Complications Uncontrolled diabetes can cause a wide range of complications including eye, kidney, nerve, cardiovascular, skin and limb complications. In all cases, the best treatment includes controlling blood glucose levels BEFORE the damage starts. Unfortunately, once damage has been noticed, it is frequently advanced and difficult to treat. Eye Complications Unfortunately, diabetes can cause eye problems that lead to blindness so it is important to get frequent eye checks. Diabetes are 40% more likely to suffer from glaucoma and 60% more likely to develop cataracts. In addition, poorly controlled blood glucose can result in the development of diabetic retinopathy. Non-proliferative retinopathy occurs when the blood vessels in the eye become damaged and blocked. The retina fed by these capillaries dies, causing blindness. If it is caught early, the damaged capillaries can be eliminated, preventing the blindness. Proliferative retinopathy occurs later in the disease. In response to the damaged capillaries, new weak vessels attempt to grow but leak and form scar tissue that blocks vision and distorts the retina and vision. Kidney Disease High blood glucose causes damage to kidneys both by directly damaging the kidney capillaries and by forcing the kidneys to work harder to filter out the excess glucose and debris from cells dying in other places in the body. Over time, the extra work put on the kidneys causes them to fail. If the kidney damage is caught early, various treatments including better control of blood glucose can prevent additional damage. Unfortunately, if the diabetes is caught and control late, the kidneys will have already entered end-stage renal disease. Unfortunately at this point, treatment requires dialysis or a kidney transplant. Nerve Damage Diabetic neuropathy will occur in about half the people with diabetes. It is most common in nerves in the arms and lower legs, resulting in tingling, pain, numbness, or weakness in feet and hands. It can also affect nerves in the digestive system, urinary tract, sex organs, heart and blood vessels, sweat glands, and eyes.
Although nerve damage cannot be reversed, careful control of blood glucose can prevent or delay its development. Cardiovascular Disease Unfortunately, diabetics frequently also suffer from high blood pressure. Although they are separate diseases, the two together cause significant damage. It is important that diabetics are screened for high blood pressure and they aggressively treat it. Diabetics have a 2 to 4 times higher risk for strokes than non-diabetics. Carefully controlling blood pressure and diabetes will significantly reduce that risk.
Diabetics have a significant increase risk for developing peripheral arterial disease(PAD), a blocking or narrowing of the blood vessels in the legs. In addition to an increased risk of heart attack and stokes, PAD increases the chance of developing chronic foot wounds and inhibiting their healing.
To reduce the risk of cardiovascular disease, it is important the diabetes control as may sources of diabetic damage as possible. This include controlling blood pressure and blood glucose. As importantly, if a diabetic smokes, it is critical that they reduce the amount they smoke and if at all possible, quit smoking completely. Foot Complications Diabetics are prone to foot problems. Diabetic neuropathy results in patients not feeling pain so the patient may not realize they have a foot injury until the injury is serious. Due to cardiovascular damage, blood supply to the feet is poor so critical oxygen and nutrients are insufficient. In addition, skin changes due to the glucose can lead to weak skin and/or calluses that break down, giving an opening for infections. Combined, all these system failures can result in the development of foot wounds that do not heal. Chronic Diabetic Wounds Unfortunately 15-20% of all diabetics will develop wounds on their feet and legs that will not heal (Diabetic Foot Ulcers. DFU). They occur as a result of many of the complications discussed above - cardiovascular disease, neuropathy and other complications. Skin chronically exposed to high blood glucose is very slow to heal. When the wound stays open, infection can invade creating life-threatening damage.
There are few treatment options and most require long-term, labor intensive wound care. Existing pharmaceutical treatments are expensive, potentially unsafe and inadequately effective.
If the wound cannot be encouraged to heal, amputation of toes, the foot or the lower limb is the only option. In the US, more than half of all non-traumtic amputations are caused by diabetes. Unfortunately, the amputation treatment is only temporarily helpful. Within 3-5 years, 50% of diabetic amputees have died.