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  Diabetic Complications: Hypoglycemia, Ketoacidosis, Diabetic Neuropathy continued...
Potential Long-Term Diabetic Complications
Diabetic complications can read like a horror novel, but remember that much of this can be avoided through education about the disease and being careful. Complications may create blood vessel and nerve damage, which can lead to vision impairment, loss of sensation and numbness, and kidney disease. In addition, atherosclerosis can develop rapidly in a diabetic's cardiovascular system, which heightens the risk for heart attack or stroke. Consistent monitoring of your blood sugar to maintain safe levels is the key to reducing your risk of long-term complications.

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Diabetic Retinopathy and Other Eye Disorders: Diabetic retinopathy is one of a group of eye disorders that can affect people with diabetes. Diabetic retinopathy is a very common complication: damaged blood vessels in the eye's retina swell and leak. As they heal, new blood vessels grow on the retina, hindering vision or possibly causing blindness. Blindness is four times as likely in diabetes sufferers compared to the normal population.

People with diabetes are also at risk for eye disorders such as glaucoma and cataracts. These are serious complications. The best preventive actions are to control blood sugar, reduce blood pressure, and get an annual eye exam. Caught early enough, many eye disorders can be treated.

Cardiovascular, Kidney and Nerve Problems: Excess blood sugar puts a strain on blood vessels, nerves and the kidneys. Blood vessels damaged by high glucose levels are at a heightened risk for cholesterol build-up and the development of atherosclerosis (hardened arteries). As the hardened arteries lose their elasticity and begin to narrow, blood flow becomes compromised. Strokes, heart disease and kidney failure may all occur as a result of poor blood flow.

Damaged nerves reduce feeling and sensitivity to touch, making the chance of injury more likely. Most commonly, the feet and hands are the first body parts to suffer. With time, nerve damage can evolve to the point where autonomic functions like blood pressure, erectile function, and bladder control become affected.

Peripheral Neuropathy and the Diabetic Foot: Foot problems are common complications associated with peripheral neuropathy. The nerves in the feet are long and susceptible to damage caused by high blood sugar levels. The ability to feel foot pain and injury diminishes with nerve deterioration (neuropathy), until it may not even be noticed at all. When neuropathy is coupled with reduced circulation and higher rates of infection, the possibility of a foot injury becoming ulcerated increases markedly. Left unchecked, foot ulcers can lead to a need for amputation.

Researchers at Washington University School of Medicine in Missouri are currently evaluating BOTOX® injections to help treat foot ulcers. Participants receive injections of the toxin in six places in the calf muscle and then the leg is put into a cast. The idea is that this will help prevent pressure on the ball of the foot during walking. The ball if the foot is the area most affected by foot ulcers and allowing an ulcer to heal completely helps prevent recurrence.

Diabetics should check their feet daily for wounds, corns, or oddly colored calluses. Even ingrown toenails should receive prompt medical attention. Pain in the legs, redness and swelling of the foot, or change in foot shape are all indications that something is wrong.

To reduce the risk of foot problems, people with diabetes should wear appropriate footwear, avoiding footwear that is worn, broken, tight, or rubs against the foot. Diabetics should avoid walking barefoot, which increases the chances of foot injuries. Care should be taken while trimming toenails, as even a small wound can cause ulcers. A doctor should check blood circulation and nerve sensitivity at least annually.

Note that in some instances, severe foot pain instead of numbness results from the nerve damage caused by diabetes. Diabetics often describe their foot pain as a severe burning sensation.

Skin Problems: Peripheral neuropathy and high rates of infection can also cause diabetes-related skin problems. Wounds heal more slowly, and are more likely to become infected. Damaged nerves cause the body to sweat less, leading to dry, cracked skin. The skin sometimes yellows and thickens.

Skin problems can be prevented, or at least minimized, by following a few simple guidelines.
  • Avoid exposure to wind and sun where possible, and use a high quality sunscreen.
  • Use moisturizers that contain gentle ingredients.
  • Avoid harsh cleansers or perfumes.
  • Drink at least eight cups of water each day to help keep skin hydrated.
Gastroparesis: Gastroparesis means "stomach paralysis" and is when the stomach takes an abnormally long time to empty its contents. Gastroparesis, also called delayed gastric emptying, is usually due to damage of vagus nerves leading to the stomach. As a result, the muscles in the stomach and intestine stop working, which is why the movement of the stomach contents is slowed. The most common cause for gastroparesis is diabetes (prolonged high blood glucose levels may damage the vagus nerves). Approximately 20 percent of type 1 diabetics develop gastroparesis. Type 2 diabetics may also develop gastroparesis, but the occurrence rate is lower. Symptoms of gastroparesis include:
  • heartburn
  • nausea
  • vomiting undigested food
  • weight loss
  • early feeling of fullness
  • abdominal pain
  • abdominal bloating
  • lack of appetite

Centers for Disease Control and Prevention. (2001). Diabetes public health resource: Frequently asked questions. Retrieved May 15, 2001, from www.cdc.gov/diabetes/faqs.htm.

Levin, M. E. & Pfiefer, M. A. (eds). The uncomplicated guide to diabetes complications. American Diabetes Association, Alexandria, VA, 1998.

National Digestive Diseases Information Clearinghouse. (updated 2003). Gastroparesis and diabetes [NIH Publication No. 04-4348].

National Institutes of Diabetes & Digestive & Kidney Diseases. (nd). Why it's important to take care of your diabetes. Retrieved August 25, 2003, from diabetes.niddk.nih.gov/dm/ pubs/type1and2/index.htm.
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