Gauge pointing at Red level glucose reading

6 Long Term Complications of Diabetes Mellitus

Living with Diabetes Mellitus comes with many complications which can occur even if your diabetes is well controlled. Back then diabetes was known as an endocrine disorder but these days it is widely accepted that diabetes is a vascular-metabolic disorder. This is because most of the damage done by diabetes is primarily on the small blood vessels of many organs.

Complications of Diabetes are divided into acute complications and long term complications based on how quick they develop.

Most of the chronic complications happen when the blood sugar is uncontrolled either because of poor compliance to treatment and diet changes or because the treatment given is not fully effective and needs adjustment.

The risk of development of complications is mostly determined by the value of HbA1C. HbA1C, also called glycated hemoglobin measures the average blood glucose in the past 120 days. It is expressed in percentage. People who do not have diabetes have HbA1C of less than 6%.

The target HbA1C of people with diabetes is 7.0% or less. If you have average HbA1C higher than that, there is increased risk of developing long term complications.

For acute complications read Here.

1.     Eye complications

Retina with diabetic retinopathy
Retina with diabetic retinopathy

Diabetes targets small blood vessels and capillaries in the retina of the eyes and overall health of the eye. Retina is the inner layer of the eye that is responsible for vision as it contains light receptors.

In the retina the damage in blood vessels causes poor blood supply to the light receptor which then die and lead to Diabetic Retinopathy. The diagnosis of Diabetic retinopathy is made with proper eye examination called fundoscopy.

The sad thing about diabetic retinopathy is that the damage is permanent. It can only be slowed down or stopped from progressing but cannot be reversed fully with the current options that exist. The visual loss is gradual and may be associated with floaters (black spots).

Other common eye condition associated with Diabetes are cataract and glaucoma.

Cataract is defined as cloudiness of the eye lens, preventing light from entering the eye. It is treated through replacement of the lens with an artificial one in a cataract surgery procedure.

Glaucoma is progressive damage of the optic disc, usually due to increase in intraocular pressure, diabetes increases the risk of development of glaucoma.

2.     Kidney Damage

Small vessels of the kidneys are also damaged over time leading to a condition called Diabetic Nephropathy. Again Diabetic Nephropathy is also irreversible but can be slowed down with treatment.

The kidneys, due to damage slowly leak proteins into the urine. For this reason, presence of proteins in the urine (Proteinuria) is the main indicator of diabetic nephropathy. Proteinuria is detected with urine dipstick or laboratory test.

Diabetic nephropathy eventually leads to Chronic Kidney Disease (CKD) and Kidney failure.

3.     Weak Immune System

Diabetes is one of the medical conditions that causes immunosuppression. Other medical conditions that weaken immune system include Obesity, HIV, Cancer and Certain drugs. Weak immune system exposes an individual to many infections and medical conditions that are not common in healthy people. People with diabetes are prone to:

  • Respiratory infections like TB and Pneumonia
  • Delayed wound healing especially in the feet, sometimes leading to amputations of the legs
  • Fungal skin infections such as Tinea
  • Herpes zoster
  • Bladder infection

4.     Erectile dysfunction

Man stressed by weak erections

Men with uncontrolled diabetes suffer from problems related to erection. They may have problems maintaining erection (weak erections) or no erections at all. The main reason for that lies on two main factors.

One factor is damage on the capillaries of the blood vessels to the penis. The other factor is the nerve damage that is done by diabetes mellitus.

5.     Diabetic Neuropathy

Diabetic Neuropathy is defined as damage of the peripheral nerves caused by persistently elevated blood glucose. The damage results in chronic pain, cramps, numbness or paraesthesia and tingling sensation of the feet, toes and fingers of the hands.

The pain of diabetic neuropathy is described as burning sensation at night, many people feel like they need to hang their feet outside the blankets to cool them down. Sometimes the pain feels like pricking needles and pins on the soles of feet and palms of hands.

Diabetic Neuropathy is common in people who have had diabetes for five years or more. When the damage is severe, there is loss of sensation in the affected foot. It becomes easier to get injured on the foot and not feel it since sensation is lost.

It is therefore important for people with diabetes to regularly check their feet soles (bottom of the foot) to see if they have any injuries and also make sure they inspect the shoe for foreign bodies before wearing it.

Diabetic foot ulcer is a common complication of diabetic neuropathy and leading cause of amputation in people with diabetes mellitus.

6.     Peripheral Vascular Disease (PVD)

Left foot with gangrene on toes due to diabetes mellitus
Gangrene on left foot toes

Diabetes damages small and large blood vessels. It can cause Peripheral Arterial Disease (PAD), which is blockade of arteries of the legs by atherosclerotic plaque. Atherosclerosis in diabetes happens due to increased insulin levels in the blood (hyperinsulinaemia) seen in type 2 diabetes.

The blocked artery leads to poor blood supply to the foot or toes, then gangrene develops if the condition is not treated. This is why Diabetes needs to be Treated Early.

There are many more complications of Diabetes mellitus which are not listed here, it is therefore important to know your health status at all times. Eat healthy food, exercise and stay updated with health information all the time.

Ask any question or tell your story on the comments section.

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