Complications of Diabetes

Pennington Biomedical Research Center Division of Education

PBRC 2009

1

Common Potential Complications of Diabetes

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Heart Disease Kidney Disease/Kidney Transplantation Eye Complications Diabetic Neuropathy and Nerve Damage

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Foot Complications S in Complications !astroparesis and Diabetes Depression

PBRC 2009

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Heart Disease

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Caused by a narrowing or blocking of the blood vessels to your heart" The vessels carry o#ygen and nutrients to your heart" $essels can become partially or totally bloc ed by fatty deposits" % heart attac & 'hen the blood supply to your heart is reduced or cut off"
PBRC 2009 3 of 39

Heart Disease and Diabetes

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Diabetes increases the ris for coronary artery disease( a heart attac or stro e" Ta e preventive steps no'" Keep your %)Cs of diabetes on target"

PBRC 2009

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C is the blood glucose chec *'ith a memory+ over the past . months" *)+ is for blood pressure *C+ is for cholesterol The %D% recommends a blood pressure belo' .to .*The %)Cs+ *%+ is for %..C %.//0/" HD1 protects your heart" 1D1 can clog your blood vessels( leading to heart disease" Triglycerides can increase your ris for heart disease" PBRC 2009 5 of 39 .

Kidney Function      Kidneys act as filters" Kidneys remove 'aste products from the blood" 2e create 'aste products from digestion" Normally( 'aste products are eliminated in urine from the body" 3rotein and red blood cells are too big to pass through the filter and remain in the blood" PBRC 2009 6 of 39 .

Kidney Disease     High levels of blood sugar can put e#tra stress on the idneys" %fter years of damage( the idneys start to lea " 4seful proteins are lost in the urine" !et a condition no'n as microalbuminuria"   There are several treatments at this point that may eep the idney disease from getting 'orse" 2hen idney disease is diagnosed later( during macroalbuminuria( end&stage renal disease 5ES6D7 usually follo's" PBRC 2009 7 of 39 .

Kidney Disease Kidneys lose their filtering ability" 2aste products begin to build up in the blood" Finally( the idneys fail" ES6D       idney transplant or regular visits to a dialysis clinic" PBRC 2009 8 of 39 .

2ho !ets Kidney Disease8  Factors that influence idney disease development include9    !enetics )lood pressure )lood sugar control  Controlling blood sugar and blood pressure are very important in reducing the chances of developing idney disease" PBRC 2009 9 of 39 .

. <. diabetes    < times higher in %frican %mericans( < to = times higher in >e#ican %mericans = times higher in Native %mericans than in the general population of diabetes patients" PBRC 2009 10 of 39 .Facts %bout Diabetes and Kidney Disease   Nephropathy & .: of ne' cases of ES6D are attributed to diabetes"  .times higher in people 'ith type .: of diabetes cases" ./&-.

&&&Eye Complications&&& Higher ris of blindness" >any have minor eye disorders" Early treatments critical"    PBRC 2009 11 of 39 .

!laucoma  3ressure build&up in the eye"    3inches the blood vessels" Damages nerves" $ision is gradually lost"   </: more li ely to suffer from glaucoma" 6is increases 'ith age and duration of diabetes" PBRC 2009 12 of 39 .

Cataracts  The eye?s clear lens clouds( bloc ing light"    Damaged lens @   2ear sunglasses 4se glare&control lenses in eyeglasses" remove" transplant" PBRC 2009 13 of 39 .

Cataracts  Andividuals 'ith diabetes are9  =/: more li ely 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 PBRC 2009 14 of 39 .

6etinopathy  Diabetic retinopathy is a general term for all disorders of the retina caused by diabetes" There are .maBor types of retinopathy9    Nonproliferative9 This is the common( mild form" 3roliferative9 This form is much more serious" PBRC 2009 15 of 39 .

6etinopathy  There are several factors that influence 'hether you get retinopathy9     )lood sugar control )lood pressure levels Ho' long you have had diabetes !enetics  %lmost everyone 'ith type . diabetes 'ill eventually develop nonproliferative retinopathy" PBRC 2009 16 of 39 .

Diabetic Neuropathy C Nerve Damage    .D/: have some form of nerve damage" At?s more common in those 'ho have had the disease for many years" )lood glucose control can help prevent or delay nerve damage" PBRC 2009 17 of 39 .

