Pennington Nutrition SeriesHealthier lives through education in nutrition and preventive medicine No. 34 Complications of Diabetes Diabetes is a chronic disease that requires lifetime treatment by a physician. The physician will monitor blood glucose and insulin levels, check for development of complications and treat symptoms as needed. Potential Diabetes Complications Heart disease Foot Complications Kidney disease/Kidney transplantation Skin Complications Eye complications Gastroparesis Diabetic Neuropathy and nerve damage Depression Heart Disease Coronary artery disease is caused by a narrowing or blocking of the blood vessels to the heart. It is the most common form of heart disease. The blood vessels to the heart are important because the blood flowing through them carries oxygen and other necessary materials. Unfortunately, these blood vessels can become partially or totally blocked by fatty deposits. A heart attack occurs when the blood supply to the heart is reduced or cut off. Having diabetes means that there is an increased likelihood of having coronary artery disease, a heart attack or stroke. Luckily, there are steps that can be taken to prevent heart disease or reduce the chances of having another heart attack. The risk can be reduced by keeping the ABCs of diabetes on target through wise food choices, physical activity and/or medication. “The ABCs” “A” is for A1C A1C is the blood glucose check “with a memory.” It determines average blood glucose control over the past 2 to 3 months. The American Diabetes Association (ADA) recommends an A1C below 7. “B” is for blood Blood pressure (BP) numbers tell the force of blood inside the blood vessels. With a pressure high blood pressure, this means that the heart is having to work harder than it should. The ADA recommends a BP below 130/80. “C” is for Cholesterol numbers tell you the amount of fat in the blood. Some kinds, such as HDL, cholesterol help protect the heart. Other kinds, such as LDL, can clog the blood vessels, leading to heart disease. Triglycerides are another kind of blood fat that can raise the risk for heart disease.
Kidney FunctionThe kidneys’ role is to remove waste products fromthe blood. Inside the kidneys are millions of tiny bloodvessels (capillaries) that act as filters. Digestion ofproteins creates waste products that need to beremoved. Normally, as blood flows through thesmall capillaries, tiny molecules (waste products)flow through the holes with water to make urine forremoval from the body. Useful substances, such asprotein and red blood cells are too big to pass throughthe filter and they remain in the blood.High levels of blood sugar (from poorly controlleddiabetes) can make the kidneys work too hard, puttingextra stress on them. After years of damage, thekidneys start to leak and useful protein leaks in the With time, the stress of overwork causesurine. Having a small amount of protein in the urine is the kidneys to lose their filtering ability.known as microalbuminuria. When kidney disease is Waste products begin to build up in thediagnosed early (during microalbuminuria), there are blood. Finally, the kidneys fail. ESRD is a veryseveral treatments that may keep the kidney disease serious condition requiring either a kidneyfrom getting worse. However, when kidney disease is transplant or regular visits to a dialysis cliniccaught later, end-stage renal disease (ESRD) usually where blood is filtered by a machinefollows. which contains an artificial kidney.Facts about Diabetes & Kidney Disease Not everyone with diabetes will develop kidney disease. Factors that influence kidney 10-21% of all people with disease development include: genetics, diabetes have nephropathy blood pressure, and blood sugar control. (kidney disease). Of course, genetics are beyond our control. On the other hand, blood pressure and blood Approximately 43% of new cases sugar levels can be improved with diet and of ESRD are attributed to exercise. By doing this, the risk for kidney diabetes. disease is reduced. The risk of ESRD is 12 times higher in people with type 1 diabetes than in those with type 2. In the US, the incidence of ESRD in people with diabetes is more than 4 times higher in African Americans, 4 to 6 times higher in Mexican Americans and 6 times higher in Native Americans than the remaining population of diabetic patients.
Eye Complications CataractsPeople with diabetes have a higher risk of With cataracts, the eye’sblindness than people without diabetes. clear lens clouds, blockingMost people with diabetes have nothing light. For mild cataracts, onemore than minor eye disorders. With minor may need to wear sunglassesand major problems, treatments must begin more often, and use glare-immediately to avoid loss of eyesight. control lenses in eyeglasses. For cataracts that interfere greatly with vision, doctors generally remove the lens of the eye, replacing it with a new transplanted lens.GlaucomaGlaucoma occurs when pressure builds up in Individuals with diabetes are:the eye. The pressure pinches the bloodvessels carrying blood to the retina and the 60% more likely to develop cataractsoptic nerve. Vision is gradually lost because Likely to get cataracts at a younger agethe retina and nerve are damaged. The risk Likely to have problems if removal of the lens isfor glaucoma increases with age and duration necessary due to the beginning stages of glaucomaof diabetes. People with diabetes are 40%more likely to suffer from glaucoma than arepeople without diabetes. Luckily, there areseveral effective treatments for glaucoma.For some, drugs are used to reduce thepressure in the eye, and for others, surgeryis an option.RetinopathyDiabetic retinopathy is a general term for all disorders of theretina caused by diabetes. There are two major types ofretinopathy: nonproliferative and proliferative. Nonproliferativeis the more common, milder form. It usually has no effect onvision and needs no treatment. Yearly monitoring is important, Almost everyone with type 1however, to make sure the condition is not getting any worse. diabetes will eventually developProliferative retinopathy is a much more serious condition. nonproliferative retinopathy.With proliferative retinopathy, blood vessels are so damaged Luckily, the retinopathy thatthat they close off. In response, new vessels begin growing in destroys vision, proliferativethe retina. These vessels are weak and can leak blood, blocking retinopathy, is far less common.vision. This condition is known as vitreous hemorrhage. A moreserious condition that can occur with proliferative retinopathy isretinal detachment.
