PBRC 2009 1

Complications of Diabetes
Pennington Biomedical Research Center
Division of Education
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Heart Disease
Kidney Disease/Kidney
Transplantation
Eye Complications
Diabetic Neuropathy and Nerve
Damage


Foot Complications
Skin Complications
Gastroparesis and Diabetes
Depression

Common Potential Complications of
Diabetes
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Heart Disease

Caused by a narrowing or
blocking of the blood vessels to
your heart.
The vessels carry oxygen and
nutrients to your heart.
Vessels can become partially or
totally blocked by fatty
deposits.
A heart attack - when the blood
supply to your heart is reduced
or cut off.
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Diabetes increases the risk for
coronary artery disease, a heart
attack or stroke.
Take preventive steps now.
Keep your ABCs of diabetes on
target.
Heart Disease and Diabetes
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A is for A1C

A1C is the blood glucose check with a memory over the past 2 to 3
months.

B is for blood
pressure

The ADA recommends a blood pressure below 130/80.

C is for
cholesterol

HDL protects your heart.
LDL can clog your blood vessels, leading to heart disease.
Triglycerides can increase your risk for heart disease.

The ABCs
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Kidney Function
Kidneys act as filters.
Kidneys remove waste products from the
blood.
We create waste products from digestion.
Normally, waste products are eliminated in
urine from the body.
Protein and red blood cells are too big to pass
through the filter and remain in the blood.

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Kidney Disease
High levels of blood sugar can put extra stress on
the kidneys.
After years of damage, the kidneys start to leak.
Useful proteins are lost in the urine.
Get a condition known as microalbuminuria.
There are several treatments at this point that may
keep the kidney disease from getting worse.
When kidney disease is diagnosed later, during
macroalbuminuria, end-stage renal disease (ESRD)
usually follows.
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Kidney Disease


Kidneys lose their filtering ability.
Waste products begin to build up in the
blood.
Finally, the kidneys fail.
ESRD
kidney transplant or
regular visits to a dialysis clinic.
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Who Gets Kidney Disease?

Factors that influence kidney disease development
include:

Genetics
Blood pressure
Blood sugar control

Controlling blood sugar and blood pressure are very
important in reducing the chances of developing kidney
disease.
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Facts About Diabetes and
Kidney Disease

Nephropathy - 10-21% of diabetes cases.
~ 43% of new cases of ESRD are attributed to
diabetes.
12 times higher in people with type 1 diabetes
4 times higher in African Americans,
4 to 6 times higher in Mexican Americans
6 times higher in Native Americans
than in the general population of diabetes patients.
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---Eye Complications---


Higher risk of blindness.
Many have minor eye disorders.
Early treatments critical.
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Glaucoma
Pressure build-up in the eye.
Pinches the blood vessels.
Damages nerves.
Vision is gradually lost.
40% more likely to suffer from
glaucoma.
Risk increases with age and
duration of diabetes.
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Cataracts


The eyes clear lens clouds,
blocking light.
Wear sunglasses
Use glare-control lenses in
eyeglasses.
Damaged lens
remove.
transplant.
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Individuals with diabetes are:
60% more likely to develop cataracts
at a younger age
faster progression
have problems if removal of the lens is necessary
due to the beginning stages of glaucoma


Cataracts
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Retinopathy
Diabetic retinopathy is a general term
for all disorders of the retina caused
by diabetes.

There are 2 major types of
retinopathy:
Nonproliferative: This is the common, mild
form.
Proliferative: This form is much more
serious.
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There are several factors that
influence whether you get
retinopathy:
Blood sugar control
Blood pressure levels
How long you have had diabetes
Genetics


Almost everyone with type 1
diabetes will eventually develop
nonproliferative retinopathy.
Retinopathy
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Diabetic Neuropathy & Nerve Damage

~50% have some form of nerve damage.
Its more common in those who have had the
disease for many years.
Blood glucose control can help prevent or
delay nerve damage.

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2 Common Types of Nerve Damage
Sensorimotor neuropathy:
Also known as peripheral neuropathy
Can cause tingling, pain, numbness, or weakness in
hands and feet.

