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Diabetes complications

As you may already know, controlling your blood glucose is important for avoiding hypoglycemia and hyperglycemia—blood glucose lows and highs.

By keeping your blood glucose in your target range, you may delay or prevent long-term diabetes complications. High blood glucose can damage many parts of your body, including your eyes, heart and toes. The good news is that you, along with your healthcare professional, may be able to lessen or even prevent the impact of diabetes complications on your life.

The following lists some of the more common diabetes-related complications, their symptoms and treatments, and some steps your healthcare professional may recommend to help reduce your risk.

Diabetes & eye disease

People with diabetes are at higher risk for several types of eye disease, including retinopathy, cataracts and glaucoma. These diseases can lead to blindness over time, so early detection is the key to avoiding or lessening the risk of these diseases.

Retinopathy, the most common eye disease in people with diabetes, is caused by damage to the blood vessels of the retina. In some cases, these vessels may swell and leak fluid. This is called nonproliferative or background retinopathy.

As these areas heal, scarring occurs and abnormal new blood vessels may grow on the retina's surface, causing vision loss or blindness. This is called proliferative retinopathy and has more serious consequences. Unfortunately, some level of retinopathy is common, especially in people who have had diabetes for many years. However, with good blood glucose control, it does not have to affect your vision.

Cataracts cloud the lens of the eye. They are often an early complication of diabetes. An annual eye examination can help detect cataracts before they become severe.

Glaucoma is an increased pressure in the fluid inside the eye. This can damage the optic nerve and lead to vision loss.

Reducing your risk for eye disease

Taking a few important steps may greatly reduce your risk of diabetes-related eye disease.

  • Control your blood glucose. As average blood glucose levels rise, so does the risk of retinopathy. Typically, the better a person's blood glucose control, the slower the onset and progression of retinopathy. Proper control may also reduce your chance of getting cataracts.
  • Lower your blood pressure. High blood pressure may increase the risk of retinopathy.
  • Stop smoking. Smoking raises your risk of cataracts and many other diabetes-related complications.
  • Get an annual dilated-eye examination. People with diabetic eye disease often have no symptoms or pain until a disease becomes advanced. Your healthcare professional can detect retinopathy before you have any vision problems. A dilated-eye exam lets your healthcare professional examine the blood vessels in the back of the eye. The earlier retinopathy is diagnosed, the better your chances for preventing further damage to your eyes.

You can get further information on eye diseases in the following links:

Diabetes & heart disease

Diabetes increases the risk of heart disease and stroke. Heart or blood-vessel (cardiovascular) disease accounts for about 50% of all deaths for those with diabetes.1

High blood glucose levels can damage blood vessels, leading to cardiovascular complications, such as high blood pressure, high cholesterol and hardening of the arteries. In addition to risk factors you cannot control—such as heredity, age and gender—you may be at greater risk of heart problems if you have diabetes and any of the following risk factors:2

  • smoking
  • high blood pressure
  • high blood cholesterol level
  • lack of regular exercise
  • being obese or overweight
  • having a family history of heart attack or angina

Heart disease symptoms

Any one of the following symptoms could be a sign of heart disease, stroke or other heart problems. If you experience any of these symptoms, talk to your healthcare professional:

  • Chest pain or discomfort
  • Dizzy spells
  • Jaw, back, arm, neck or stomach pain
  • Slow-healing cuts and sores
  • Numbness or weakness on one side of the body
  • Leg pain, which may go away with rest
  • Shortness of breath
  • Sweating or light-headedness

Taking care of your heart

You should discuss with your healthcare professional how often you should have check-ups to monitor your diabetes and any other problems you may have.

Diabetes & high blood pressure

People with diabetes and high blood pressure have nearly twice the risk of heart disease as people who have only high blood pressure.3

High blood pressure, or hypertension, occurs when the force of blood flow inside blood vessels is too high. The heart has to work harder to pump blood through the body, which can contribute to serious health problems.

Identifying high blood pressure

High blood pressure has no signs or symptoms. The only way to identify it is by having your blood pressure checked by your healthcare professional. This is a quick and easy procedure and is something you have probably done many times before.

If you have a high blood pressure reading, your healthcare professional may recommend a series of additional blood pressure tests.

Preventing and treating high blood pressure

You can reduce your chances of developing high blood pressure by the following:4

  • regular exercise of at least 30 minutes a day, five times a week
  • moderating your alcohol intake to recommended levels (less than 14 units per week)
  • eating a low-fat, balanced, healthy diet
  • restricting your consumption of salt to less than 6g (0.2oz) a day,
  • losing weight if you are overweight or obese,
  • restricting caffeine consumption to less than five cups of coffee or tea a day

Your healthcare professional may also prescribe medication to control high blood pressure. The type and amount of medication will depend on your specific situation.

