Long Term Complications of Diabetes - An Overview

Even if the topic of long term complications is an unpleasant topic, it is still important to talk about it and educate people about it. The more we know about complications of diabetes, the more we can do to prevent those complications.

Retinopathy - diabetes can “go to your eyes”

Retinopathy is caused by damage to the blood vessels within the light-sensitive tissue at the back of the eye (the retina). This is caused when elevated blood sugars cause damages within the tiny blood vessels that nourish the retina. Blood flow to the eyes are altered and your body then attempts to grow NEW blood vessels which can become leaky. 

Unfortunately, the very early phase of diabetic retinopathy is asymptomatic and these leaks are only visible to your ophthalmologist. Luckily, a regular preventive eye examination can detect any changes in the retina early on, thus allowing for faster treatment and improved prognosis. This is why the regular eye-exam is such a crucial part of whole-body health! 

You can find out more about regular check-ups that people with diabetes need in this article: 8 regular and important lab checks for people with type 2 diabetes.

There are two types of diabetic retinopathy: 

1. Non-proliferative retinopathy:

"Non-proliferative" means that no newly formed blood vessels are growing. In Non-proliferative retinopathy, no NEW blood vessels have yet formed but you have developed tiny bulges in the vessel walls (microaneurysms). If these new, fine, veins burst open, leaks occur. This phase of retinopathy is early and offers the best chance to slow the progression by improving your diabetes management.

2. Proliferative retinopathy:

If left untreated, the course of non-proliferative retinopathy can progress to promote the growth of new blood vessels. These new vessels are weak and can leak into the vitreous body (jelly-like substance that fills your eye). Once leaking occurs, visual disturbances will be noticeable. Left unchecked, retinopathy can lead to retinal detachment, macular edema, or glaucoma. Treatment for advanced diabetic retinopathy is typically surgical in nature to halt additional damage.

If you have been diagnosed with retinopathy you and your diabetes team should aim to slowly lower your glucose levels down into a healthy range. Special care will need to be taken to monitor your blood pressure levels as well.

Neuropathy - Diabetes can get on your nerves

We all know that diabetes can really get on your nerves! But impaired nerves can also be a long-term complication of diabetes mellitus called Neuropathy.

Diabetic neuropathy is a type of nerve damage typically caused by prolonged high blood glucose levels. The four main types of this disorder can affect all systems of the body, but most commonly, people with diabetes wrestle with peripheral neuropathy in their feet and legs. 

Like it’s cousin, retinopathy, the initial onset of neuropathy can be asymptomatic and go unnoticed in its early stages, though symptoms occur more frequently during periods of inactivity. Common symptoms of neuropathy are:

• Muscle weakness, loss of reflexes, and even muscle wasting      
• Numbness or reduced sensitivity to temperature changes      
• Sharp pain/cramping without apparent reason     
• Burning pain or tingling in the affected areas     
• Increased sensitivity to touch      
• Slow healing wounds and ulcers      

Even a reduction in sensation of the affected parts of the body can cause pressure points, blisters, cornea formation, injuries, burns or ulcers. If left unchecked, these can lead to the most well-known consequence of this nerve damage: the diabetic foot syndrome.

As part of your regular check-up with your healthcare provider, a foot examination should take place at least once a year. They can check for changes in sensation of pressure and pain and help make sure your feet and legs stay healthy. 

Autonomic neuropathy

Autonomous diabetic neuropathy occurs less often and affects the nerves of the internal organs (autonomous or vegetative nervous system). This form of neuropathy affects the cardiovascular system, the gastrointestinal tract, the skin or the urogenital tract in the organ system. Possible symptoms are:

• Blood pressure drops
• Hypoglycemia Unawareness
• Gastroparesis
• Bladder or bowel dysfunction
• Decreased sexual response
• Increased or reduced perspiration

The symptoms are not always clear and usually only appear after a very long period of diabetes. Along with proximal neuropathy, and mononeuropathy, this form of autonomic neuropathy requires regular check-ups to help catch any early warning signs of these long-term complications of diabetes.

Nephropathy - Kidneys make the perfect pair

Our kidneys have valuable, vital tasks. They clean the blood of waste and toxins and they balance the salt and fluid balance. They also help regulate blood pressure. For the filter function, the kidney has millions of small blood vessels that can be damaged by long-term increased sugar levels. 

To measure kidney health, doctors evaluate urinary albumin. This is a small protein building block that is excreted through the kidneys when they have become permeable due to long-term elevated blood sugar levels. If the albumin level is increased, this may be the first sign of an onset of renal impairment. Other symptoms can include:

• Fatigue
• Itching     
• Headache     
• Water retention, especially in the legs     
• Weight gain (typically from water retention)     
• Change in skin color     
• Nausea, vomiting     

Prevent long term complications 

Whether or not long term complications occur in the course of diabetes depends on a variety of factors. However, there are measures that help prevent the occurrence and reduce your risk of developing long-term complications. 

Top of the list is good blood glucose management. Beyond the HbA1c and Time in Range numbers, a smoke-free lifestyle and limiting alcohol intake are top priorities. Likewise, blood pressure and blood lipids should be kept in check as well as possible and as always, get those regular check-ups with your healthcare provider! 

If you are already experiencing symptoms, there is no reason to be ashamed. Be bold and speak to your doctor. The sooner you talk about it, the better an individual treatment plan can be developed.