.Common Types of Nerve Damage  Sensorimotor neuropathy9   %lso no'n as *peripheral neuropathy+ Can cause tingling( pain( numbness( or 'ea ness in hands and feet" Digestive problems such as feeling full( nausea $omiting( diarrhea( or constipation 3roblems 'ith ho' 'ell the bladder 'or s 3roblems having se# DiEEiness or faintness 1oss of the typical 'arning signs of a heart attac 1oss of 'arning signs of lo' blood glucose Ancreased or decreased s'eating Changes in ho' your eyes react to light and dar  %utonomic neuropathy9 Can lead to          PBRC 2009 18 of 39 .

Keep Four )lood !lucose 1evels in Four Target 6ange  At is important to9       6eport all possible signs of diabetic neuropathy !et treatment right a'ay if you have problems" Ta e good care of your feet( chec ing them every day" 3rotect your feet" 2ear shoes and soc s that fit 'ell and 'ear them all the time" 3urchase special shoes( if they are needed" )e careful 'ith e#ercising" Some activities are not safe for individuals 'ith neuropathy" PBRC 2009 19 of 39 .

Foot complications  S in Changes Calluses Foot 4lcers 3oor Circulation %mputation     PBRC 2009 20 of 39 .

S in Changes and Calluses  S in Changes9    Dry s in and feet" Seal remaining moisture in 'ith plain petroleum Belly( unscented hand cream( or a similar product" At is important not to put oils or creams bet'een toes"  Calluses      Gccur more often and build up faster" >ay need therapeutic shoes and inserts" Calluses can lead to ulcers 5open sores7" Never try to cut calluses yourself@ this can lead to infection" 1et your healthcare provider cut them" PBRC 2009 21 of 39 .

Foot 4lcers and 3oor Circulation  Foot 4lcers     3oor Circulation   Every ulcer should be seen by your health care provider immediately" Can result in infections( potentially leading to loss of a limb" At is important to eep off of your feet" Can lead to infection and delay healing" To improve poor circulation9   E#ercise improves circulation" At increases blood flo'" E#ercise is a good idea for individuals 'ho currently do not have any open sores on the foot" 3roper shoes are essential" PBRC 2009 22 of 39 Stop smo ing and eep blood pressure and cholesterol in chec .

%mputation     Highly li ely in diabetes" Due to artery disease( 'hich reduces blood flo' to the feet and nerve damage( 'hich reduces sensation" These can lead to ulcers and infections that may lead to amputation" %mputations are preventable" PBRC 2009 23 of 39 .

%mputation & 3revention    Ta e good care of your feet" %l'ays follo' your health care provider?s advice 'hen caring for foot problems" Stop smo ingH  Smo ing decreases blood flo' to the feet" PBRC 2009 24 of 39 .

S in Complications        )acterial infections Fungal infections Atching Diabetic Dermopathy Necrobiosis 1ipoidica Diabeticorum %therosclerosis %llergic 6eactions      Diabetic )listers Eruptive Ianthomatosis Digital Sclerosis Disseminated !ranuloma %nnulare %canthosis Nigricans PBRC 2009 25 of 39 .

)acterial and Fungal Anfections  )acterial infections       Stye >any inds" Styes" )oils" Carbuncles" Anflamed tissues are usually hot( s'ollen( red( and painful" Treated by antibiotics"  Fungal infections    Candida albicans is a yeast&li e fungus" 1eads to common fungal infections" Can be treated by medication" PBRC 2009 Athlete’s foot 26 of 39 .

Atching and Diabetic Dermopathy  Atching     1ocaliEed" Can be caused by a yeast infection( dry s in( or poor circulation" Gccurs often in the lo'er parts of the legs" 4se mild soap 'ith moisturiEer( and apply s in cream after bathing to help resolve the issue" Changes in the small blood vessels" 1oo s li e light bro'n( 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 reJuire treatment"  Diabetic Dermopathy      PBRC 2009 27 of 39 .

%therosclerosis and %llergic 6eactions  %therosclerosis      Thic ening of the arteries Gccurs at younger ages" Can lead to s in changes" S in becomes hairless( thin( cool( and shiny" %ffected legs heal slo'ly 'hen the s in is inBured"  %llergic 6eactions    An response to medications( such as insulin or diabetes pills" Af you thin you are having a reaction to a medication( contact your doctor immediately" 6eport any rashes( depressions( or bumps around the insulin inBection sites immediately" PBRC 2009 28 of 39 .