Diabetes & kidney disease

Kidneys filter your blood through millions of blood vessels and then dispose of body waste in your urine. Diabetes can damage these small blood vessels, making it hard for the kidneys to work effectively. As a result, diabetes is the leading cause of kidney failure.1

Smoking, uncontrolled blood glucose levels, and high blood pressure can increased your risk of kidney disease if you have diabetes. Having a family member with kidney disease also increases the risk of developing kidney disease.

Detecting kidney disease

While there are often no early symptoms of kidney damage, your healthcare professional can test for it. They will check your urine for a protein called albumin. This screening can detect kidney disease in its early stages, when treatment can slow or even prevent progression of the disease.

Prevention and care

  • Keep your blood glucose levels close to normal range. In partnership with your healthcare professional, you should agree a target range that is suited to you.
  • Lower your blood pressure, if it is high. Discuss your normal range and how to treat high blood pressure with your healthcare professional.
  • If you have been told you have protein in your urine, discuss how to treat it—whether through medication or by limiting protein in your meals—with your healthcare professional.
  • Smoking increases your risk of kidney damage. Talk to your healthcare professional to find out how they can support you to stop smoking.

You can find some useful information about kidney disease at the link below:

Diabetes & nerve disease (neuropathy)

High blood glucose may cause damage to nerve cells, causing interference with the way they send signals through the body.

Many people know that nerve damage can affect their hands and feet — that is why your healthcare professional should check your feet for early signs of damage at every visit. However, nerve damage can affect every organ in the body—from your digestive tract to your bladder and sexual organs. Nerve damage can also affect your ability to feel the symptoms of low blood glucose.5

Who is at risk for nerve disease?

About 60%–70% of people with diabetes have some form of nerve damage. The highest rates are among those who have had diabetes for at least 25 years and among those who have high cholesterol, high blood pressure or weight issues. It is also more prevalent among people with problems controlling their blood glucose.5

Symptoms of nerve disease

The symptoms of nerve damage depend on the type of neuropathy and which nerves are affected. In some types of neuropathy, there may be no symptoms at all. Because it develops slowly, mild cases can go unnoticed for a long time. Look for the following symptoms:5

  • Numbness, tingling or pain in the toes, feet, legs, hands, arms and fingers
  • Sensitivity to touch
  • Difficulty swallowing
  • Dizziness or faintness when you stand or sit up
  • Profuse sweating at night or when eating
  • Problems with urination
  • Sexual issues, such as erectile dysfunction in men and vaginal dryness in women
  • Loss of balance or coordination

Treatment for Diabetic Nerve Damage

Your treatment for diabetic neuropathy is likely to start with blood sugar control. Blood glucose monitoring, meal planning, physical activity and medication may all help as well. Your healthcare professional may also recommend oral medication or a topical cream for pain relief.

If you have any of the symptoms listed above, talk to your healthcare professional to find out what options are available to you.

Diabetes & foot problems

Proper foot care is an important part of a person with diabetes’ daily routine. High blood glucose levels can damage the blood vessels that carry oxygen and nutrients to the legs and feet. This can lead to nerve damage, poor circulation, infections and foot deformities. Left untreated, the consequences can be severe. The risk of amputation in diabetes is 23 times that of people without diabetes. 6

Healthy diabetic foot care habits

By keeping your blood glucose within the target range recommended by your healthcare professional and by paying special attention to your feet every day, you may be able to prevent long-term complications. For healthy toes and feet, follow these simple steps:

  • Check your feet regularly
  • Wear comfortable shoes that fit
  • Wash your feet daily with soap and lukewarm water
  • Trim your toenails straight across and not too short

What to look for

It is recommended that you have your feet examined at least once a year by your healthcare professional. It is also advisable to perform regular checks yourself.

If you experience any of the following symptoms, see your healthcare professional:

  • Less pain or less sensitivity in the leg or foot
  • Cuts or breaks in the skin
  • Ingrown nails
  • Changes in the shape of your foot
  • Corns or calluses

Diabetes & gum disease

It is thought that as many as a third of those with diabetes suffer from gum disease.7 Both gum disease and gum infection are common complications of diabetes. Regular dental checkups and good dental care at home can reduce dental problems.

Preventing gum disease

Gum disease is preventable. The following may help to keep healthy teeth and gums:8

  • Tell your dentist you have diabetes
  • Brush your teeth twice a day with fluoride toothpaste
  • Flossing your teeth regularly
  • Have regular dental exams, as often as your dentist recommends

When to see your dentist

Contact your dentist if you notice any of the following:

  • Gums that bleed easily
  • Red, swollen or tender gums
  • Gums that have pulled away from your teeth
  • Persistent bad breath or bad taste in your mouth
  • Loose teeth or a change in the way it feels when you bite down
  • A change in the way your dentures fit

Skin problems and skin care

High blood glucose levels can affect your skin in several ways.