Autonomic neuropathy: Can lead to
Digestive problems such as feeling full, nausea
Vomiting, diarrhea, or constipation
Problems with how well the bladder works
Problems having sex
Dizziness or faintness
Loss of the typical warning signs of a heart attack
Loss of warning signs of low blood glucose
Increased or decreased sweating
Changes in how your eyes react to light and dark
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Keep Your Blood Glucose Levels in
Your Target Range
It is important to:
Report all possible signs of diabetic
neuropathy
Get treatment right away if you have
problems.
Take good care of your feet, checking them
every day.
Protect your feet. Wear shoes and socks that
fit well and wear them all the time.
Purchase special shoes, if they are needed.
Be careful with exercising. Some activities are
not safe for individuals with neuropathy.
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Foot complications

Skin Changes

Calluses

Foot Ulcers

Poor Circulation

Amputation
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Skin Changes and Calluses
Skin Changes:
Dry skin and feet.
Seal remaining moisture in with plain petroleum jelly,
unscented hand cream, or a similar product.
It is important not to put oils or creams between toes.

Calluses
Occur more often and build up faster.
May need therapeutic shoes and inserts.
Calluses can lead to ulcers (open sores).
Never try to cut calluses yourself this can lead to
infection.
Let your healthcare provider cut them.
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Foot Ulcers and Poor Circulation
Foot Ulcers
Every ulcer should be seen by your health care provider
immediately.
Can result in infections, potentially leading to loss of a limb.
It is important to keep off of your feet.
Poor Circulation
Can lead to infection and delay healing.
To improve poor circulation:
Stop smoking and keep blood pressure and cholesterol
in check
Exercise improves circulation. It increases blood flow. Exercise
is a good idea for individuals who currently do not have any
open sores on the foot. Proper shoes are essential.

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Amputation

Highly likely in diabetes.
Due to artery disease, which
reduces blood flow to the feet and
nerve damage, which reduces
sensation.
These can lead to ulcers and
infections that may lead to
amputation.
Amputations are preventable.
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Amputation - Prevention
Take good care of your
feet.
Always follow your health
care providers advice
when caring for foot
problems.
Stop smoking!
Smoking decreases blood
flow to the feet.
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Skin Complications
Bacterial infections
Fungal infections
Itching
Diabetic Dermopathy
Necrobiosis Lipoidica
Diabeticorum
Atherosclerosis
Allergic Reactions


Diabetic Blisters
Eruptive Xanthomatosis
Digital Sclerosis
Disseminated Granuloma
Annulare
Acanthosis Nigricans

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Bacterial and Fungal Infections
Bacterial infections
Many kinds.
Styes.
Boils.
Carbuncles.
Inflamed tissues are usually hot,
swollen, red, and painful.
Treated by antibiotics.

Fungal infections
Candida albicans is a yeast-like
fungus.
Leads to common fungal infections.
Can be treated by medication.
Stye
Athletes foot
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Itching and Diabetic Dermopathy
Itching
Localized.
Can be caused by a yeast infection, dry skin, or poor circulation.
Occurs often in the lower parts of the legs.
Use mild soap with moisturizer, and apply skin cream after bathing to
help resolve the issue.

Diabetic Dermopathy
Changes in the small blood vessels.
Looks like light brown, scaly patches.
The disorder most often occurs on the front of both legs.
The patches do not hurt, open up, or itch.
Dermopathy is harmless and does not require treatment.
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Atherosclerosis and Allergic Reactions
Atherosclerosis
Thickening of the arteries
Occurs at younger ages.
Can lead to skin changes.
Skin becomes hairless, thin, cool, and shiny.
Affected legs heal slowly when the skin is injured.

Allergic Reactions
In response to medications, such as insulin or diabetes pills.
If you think you are having a reaction to a medication, contact
your doctor immediately.
Report any rashes, depressions, or bumps around the insulin
injection sites immediately.
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Diabetic Blisters and
Eruptive Xanthomatosis
Diabetic Blisters
Occurs rarely in individuals with diabetes
They can occur on the backs of fingers, hands, toes, feet, and on legs or
forearms.
They are sometimes large and resemble burn blisters.
Painless and with no redness around them, they often heal themselves within
3 weeks.
The only treatment is to bring blood sugar levels under control.

