Complications of Type 2 Diabetes
Approximately 18 million people in the United States, or 6.3% of the population, have diabetes. Of these, 90-95% have type 2 diabetes. There is little doubt that diabetes is a serious disease. There is also little doubt that people with diabetes can live long, healthy, happy lives, if they keep their diabetes under control. But, do you know that how well you manage your disease on a day-to-day basis can have a dramatic impact on your degree of risk for the complications of diabetes?
What Are the Complications of Type 2 Diabetes?
The complications of diabetes are both numerous and serious. They include:
- Heart disease and stroke
- Vision problems
- Kidney disease
- Frozen shoulder (adhesive capsulitis)
- Skin conditions
- Gum disease (gingivitis)
Heart Disease and Stroke
Two out of three people with diabetes die from heart disease and stroke. In fact, diabetes, along with cigarette smoking, high blood pressure, high cholesterol, obesity, and lack of exercise is considered a major, modifiable risk factor for heart disease and stroke.
Diabetes can change your blood, causing blood vessels throughout your body to become narrowed or to clog completely. If this occurs in your heart, you may have a heart attack. If it occurs in a blood vessel in your brain, you could have a stroke.
This means that people with diabetes must work to keep not only their blood sugar under control, but their blood pressure and cholesterol levels as well.
While it’s true that people with diabetes have a higher risk of blindness than people who do not have the disease, most people who have diabetes experience only minor eye disorders. These vision problems are generally the result of persistent high levels of sugar in the blood, which damage the tiny blood vessels in your eyes.
In general, people with type 2 diabetes are at increased risk for three types of vision problems: glaucoma, cataracts, and diabetic retinopathy (a general term for all disorders of the retina caused by diabetes). Fortunately, most diabetes-related vision problems can be slowed or stopped if caught early and can be prevented with good blood sugar control.
High levels of blood sugar make the kidneys filter too much blood. Eventually, the kidneys begin to leak, causing needed protein to be lost in the urine and waste products to build up in the blood. If diagnosed early, there are several treatments that may keep your kidney disease from getting worse. If caught later, end-stage renal disease (ESRD), usually follows. People with ESRD may need to have their blood filtered by machine (dialysis) or may require a kidney transplant.
Diabetic neuropathies are a family of nerve disorders caused by diabetes. Neuropathy is the most common complication of diabetes and can be both painful and disabling. Over time, diabetes can damage the nerves throughout the body. This may lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. It may also affect other organ systems, such as the digestive tract, the vascular system, and the sex organs.
The most common manifestation of diabetic neuropathy is a small injury to the foot. When the nerves of your foot are damaged, you may not notice small sores or cuts on your foot and therefore not treat them appropriately. It may also take these injuries longer to heal. Both situations leave you at risk for infection, which in serious cases can lead to gangrene or foot amputation.
Researchers do not yet know what causes diabetic neuropathy, however, glucose control seems to play a role. This means that the longer a person has diabetes, the greater their risk of developing diabetic neuropathy, particularly if they have difficulty controlling their glucose, cholesterol, and blood pressure levels. Fortunately, maintaining good blood sugar control seems to help prevent diabetic neuropathy and help relieve it once it occurs.
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder affects about 20% of people with diabetes, compared with 5% of people without diabetes. A frozen shoulder, technically known as adhesive capsulitis, often begins as tenderness or soreness in the shoulder joint, usually following a bout with another musculoskeletal condition such as tendinitis or bursitis. As the shoulder becomes stiffer and more painful, people tend to use it less and less. Unfortunately, this eventually only adds to the stiffness and pain, creating a vicious cycle in which the shoulder’s range of motion decreases while the pain and stiffness increases.
Researchers aren’t sure exactly why diabetes is a risk factor for frozen shoulder. One theory is that high (uncontrolled) levels of glucose in the blood may contribute to abnormal deposits of collagen (a major part of the ligaments that hold the bones together in a joint) in the cartilage and tendons of the shoulder. This buildup can cause the affected shoulder to stiffen.
People with diabetes are also prone to skin conditions. It is so common, in fact, that as many as one third of people with diabetes will have some type of skin disorder during their lifetime.
Indeed, skin problems such as infections and itching are sometimes the first indication that a person has diabetes. Other types of skin disorders common in people with diabetes include dermopathy, necrobiosis lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis. Fortunately, most of these skin conditions can be either prevented or easily treated if caught early.
Gum Disease (Gingivitis)
If you have diabetes, you are at higher risk for gum disease than people who do not have the disease. This is because diabetes may weaken your mouth's ability to fight germs. And while it’s true that anyone can get gum disease, having diabetes can make it worse and make it more difficult to control.
What Can You Do?
The good news is that complications of diabetes can be prevented, or at least slowed, and the power to do so is in your hands. If you have type 2 diabetes, here’s what you can do:
- Follow the ABC’s of preventive diabetic care:
- A = Hemoblogin A1C: Get your Hemoglobin A1C checked, to get a sense of your long-termblood sugar control
- B = Blood pressure: Get your blood pressure checked regularly, and keep it below 130/80
- C = Cholesterol: Keep your total cholesterol level below 200 and LDL ("bad" cholesterol) cholesterol below 100.
- Check your blood glucose every day. Keep your levels between 80-120 before a meal, and between 100-140 before bedtime. Keep a record of your glucose levels and bring it with you when you see your doctor.
- Follow the healthy eating plan that you and your doctor have worked out.
- Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
- Take your diabetes medicines at the same times each day.
- Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails. Have your doctor or nurse check the nerves in your foot at least once a year.
- Periodically, request a microalbumin test from your doctor. This test will tell you how well you kidneys are working.
- Brush and floss your teeth and gums everyday.
- Get an eye exam every year. Make sure your eye doctor is aware of your diabetes.
- Don't smoke.
The American Diabetes Association
American Heart Association
Harvard School of Public Health
National Diabetes Information Clearinghouse (NDIC)
Canadian Council on Food and Nutrition
Canadian Diabetes Association
American Heart Association says diabetes is a major risk factor for heart disease and stroke. Stroke News. September 11, 1999. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=2833. Accessed October 14, 2003.
Diabetes complications and related concerns. American Diabetes Association website. Available at: http://www.diabetes.org/type2/complications/default.jsp. Accessed October 13, 2003.
Diabetic neuropathies: the nerve damage of diabetes. National Diabetes Information Clearinghouse (NDIC) website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/index.htm. Accessed October 14, 2003.
Eye care and retinopathy. American Diabetes Association website. Available at: http://www.diabetes.org/type2/complications/retinopathy/default.jsp. Accessed October 13, 2003.
Link for life: an interactive program on diabetes and heart disease. American Diabetes Association website. Available at: http://www.diabetes.org/info/link.jsp. Accessed October 13, 2003.
Living with type 2 diabetes. American Diabetes Association website. Available at: http://www.diabetes.org/type2/living/default.jsp. Accessed October 13, 2003.
Prevent diabetes problems: keep your diabetes under control. National Diabetes Information Clearinghouse (NDIC) website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/complications_control/index.htm#daily. Accessed October 14, 2003.
Last reviewed January 2008 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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