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How diabetes causes long-term problems is unclear. However, changes in the small blood vessels and nerves are common. These changes may be the first step toward many problems that diabetes causes. Scientists can't predict who among people with diabetes will develop complications, but complications are most likely to occur in someone who has had diabetes for many years. However, because a person can have diabetes without knowing it, a complication may be the first sign.
Heart disease is the most common life-threatening disease linked to diabetes, and experts say diabetes doubles a person's risk of developing heart disease. In heart disease, deposits of fat and cholesterol build-up in the arteries that supply the heart with blood. If this buildup blocks blood from getting to the heart, a potentially fatal heart attack can occur.
Other risk factors include hypertension or high blood pressure, obesity, high amounts of fats and cholesterol in blood, and cigarette smoking. Eliminating these risk factors, along with treating diabetes, can reduce the risk of heart disease. The American Heart Association has literature that explains what heart disease is and how to prevent it. The association's address is in the resources section of this hypertext.
People with diabetes are also more likely to develop kidney disease than other people. The kidneys filter waste products from the blood and excrete them in the form of urine, maintaining proper fluid balance in the body. While people can live without one kidney, those without both must have special treatment, called dialysis. Most people with diabetes will never develop kidney disease, but proper diabetes treatment can further reduce the risk. High blood pressure also can add to the risk of kidney disease. Therefore, regular blood pressure checks and early treatment of the disorder can help prevent kidney disease.
Urinary tract infections are also a cause of kidney problems. Diabetes can affect the nerves that control the bladder, making it difficult for a person to empty his or her bladder completely. Bacteria can form in the unemptied bladder and the tubes leading from it, eventually causing infection. The symptoms of a urinary tract infection include frequent, painful urination, blood in the urine, and pain in the lower abdomen and back. Without prompt examination and treatment by a doctor, the infection can reach the kidneys, causing pain, fever, and possibly kidney damage. A doctor may prescribe antibiotics to treat the infection and may suggest that the person drink large amounts of water.
Kidney problems are one cause of water retention, or edema, a condition in which fluid collects in the body, causing swelling, often in the legs and hands. A doctor can decide if swelling or water retention relates to kidney function.
A nephrologist, a doctor specially trained to diagnose and treat kidney problems, can identify the cause of problems and recommend ways to reduce the risk of kidney disease.
Diabetes can affect the eyes in several ways. Frequently, the effects are temporary and can be corrected with better diabetes control. However, long-term diabetes can cause changes in the eyes that threaten vision. Stable blood glucose levels and yearly eye examinations can help reduce the risk of serious eye damage.
Blurred vision is one effect diabetes can have on the eyes. The reason may be that changing levels of glucose in blood also can affect the balance of fluid in the lens of the eye, which works like a flexible camera lens to focus images. If the lens absorbs more water than normal and swells, its focusing power changes. Diabetes also may affect the function of nerves that control eyesight, causing blurred vision.
Cataract and glaucoma are eye diseases that occur more frequently in people with diabetes. Cataract is a clouding of the normally clear lens of the eye. Glaucoma is a condition in which pressure within the eye can damage the optic nerve that transmits visual images to the brain. Early diagnosis and treatment of cataract and glaucoma can reduce the severity of these disorders.
Retinopathy, a disease of the retina, the light sensing tissue at the back of the eye, is a common concern among people with diabetes. Diabetic retinopathy damages the tiny vessels that supply the retina with blood. The blood vessels may swell and leak fluid. When retinopathy is more severe, new blood vessels may grow from the back of the eye and bleed into the clear gel that fills the eye, the vitreous.
While most people with diabetes may never develop serious eye problems, people who have had diabetes for 25 years are more likely to develop retinopathy. Experts think high blood pressure may contribute to diabetic retinopathy, and that smoking can cause the condition to worsen. If someone experiences blurred vision that lasts longer than a day or so, sudden loss of vision in either eye, or black spots, lines, or flashing lights in the field of vision, a doctor should be alerted right away.
