgically removed, and an artificial lens put in.


For more information -Canadian National Institute for the Blind

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4. Nerves

Messages between the brain and body parts travel back and forth through a pathway of nerves. This is called the body's nervous system.

With diabetes, high glucose levels can damage the blood vessels that carry oxygen to the nerves as well as damage the covering on the nerves. Damaged nerves may send messages too slowly, at the wrong time or not at all, like a scrambled message. Diabetic Neuropathy is the term used to describe damage to the nervous system from diabetes. It is one of the most common complications of diabetes.

Any nerve is a potential target for neuropathy.

There are different types of nerves in the body:

Motor nerves control movement.
Sensory nerves control sensation.
Autonomic nerves control automatic body functions
Symptoms you feel depend on the nerves that are damaged.

Many people with diabetes may have one or more types of nerve damage, (varies from person to person).

Certain nerves seem to be affected more often.

A. Motor neuropathy:

Electrical impulses pass from nerves to muscle tissue in the body.
If nerve cells are damaged, nerve impulses are lost and loss of muscle strength occurs
Example: weakness of eye muscles, facial droop, foot drop.
Symptoms might include:

sudden paralysis
numbness, tingling
pain and burning
B. Sensory neuropathy:

The most common form of neuropathy is peripheral neuropathy, which affects hands and feet. Common sensations are:

pins and needles feeling
tingling, numbness or burning
tend to be more noticeable at night
Over time,you may lose feeling in your feet. Proper foot care is essential. (More Information on Foot Care).
C. Autonomic Neuropathies:

Affects the nerves that control automatic body functions
The most common problems can include:
1.Low blood pressure when rising quickly.

2. Poor warning signs of low blood sugar.

3. Digestive tract problems.

Stomach - may empty more slowly - may feel full or have nausea and vomiting. Can cause low blood glucose due to delayed food absorption.
Bowel – may have diarrhea - may last for a month at a time.
4. Loss of Sexual Function

May be the result of nerve and circulation damage to the sexual organs.
Men may have difficulty with erections.
Women may have less vaginal lubrication.
5. Bladder Problems

May have problems emptying bladder completely.
Can lead to bladder and kidney infections.
6. Sweat changes

May sweat less on feet and lower body, causing dry, cracked skin, often noticeable on feet.
May perspire more on face and chest.
May have attacks of sweating a lot, especially when eating.
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Prevention of Neuropathy:

Eat according to your diabetes meal plan.
Engage in regular physical activity.
Maintain a good blood pressure and blood glucose levels.
Have a yearly check for sensation in feet.
Do not smoke.
Avoid or reduce alcohol consumption.


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