  • Diabetes can damage nerves that make your body sweat less, particularly in the legs and feet. Your skin relies on sweat to keep it moist - the loss of sweat can make it dry. Dry skin cracks easily, letting germs enter.
  • Diabetes can cause blood vessels to become damaged (narrowed), resulting in poor blood flow. When blood flow is poor, an injured area cannot get enough oxygen and food to heal.
  • With diabetes, your body's natural defences are weakened. White blood cells that fight germs are fewer in number and work more slowly. This makes you more prone to infection. Breaks in the skin can become easily infected, spread faster, be harder to treat, and take longer to heal.
  • If you frequently have high blood glucose levels, you may notice your skin is extra dry, itchy, cracked or you may have rashes, boils, pimples or other skin changes.

How can I keep my skin healthy?

You can keep your skin healthy by following these tips.

Cleaning

  • Use a mild, unfragranced soap that will not rob your skin of natural oils or cause irritation. Some soaps, particularly those with heavy fragrances, can be harsh to skin.
  • Use warm (not hot) water and limit your use of soaps or cleansers to parts of your body that sweat. Always rinse off soaps or cleansers completely.
  • Spend only 5-10 minutes in water. Soaking in a bath or shower can cause skin to dry out.
  • Pat skin dry with a soft towel. Avoid rubbing. Dry between all skin folds such as armpits and under breasts. Moisture, warmth and darkness in these body areas, along with high blood sugars, can lead to yeast and bacterial infections.

Moisturising

  • Drink at least eight glasses of water or sugar-free fluids a day to give your body necessary hydration.
  • Apply moisturising lotion to your skin after bathing, while skin is damp. Do not use cream in skin folds such as between toes and under breasts.
  • Avoid lotions or creams that contain dyes, additives, fragrance, and perfume.

Protecting skin from sun and wind

  • Use a sunscreen lotion with an SPF (sun protection factor) before going outdoors.
  • Limit time in the sun to avoid sunburn and skin dryness.
  • Wear layered clothing to protect you from the sun, cold weather, and wind. Protect your skin from injury
  • Wash minor breaks in the skin with antibacterial soap and water.
  • Cover with a non-stick sterile pad.
  • Hold in place with a gauze bandage and paper tape.
  • Do not disturb a blister; it is a natural sterile protective cover. When it breaks open, care for it as you would any other break in the skin.
  • Check the injured area every day to be sure it is healing properly.

Call your healthcare professional immediately if you notice any of the following:

  • very dry, itchy, cracked skin
  • skin that is red, swollen, feels warm or hot, has pus or bad-smelling discharge
  • a cut or scratch that does not heal

Diabetes, impotence and sexual health

Diabetes can lead to difficulty with sexual performance for men and women.

Issues affecting men

Diabetes may cause nerve and artery damage, disrupting the blood flow needed for an erection. Men who have diabetes are 2-3 times more likely to experience this issue, known as erectile dysfunction or impotence.9 Experiencing erectile dysfunction is common and can be treated.

Prevention and treatment

Several types of treatment are available for erectile dysfunction, including oral medications, injections, suppositories and vacuum devices. If you notice any erectile dysfunction, talk with your healthcare professional right away.

Issues affecting women

Sexual dysfunction from diabetes can affect women as well. High blood glucose, nerve damage, depression and yeast infections are all relatively common in women with diabetes and can contribute to sexual problems.9

Prevention and treatment

Start by talking with your healthcare professional, who can help you determine the best course of action. A simple solution, such as using a lubricant during sex, may help.

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  1. Diabetes UK, Facts and Stats. Available at: https://www.diabetes.org.uk/Documents/Position%20statements/Diabetes%20U.... Accessed 28 September 2016.
  2. NHS, Causes of heart disease. Available at: http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Causes.aspx. Accessed 28 September 2016.
  3. Diabetes UK, Hypertension and Diabetes. Available at: https://www.diabetes.org.uk/upload/How%20we%20help/catalogue/Hypertensio.... Accessed 18 June 2014.
  4. NHS, Preventing and reducing high blood pressure. Available at: http://www.nhs.uk/Conditions/Blood-pressure-%28high%29/Pages/Prevention..... Accessed 18 October 2016.
  5. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetic neuropathies: the nerve damage of diabetes. Available at: http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/index.htm. Accessed 18 June 2014.
  6. NHS, The economic case for change: Foot care for people with diabetes. Available at: https://www.diabetes.org.uk/upload/News/Factsheet%20Footcare%20for%20peo.... Accessed 18 October 2016.
  7. Diabetes.co.uk, Diabetes and gum disease. Available at: http://www.diabetes.co.uk/diabetes-complications/gum-disease.html. Accessed 18 October 2016.
  8. NHS, Gum disease – Treatment. Available at: http://www.nhs.uk/Conditions/Gum-disease/Pages/Treatment.aspx. Accessed 18 October 2016.
  9. National Institute of Diabetes and Digestive and Kidney Diseases. Sexual and Urologic Problems of Diabetes. Available at: http://www.niddk.nih.gov/health-information/health-topics/Diabetes/sexua.... Accessed 18 June 2014.