Treatment for diabetic retinopathy can help prevent loss of vision and can sometimes restore vision lost because of the disease. A yearly eye examination with dilated pupils makes it possible for an ophthalmologist, an eye doctor, to notice changes before the illness becomes harder to treat. Scientists are testing new means of treating diabetic retinopathy. For more information on eye complications of diabetes and the treatment of these conditions, see the resource list at the end of this hypertext document.
Legs and Feet
Leg and foot problems can arise in people with diabetes due to changes in blood vessels and nerves in these areas. Peripheral vascular disease is a condition in which blood vessels become narrowed by fatty deposits, reducing blood supply to the legs and feet. Diabetes also can dull the sensitivity of nerves. Someone with this condition, called peripheral neuropathy, might not notice a sore spot caused by tight shoes or pressure from walking. If ignored, the sore can become infected, and because blood circulation is poor, the area may take longer to heal.
Proper foot care and regular visits to a doctor can prevent foot and leg sores and ensure that any that do appear don't become infected and painful. Helpful measures include inspecting the feet daily for cuts or sore spots. Blisters and sore spots are not as likely when shoes fit well and socks or stockings aren't tight. A doctor also may suggest washing feet daily, with warm, not hot water; filing thick calluses; and using lotions that keep the feet from getting too dry. Shoe inserts or special shoes can be used to prevent pressure on the foot.
Diabetic neuropathy, or nerve disease, dulls the nerves and can be extremely painful. A person with neuropathy also may be depressed. Scientists aren't sure whether the depression is an effect of neuropathy, or if it's simply a response to pain. Treatment, aimed at relieving pain and depression, may include aspirin and other pain-killing drugs.
Any sore on the foot or leg, whether or not it's painful, requires a doctor's immediate attention. Treatment can help sores heal and prevent new ones from developing. Problems with the feet and legs can cause life-threatening problems that require amputation-surgical removal of limbs if not treated early.
Other Effects of Diabetic Neuropathy
Nerves provide muscle tone and feeling and help control functions like digestion and blood pressure. Diabetes can cause changes in these nerves and the functions they control. These changes are most frequent in people who have had other complications of diabetes, like problems with their feet. Someone who has had diabetes for some years and has other complications, may find that spells of indigestion or diarrhea are common. A doctor may prescribe drugs to relieve these symptoms. Diabetes also can affect the nerves that control penile erection in men, which can cause impotence that shows up gradually, without any loss of desire for sex. A doctor can find out whether impotence is the result of physical changes, such as diabetes, or emotional changes, and suggest treatment or counseling.
Skin and Oral Infections
People with diabetes are more likely to develop infections, like boils and ulcers, than the average person. Women with diabetes may develop vaginal infections more often than other women. Checking for infections, treating them early, and following a doctor's advice can help ensure that infections are mild and infrequent. Infections also can affect the teeth and gums, making people with diabetes more susceptible to periodontal disease, an inflammation of tissue surrounding and supporting the teeth. An important cause of periodontal disease is bacterial growth on the teeth and gums. Treating diabetes and following a dentist's advice on dental care can help prevent periodontal disease.
Very high blood glucose levels cause symptoms that are hard to ignore: frequent urination and excessive thirst. However, in someone who is elderly or in poor health these symptoms may go unnoticed. Without treatment, a person with high blood glucose or hyperglycemia can lose fluids, become weak, confused, and even unconscious. Breathing will be shallow and the pulse rapid. The person's lips and tongue will be dry, and his or her hands and feet will be cool. A doctor should be called immediately.
The opposite of high blood glucose, very low blood glucose or hypoglycemia, is also dangerous. Hypoglycemia can occur when someone hasn't eaten enough to balance the effects of insulin or oral medicine. Prolonged, strenuous exercise in someone taking oral diabetes drugs or insulin also can cause hypoglycemia, as can alcohol.
Someone whose blood glucose has become too low may feel nervous, shaky, and weak. The person may sweat, feel hungry, and have a headache. Severe hypoglycemia can cause loss of consciousness. A person with hypoglycemia who begins to feel weak and shaky should eat or drink something with sugar in it immediately, like orange juice. If the person is unconscious, he or she should be taken to a hospital emergency room right away. An identification bracelet or necklace that states that the wearer has diabetes will let friends know that these symptoms are a warning of illness that requires urgent medical help.
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