Complications of Diabetes

Pennington Biomedical Research Center Division of Education

PBRC 2009

Common Potential Complications of Diabetes

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

Foot Complications Skin Complications Gastroparesis and Diabetes Depression

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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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Heart Disease and Diabetes

Diabetes increases the risk for coronary artery disease, a heart attack or stroke. Take preventive steps now. Keep your ABCs of diabetes on target.

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The ABCs
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 C is for cholesterol

The ADA recommends a blood pressure below 130/80.

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

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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.

Damaged lens

Wear sunglasses Use glare-control lenses in eyeglasses. remove. transplant.

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Cataracts

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

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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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Retinopathy

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.

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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. 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

Autonomic neuropathy: Can lead to

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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. 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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Calluses

Foot Ulcers and Poor Circulation

Foot Ulcers

Poor Circulation

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. Can lead to infection and delay healing. To improve poor circulation:

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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Stop smoking and keep blood pressure and cholesterol in check

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

Stye

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.

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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.
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.

Diabetic Dermopathy

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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

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*These symptoms may of 39mild be 32 or severe, depending on the person.*

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. Refer to your physician or a dietitian for more information. May be used in severe cases.

Meal and food changes Feeding tube

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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.

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Division of Education
Division of Education Phillip Brantley, PhD, Director Pennington Biomedical Research Center Claude Bouchard, PhD, Executive Director Heli J. Roy, PhD, RD

Reviewed by: Beth Kalicki

Edited : 10/ 2009

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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

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THANK YOU.