Introduction

To reduce the risk of developing long term complications, it is recommended that the person with diabetes:

• Keeps blood glucose levels as close as possible to the ideal range set by the doctor
• Exercises regularly
• Eats healthy food
• Checks their feet daily for any sores, calluses or cuts
• Visits the doctor at the recommended times
• Quits smoking.

A great deal can be done to prevent serious damage and long-term complications if there is early detection and prompt treatment of any problems. Damage is done by having high blood glucose levels for a long time.

High blood glucose levels can affect the blood vessels, nerves, heart, eyes, kidneys and sexual health.

This damage can lead to a heart attack, blindness, a stroke or amputation.

Next: Heart Disease

Heart Disease

Heart disease is the biggest complication to the health of people with diabetes.

It occurs at an increased rate for them compared with other people. It happens in both type 1 and type 2 diabetes.

Heart disease is the biggest cause of death in people with diabetes. 43% of people with type 2 diabetes die with their first heart attack.

High blood glucose, high blood pressure, high blood cholesterol and family history all contribute to heart disease. With diabetes, heart disease happens the same way as it happens to people without diabetes. But with diabetes it happens faster and causes more blockages in the heart.

When people with type 1 diabetes have mostly normal blood glucose levels, the cholesterol levels are mostly normal too.

This is not the case for people with type 2 diabetes, especially if they are overweight. It is not so simple for them. Their blood cholesterol control systems are much more complicated.

That is why it is recommended that they have regular health checks with their Doctor.

The doctor needs to monitor and adjust the blood fat levels as well as the blood glucose and blood pressure in both type 1 and type 2 diabetes.

Blood Vessels

Long-term high blood glucose levels cause damage to the blood vessels.

The damage causes the blood vessels to become thick and stiff. This happens in all the blood vessels, both the big ones and the small ones.

The big ones are in the heart and the small ones are in the eyes, feet and kidneys.

Management

• Diet
• Exercise
• Treatment as discussed with the doctor

Next: Nerve Damage

Nerve Damage

Long-term high blood glucose levels cause damage to the nerves in many parts of the body.

Nerves carry signals and if these signals are not carried properly there can be problems with blood pressure, sexual organs, food digestion, bladder emptying or the lack of signals of hypoglycemia.

The signs that nerve damage is occurring are numbness, tingling, shooting pain or burning pain.

Management

• It is important to keep the blood glucose levels within the recommended range

Next: Kidney Disease

Kidney Disease

High blood glucose levels over a long period of time affect the filtering system of the kidneys.

The filters become leaky which means waste products are not removed from the blood efficiently and protein leaks into the urine.

This can lead to kidney damage.

This damage occurs slowly and is usually painless. High blood pressure can make kidney damage worse and should be controlled.

Management

• Seek immediate treatment for urinary tract infections
• Yearly blood and urine tests by a doctor. The tests for kidney disease can be blood tests,an overnight urine collection or 24-hour urine collection.

Treatment

• As discussed with the doctor

Next: Sexual Problems

Sexual Problems

Another problem originating from long-term high blood glucose levels is sexual dysfunction in men.

This is due to damage to nerves and small blood vessels.

The most common result of this damage is erectile impotence. If there is a problem it needs to be discussed with the doctor, as not all sexual problems are the result of diabetes.

Next: Smoking

Smoking

Smoking is very dangerous for people with diabetes.

They are already at high risk of heart disease and smoking makes that risk much worse.

Next: Foot Care

Foot Care

It is important that people with diabetes, who have already had a foot ulcer, pay special attention to the care of their feet.

High blood glucose levels over a long period of time can lead to foot problems. Damage includes nerve damage, poor circulation, infection and foot deformities.

Nerve Damage

Nerves in the foot are damaged by high blood glucose levels.

Nerve damage may cause a lack of sensation in the feet. The person may not feel hot water, or realize they have stepped on something sharp. This lack of feeling in the feet may cause poor balance.

Other symptoms might be numbness, burning or tingling in the feet or legs.

Poor Circulation

Blood vessels carry nutrients and oxygen required for healing.

Continued high blood glucose levels cause damage to the blood vessels, making them thick and stiff. This slows the blood flow.

Good blood flow is required for healthy feet. Injured feet are slow to heal or don’t heal at all.

People might feel pain in their calves when walking short distances.

Infection

People with diabetes are less able to fight infections because of their weakened immune system.

Infections can go undetected or can quickly escalate. A symptom of an infection would be ulceration of the skin and tissues of the feet.

Foot Deformities

When a person with diabetes has neuropathy (nerve damage) it may lead to foot deformities. Claw toes may develop.

Lack of feeling may cause imbalance and put stress on other parts of the feet. Corns, calluses, blisters or ulcers can lead to more serious lesions.

Management

Daily management of feet involves:

• Checking feet every day for signs of redness, corns, calluses, cuts and sores
• Wearing comfortable well fitting shoes. Shoes should have adequate depth and width.
• Wearing shoes most times, especially at the beach
• Washing feet and drying them thoroughly, especially between the toes, so bacteria and fungi don’t grow
• Wearing bed socks or slippers if feet are cold
• Checking inside shoes for small stones that can damage the feet
• Cutting toenails correctly (link).

How to Avoid Damage to the Feet

The person should:

• Not go barefoot
• Not soak the feet
• Not use heating devices (e.g. hot water bottles) on the feet as the person may not be aware of any burning sensation
• Not wear knee high hosiery or socks with tight tops as these may cause circulation problems.

How to Cut Toe Nails Correctly:

• Cut the toenails straight across and gently file away any rough edges
• Do not cut below the shorter edge of the toenails
• Do not cut down the straight side of the toenails.

Visit the Podiatrist When:

• The toenails are cut incorrectly
• There are ingrown toenails
• There is redness and swelling of the foot or ankle
• There is pain in the legs when the person is at rest or doing exercise
• There are any open sores
• There are corns or calluses with skin discoloration
• Wounds are not healing
• There is a lack of hair growth on the feet

It is recommended a visit to the Podiatrist occur every 6 months unless otherwise directed.

Next: Eye Care

Eye Care

High blood glucose levels over a long period of time can damage the eyes.

In the beginning this is painless and vision won’t be affected, but diabetes can damage the very fine blood vessels in the retina.

This can eventually lead to blindness.

Signs to Look For

Blurred vision or flashes of light or pain all mean you should contact the person’s doctor straight away.

Blurred Vision

Blurred vision can be due to clouding of the lens, which may lead to cataract formation.

It may also be due to increased pressure in the eye, which may lead to glaucoma.

It can also be caused because of diabetic retinopathy where the small blood vessels have become fragile and leaky.

Management

Eyes need to be checked weekly for blurriness.

This can be done by asking the person about their vision or observing how they walk.

If vision problems are beginning, they may bump into things when walking, or they may trip. Whilst eating they may miss their food when trying to put it on a fork or into their mouth.

When to Visit the Eye Specialist

Visit the eye specialist every 12 months unless directed otherwise.

During this visit an ophthalmoscope will be used to look through the pupil of the eye to check the retina. This is where damage can occur in eyes due to long-term high blood glucose levels.

When the doctor examines the eyes he/she will put some drops into the eyes (the drops may sting). These make the pupils larger by relaxing the tiny muscles around them so that the retina can be checked.

For a few hours after the drops are put in the person’s vision will be blurred, particularly in bright lights. Wearing sunglasses outside may help. Support will be required.