Eruptive Xanthomatosis
This is a condition caused by diabetes that is out of control.
Consists of firm, yellow, pea-like enlargements in the skin.
The disorder usually occurs in young men with type 1 diabetes.
Like diabetic blisters, these bumps disappear when diabetes control
is restored.

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Digital Sclerosis and
Disseminated Granuloma Annulare
Digital Sclerosis
Consists of tight, thick, waxy skin on the back of the hands.
The finger joints become stiff and can no longer move the way they should.
Rarely, knees, ankles, or elbows also get stiff.
Happens to about 1/3 of people with type 1 diabetes
The only treatment is to bring blood sugar levels under control.

Disseminated Granuloma Annulare
Consists of sharply defined ring-shaped or arc-shaped raised areas on the
skin.
Rashes most often occur on parts of the body far from the trunk
(i.e., ears or fingers), but sometimes the raised areas occur on the trunk.
Contact your doctor when rash appears.
Certain drugs can help clear up the condition.


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Acanthosis Nigricans

Acanthosis Nigricans
This is a condition in which tan or brown raised
areas appear on the sides of the neck, armpits, and groin.
Usually strikes people who are overweight.
The best treatment is to lose weight.
Some creams can help the spots look better.

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Gastroparesis and Diabetes
Due to nerve damage that control the stomach.
Leads to poor muscle control of the stomach and intestines. Movement of
food is slowed or stopped.

Signs and symptoms:
Heartburn
Nausea
Vomiting of undigested food
An early feeling of fullness when eating
Weight loss
Abdominal bloating
Erratic blood glucose (sugar) levels
Lack of appetite
Gastroesophageal reflux
Spasms of the stomach wall
*These symptoms may be mild
or severe, depending on the
person.*
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Complications of Gastroparesis
Gastroparesis makes it harder to manage
blood glucose.
Slower digestion can result in:

Bacterial overgrowth due to fermentation
Food can harden into solid masses called
bezoars that may cause nausea, vomiting, and
obstruction of the stomach

Bezoars can be dangerous if they block the
passage of food into the small intestine.
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Treatment of Gastroparesis

The most important
treatment goal for
diabetes-related
gastroparesis is to
manage your blood
glucose levels as well
through the usage of:


Insulin May need to adjust schedule.
Medication

May need drugs to treat
gastroparesis.
Meal and
food
changes
Refer to your physician or a
dietitian for more information.
Feeding
tube
May be used in severe cases.
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Depression
Consult your doctor to eliminate any physical cause for your
depression.

Poorly controlled diabetes can cause depression like symptoms:
High or low blood sugar during the day can make you feel tired or anxious
Low blood sugar levels can also lead to hunger and eating too much
Low blood sugar n the night could disturb sleep
High blood sugar in the night can lead to frequent urinating and then feeling
tired throughout the next day
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Conclusions
There are many potential complications of diabetes.
Complications can be minimized with good blood glucose control.
Discuss any developments with the physician immediately.
PBRC 2009 37
Division of Education
Reviewed by:
Beth Kalicki
Edited : 10/ 2009
Division of Education
Phillip Brantley, PhD, Director
Pennington Biomedical Research Center
Claude Bouchard, PhD, Executive Director
Heli J. Roy, PhD, RD
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The Pennington Biomedical Research Center is a world-renowned nutrition research center.

Mission:
To promote healthier lives through research and education in nutrition and preventive medicine.

The Pennington Center has several research areas, including:

Clinical Obesity Research
Experimental Obesity
Functional Foods
Health and Performance Enhancement
Nutrition and Chronic Diseases
Nutrition and the Brain
Dementia, Alzheimers and healthy aging
Diet, exercise, weight loss and weight loss maintenance

The research fostered in these areas can have a profound impact on healthy living and on the prevention
of common chronic diseases, such as heart disease, cancer, diabetes, hypertension and osteoporosis.

The Division of Education provides education and information to the scientific community and the public
about research findings, training programs and research areas, and coordinates educational events for the
public on various health issues.

We invite people of all ages and backgrounds to participate in the exciting research studies being
conducted at the Pennington Center in Baton Rouge, Louisiana. If you would like to take part, visit the
clinical trials web page at www.pbrc.edu or call (225) 763-3000.

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References
All information used was obtained from:
American Diabetes Association
http://www.diabetes.org
Copyright, 2009
PBRC # PPT29