Diabetic Neuropathy & Nerve Damage It is important to:About half of all people with diabetes have Report all possible signs of diabetic neuropathysome form of nerve damage. Nerve damage Get treatment immediately at the onset of problems.from diabetes is referred to as diabetic Take good care of the feet, checking them every day.neuropathy. It is more common in those who Lack of pain sensation may lead to foot injury.have had the disease for many years. Keeping Protect the feet. Wear shoes and socks that fit wellblood glucose levels on target, can help prevent and wear them at all times. Use warm water to washor delay nerve damage. the feet and dry them carefully. Purchase special shoes if they are needed. Medicare may cover the cost of the shoes. It is important to be careful when exercising. Some activities are not safe for individuals with neuropathy. Calluses Calluses occur more often and build up faster in the diabetic. Foot Complications Too much callus build up may mean that therapeutic shoes and inserts are required. Calluses, if not trimmed, get very thick and Skin Changes can break down and turn into ulcers (open sores). It is important not to self treat calluses. This can lead to infection. Your Calluses healthcare provider should do this for you. Foot Ulcers Poor Circulation Foot Ulcers Amputation Even though some ulcers do not hurt, every ulcer should be Skin Changes seen by the health care Diabetes can cause feet to be very dry provider immediately. at times. This is because the nerves Neglecting ulcers can result that control the oil and moisture in the in infections, which can lead foot are no longer working. After to potential loss of a limb. bathing, feet need to be dried well. Keeping off the feet, when Use petroleum jelly, unscented hand there are problems, is very cream, or a similar product to seal in important. Walking on an ulcer extra moisture. It is important not to can make it get larger and put oils or creams between toes, since force the infection deeper into extra moisture can lead to infection. the foot.
Poor Circulation AmputationPoor blood flow can make the foot less able People with diabetes are far more likely to have ato fight infection and heal. There are things foot or leg amputated than anyone else. This isthat can be done to improve circulation: because many people with diabetes have arterystopping smoking, keeping blood pressure disease, which reduces blood flow to the feet.and cholesterol in check. Also, exercise is Also, individuals with diabetes usually have nervegood for poor circulation because it damage, which reduces sensation. These twostimulates blood flow in the legs and feet. problems combined make an individual much moreExercise is a good idea for individuals who likely to get ulcers and infection that may potentiallycurrently do not have any open sores on the lead to amputation. Luckily, most amputations arefoot. Proper shoes are essential. preventable with regular and proper footwear. Two of the most important factors in reducing the likelihood of amputation is to always follow your health care provider’s advice when caring for foot problems and to stop smoking! Smoking affectsSkin Complications small blood vessels by decreasing their blood flow to the extremities and delays the healing of wounds. Bacterial infections Fungal infections Bacterial Infections Itching There are several kinds of bacterial infections that Diabetic Dermopathy can occur in individuals with diabetes. Styes are infections of the glands of the eyelid. Boils are Atherosclerosis infections of the hair follicles. Carbuncles are deep infections in the skin and the tissue underneath. Allergic Reactions Inflamed tissues are usually hot, swollen, red and painful. Today, there are antibiotics that can be Stye Diabetic Blisters used to treat such infections. Eruptive Xanthomatosis Fungal Infections Digital Sclerosis Candida albicans is a yeast-like fungus Disseminated Granuloma which is often responsible for fungal Annulare infections in individuals with diabetes. Common fungal infections include: Acanthosis Nigricans jock itch, athlete’s foot, ringworm, and vaginal infections. If you suspect a yeast or fungal infection, contact your health care provider. He/she can prescribe medication to treat it. Athlete’s foot
Itching Diabetic Dermopathy Localized itching is often caused by diabetes. Diabetic Dermopathy refers Itching can be caused by a yeast infection, to changes in the small blood dry skin, or poor circulation. When poor vessels caused by diabetes. circulation is the cause, the itchiest regions Dermopathy looks like light brown, are often the lower parts of the legs. scaly patches, often mistaken for age Limiting the frequency of bathing, particularly spots. The disorder most often occurs when humidity is low, using mild soap with on the front of both legs. The patches moisturizer, and applying skin cream after do not hurt, open up or itch. bathing may help resolve the issue. Dermopathy is harmless and does not require treatment. Allergic Reactions Atherosclerosis Skin reactions can occur in response to medications, Atherosclerosis refers to the thickening of such as insulin or diabetes arteries. People with diabetes tend to get pills. If you think you are atherosclerosis at a younger age. As having a reaction to a