Diabetic )listers and Eruptive Ianthomatosis  Diabetic )listers      Gccurs rarely in individuals 'ith diabetes They can occur on the bac s of fingers( hands( toes( feet( and on legs or forearms" They are sometimes large and resemble burn blisters" 3ainless and 'ith no redness around them( they often heal themselves 'ithin . 'ee s" The only treatment is to bring blood sugar levels under control"  Eruptive Ianthomatosis     This is a condition caused by diabetes that is out of control" Consists of firm( yello'( pea&li e enlargements in the s in" The disorder usually occurs in young men 'ith type . diabetes" 1i e diabetic blisters( these bumps disappear 'hen diabetes control is restored" PBRC 2009 29 of 39 .

of people 'ith type ./.Digital Sclerosis and Disseminated !ranuloma %nnulare  Digital Sclerosis      Consists of tight( thic ( 'a#y s in on the bac of the hands" The finger Boints become stiff and can no longer move the 'ay they should" 6arely( nees( an les( or elbo's also get stiff" Happens to about . diabetes The only treatment is to bring blood sugar levels under control"  Disseminated !ranuloma %nnulare     Consists of sharply defined ring&shaped or arc&shaped raised areas on the s in" 6ashes most often occur on parts of the body far from the trun 5i"e"( ears or fingers7( but sometimes the raised areas occur on the trun " Contact your doctor 'hen rash appears" Certain drugs can help clear up the condition" PBRC 2009 30 of 39 .

%canthosis Nigricans  %canthosis Nigricans     This is a condition in 'hich tan or bro'n raised areas appear on the sides of the nec ( armpits( and groin" 4sually stri es people 'ho are over'eight" The best treatment is to lose 'eight" Some creams can help the spots loo better" PBRC 2009 31 of 39 .

!astroparesis and Diabetes   Due to nerve damage that control the stomach" 1eads to poor muscle control of the stomach and intestines" >ovement of food is slo'ed or stopped" Signs and symptoms9            Heartburn Nausea $omiting of undigested food %n early feeling of fullness 'hen eating 2eight loss %bdominal bloating Erratic blood glucose 5sugar7 levels 1ac of appetite !astroesophageal reflu# Spasms of the stomach 'all PBRC 2009 KThese symptoms may be mild 32 of 39 or severe( depending on the person"K .

Complications of !astroparesis   !astroparesis ma es it harder to manage blood glucose" Slo'er digestion can result in9   )acterial overgro'th due to fermentation Food can harden into solid masses called beEoars that may cause nausea( vomiting( and obstruction of the stomach  )eEoars can be dangerous if they bloc the passage of food into the small intestine" PBRC 2009 33 of 39 .

Treatment of !astroparesis  The most important treatment goal for diabetes&related gastroparesis is to manage your blood glucose levels as 'ell through the usage of9 Ansulin >ay need to adBust schedule" >edication >ay need drugs to treat gastroparesis" 6efer to your physician or a dietitian for more information" >ay be used in severe cases" >eal and food changes Feeding tube PBRC 2009 34 of 39 .

Depression  Consult your doctor to eliminate any physical cause for your depression" 3oorly controlled diabetes can cause depression li e symptoms9      High or lo' blood sugar during the day can ma e you feel tired or an#ious 1o' blood sugar levels can also lead to hunger and eating too much 1o' blood sugar n the night could disturb sleep High blood sugar in the night can lead to freJuent urinating and then feeling tired throughout the ne#t day PBRC 2009 35 of 39 .

Conclusions    There are many potential complications of diabetes" Complications can be minimiEed 'ith good blood glucose control" Discuss any developments 'ith the physician immediately" PBRC 2009 36 of 39 .

PhD.Division of Education Division of Education Phillip Brantley. Roy. Executive Director Heli J. PhD. Director Pennington Biomedical Research Center Claude Bouchard. RD Reviewed by Beth !"li#$i %dited 10& 2009 PBRC 2009 37 . PhD.

 The 3ennington )iomedical 6esearch Center is a 'orld&reno'ned nutrition research center" Mission: To promote healthier lives through research and education in nutrition and preventive medicine" The 3ennington Center has several research areas( including9 Clinical Gbesity 6esearch E#perimental Gbesity Functional Foods Health and 3erformance Enhancement Nutrition and Chronic Diseases Nutrition and the )rain Dementia( %lEheimer?s and healthy aging Diet( e#ercise( 'eight loss and 'eight loss maintenance L 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" 2e invite people of all ages and bac grounds to participate in the e#citing research studies being conducted at the 3enningtonLCenter in )aton 6ouge( 1ouisiana" Af you 'ould li e to ta e part( visit the clinical trials 'eb page at '''"pbrc"edu or call 5--D7 M=.&.///"              L  L  PBRC 2009 38 of 39 .

6eferences  %ll information used 'as obtained from9  %merican Diabetes %ssociation  http9//'''"diabetes"org Co'y(i)ht* 2009 PBRC + PP.29 PBRC 2009 39 of 39 .

THAN !"#$% .

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