What are the complications of Diabetes?

Diabetes potentially affects the metabolism of every cell in the body and adversely affects the body's blood supply. Over a period of months or years, it can lead to a wide range of life-threatening and disabling complications. But these can often be prevented or substantially delayed with the help of intensive diabetes therapy consistently applied, by individuals with diabetes along with their care team.

Fast Facts Life Threatening Complications: Diabetic ketoacidosis (diabetic coma) Nonketotic hyperglycaemic-hyperosmolar coma (NKHHC) Hypoglycemia

Diabetic ketoacidosis (diabetic coma)
Uncontrolled diabetes in a person with type 1 diabetes can lead to potentially fatal dehydration and metabolic imbalance known as diabetic ketoacidosis (diabetic coma). This is an emergency situation, which can almost always be prevented through good control of the diabetes. Sometimes, the occurrence of ketoacidosis is the clinician's first indicator that type 1 diabetes is present.

Nonketotic hyperglycaemic-hyperosmolar coma (NKHHC)
A similar condition, known as nonketotic hyperglycaemic-hyperosmolar coma (NKHHC), can occur in type 2 diabetes. It, too, is associated with dehydration and preceded by a period of poor control of diabetes. NKHHC has a 50% mortality rate.

Improvements in diabetes management appear to have reduced the incidence of these two complications in Canada and other industrialized countries. When they do occur, it is usually as a result of infection, poor compliance or dehydration.

Hypoglycemia (low blood sugar) can result from an excess of either insulin or oral diabetes medication. Usually, hypoglycemia is managed by consuming a sugar product or fruit juice. Most hypoglycemic reactions are mild, and people with diabetes and their families are trained to recognize them and self-administer the sugar needed to correct the situation. In the case of severe low blood sugar resulting in coma the use of glucagon and/or the assistance of a health professional may be required.

Long-term complications

Fast Facts Diabetes is a major cause of other diseases or chronic conditions. But these can often be prevented or substantially delayed with intensive diabetes therapy. heart-disease and stroke high blood pressure lower-limb amputations eye disease (retinopathy) kidney disease nervous system disorders pregnancy complications other (influenza, pneumonia, etc.)

Cardiovascular (heart) disease and stroke
Diabetes increases the risk of cardiovascular problems, including heart attacks and strokes. Canadian data indicate that people aged 35 to 64 who have diabetes are six times more likely to have heart disease or stroke than non-diabetics in the same age group.

High blood pressure
It is estimated that 60 to 65 percent of people with diabetes also have high blood pressure, increasing their risk of stroke, heart disease and kidney disease.
The good news: controlling their blood pressure and blood glucose levels can help people at risk avoid many of these problems.

Lower-limb amputations
Having diabetes increases the risk of lower-limb amputation some fifteen-fold. At highest risk are those over age 40 whose diabetes diagnosis dates back at least 10 years.
The good news: Good foot care and aggressive treatment can substantially reduce the risk for lower-limb amputation.

Diabetic eye disease (retinopathy)
Diabetic retinopathy (DR) is the leading cause of vision loss in working-age adults in both Canada and North America as a whole. The Canadian National Institute for the Blind (CNIB), which is the largest vision rehabilitation agency in Canada, reports that over the past three years DR has been the second leading cause of vision loss for its clients in all age groups.

The good news: People with diabetes can prevent or delay vision loss or blindness due to DR through proper control of blood sugar. DR develops slowly over time, and may be quite advanced before symptoms of vision loss appear. Fortunately, treatment with laser light during the developmental period can slow the progress of the condition. Eye examinations at appropriate intervals, by suitably trained health professionals, allow a determination to be made as to whether such treatment is needed.

Kidney disease
The number of Canadians with newly diagnosed kidney failure who also have diabetes nearly doubled in the 15 years between 1981 and 1996 (from 16% to 28%). By the end of 1996, over 3,300 Canadians with diabetes were being treated for kidney failure, usually by dialysis.

The good news: Diabetes-related kidney disease can often be prevented or its progress markedly slowed. Proper control of blood sugars is required, as well as regular monitoring of protein loss in the urine, enabling kidney problems to be diagnosed earlier and treated more aggressively.

Nervous system disorders
About one-half of those with diabetes experience problems with the transmission of nerve impulses. Ranging from mild to severe, these can produce disabling conditions such as impaired sensation and/or pain in the feet and hands, carpal tunnel syndrome, slowed digestion of food, impotence, as well as other problems of the nervous system.

When impaired sensation in the feet occurs, minor injuries in that area may become infected and progress without being noticed. This sometimes culminates in amputation of the feet and/or legs.

The good news: Close control of blood sugar and regular examination of the feet may prevent this type of complication.

Other complications

People with diabetes have a higher susceptibility to infectious illnesses, such as boils and yeast infections. They are also more likely to die of pneumonia or influenza than people who do not have diabetes.

The good news: Immunizations against influenza and pneumonia can protect individuals with diabetes from these particular infections.