atherosclerosis narrows blood vessels, skin medication, contact your changes occur. Skin becomes hairless, thin, doctor immediately. Be on cool, and shiny. Because blood carries the the lookout for rashes, infection-fighting white cells, affected legs depressions, or bumps tend to heal slowly when the skin is injured. around the sites where insulin is injected. Diabetic Blisters Diabetic blisters occur rarely in individualsEruptive Xanthomatosis with diabetes. When they do occur, they are typically found on the backs of fingers,Eruptive Xanthomatosis is a hands, toes, feet, or on the legs or forearms.condition caused when They are sometimes large and resemblediabetes is out of control. burn blisters. They are painless and oftenIt consists of firm, yellow, heal themselves within 3 weeks. The onlypea-like enlargements in treatment is to bring blood sugar levelsthe skin. The disorder under control.usually occurs in young Digital Sclerosismen with type 1 diabetes.Like diabetic blisters, these Digital Sclerosis consists of tight, thick, waxy skin on the back of thebumps disappear when hands. The finger joints become stiff and can no longer move the waydiabetes control is restored. they should. Rarely, knees, ankles or elbows also get stiff. Digital sclerosis happens to about 1/3 of all people with type 1 diabetes. The only treatment is to bring blood sugar levels under control.
Disseminated Granuloma Annulare Acanthosis NigricansThis condition consists of sharply defined ring-shaped Acanthosis Nigricans is a condition in which tanor arc-shaped raised areas on the skin. Rashes most or brown raised areas appear on the sides of theoften occur on parts of the body far from the trunk neck, armpits, and groin. It usually strikes people(i.e., ears or fingers), but sometimes the raised areas who are overweight. The best treatment is tooccur on the trunk. Contact your doctor if you see lose weight. Some creams can also help therashes like these. Certain drugs can help clear up the spots look better.condition.Gastroparesis & DiabetesOccurs when the nerves to the stomach are damaged or stop working. In thiscondition, the muscles of the stomach and intestines do not work normally, andthe movement of food is slowed or stopped.Signs & Symptoms Heartburn Nausea Vomiting of undigested food An early feeling of fullness when eating The most important treatment goal for diabetes-related gastroparesis Weight loss is to manage blood glucose levels through the use of: Abdominal bloating Erratic blood glucose levels Insulin May need to take more often and after meals for Lack of appetite best results. Gastroesophageal reflux Spasms of the stomach wall Medication There are several available drugs that can be used to treat gastroparesis. Different drugs or combinations of drugs may need to be triedGastroparesis can worsen before finding the most effective treatment.diabetes by making it harder to Meal and food This can help control your gastroparesis. Yourmanage blood glucose. Food changes doctor or dietitian will give you specificstaying in the stomach too long recommendations.can: Cause problems such as Feeding tube If other approaches do not work, surgery may be bacterial overgrowth due to required. A feeding tube allows for the insertion of fermentation nutrients directly into the small intestine, bypassing the stomach altogether . Harden into solid masses called bezoars that may Bezoars can be dangerous if they block the passage of food cause nausea, vomiting, and into the small intestine. obstruction of the stomach
Depression If you are feeling symptoms of depression, dont keep it bottled up. Talk to your doctor. There may be a physical cause for your depression. Diabetes that is in poor control can cause symptoms that look like depression: 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 High blood sugar in the night can lead to frequent urination and then feeling tired throughout the next day The Pennington Biomedical Research Center is a world- renowned nutrition research center. Mission:Pennington Nutrition Series, Pub No 34 To promote healthier lives through research and education in nutrition and preventive medicine.Authors: The Pennington Center has several research areas, including:Heli Roy, PhD, MBA, RDShanna Lundy, BS Clinical Obesity ResearchBeth Kalicki Experimental Obesity Functional FoodsDivision of Education Health and Performance EnhancementPhillip Brantley, PhD, Director Nutrition and Chronic DiseasesPennington Biomedical Research Center Nutrition and the BrainSteven Heymsfield, MD, Executive Director Dementia, Alzheimer’s and healthy aging Diet, exercise, weight loss and weight loss maintenance3/06; Rev. 10/09; Rev. 3/11 The research fostered in these areas can have a profound impact on healthy living and on the prevention of common chronic dis- eases, such as heart disease, cancer, diabetes, hypertension and osteoporosis. All information was obtained from the American Diabetes Association The Division of Education provides education and information to the scientific community and the public about research find- ings, training programs and research areas, and coordinates edu- Available at: http://www.diabetes.org cational 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 Penning- ton 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.