Long-Term Complications of Diabetes

Long-Term Complications

Long-term complications related to diabetes are often linked to having high blood sugar levels over a long period of time. But blood sugar control isn't the only thing that determines someone's risk for complications. Factors like genetics also can play a role.

Many diabetes complications don't appear until after many years of having the disease. They usually develop silently and gradually over time, so even if kids show no symptoms, they still might eventually have complications.

Talking or thinking about long-term complications can be scary for parents and kids. And it's difficult for kids to make changes in how they live today to decrease their risk for health problems that may not show up for decades.

But being aware of diabetes complications can help you and your child anticipate and avoid them. In fact, helping kids manage their diabetes with good nutrition, regular exercise, and medication under the supervision of the diabetes health care team is the best way to help them lessen their risk of developing complications and enjoy a healthy future.

Where Complications Can Occur

The major organs and body systems involved in diabetes complications are the:

• eyes
• kidneys
• nerves
• heart and blood vessels
• gums

Eye Problems

People with diabetes have a greater risk of developing eye problems, including:

• Cataracts: A cataract is a thickening and clouding of the lens of the eye. The lens is the part of the eye that helps you focus on what you see. People with diabetes are more likely to develop cataracts. Cataracts can make a vision blurry or impair night vision. If cataracts interfere with a person's vision, they can be surgically removed.
• Retinopathy: Another eye problem, called diabetic retinopathy, involves changes in the retina, the light-sensitive layer at the back of the eye. These changes are due to damage to, or abnormal growth of, the small blood vessels in the retina, which are thought to be related to high blood sugar levels over time. Usually, changes in the retinal blood vessels don't appear before a child has reached puberty and has had diabetes for several years. At first, someone with retinopathy may not have vision problems, yet if the condition becomes severe, can become blind.
  
  Retinopathy is more likely to become a problem in people with diabetes who also have high blood pressure or use tobacco. Although a child's eyes will be examined at regular checkups or by the diabetes health care team, kids with diabetes usually start seeing an eye specialist (an ophthalmologist or optometrist) for more extensive examinations yearly after they reach puberty. Damage caused by retinopathy can be slowed or sometimes even reversed by improving blood sugar control, if it is discovered early. Retinopathy that becomes more advanced may require laser treatment to help prevent vision loss.
• Glaucoma: People who have diabetes also have a greater chance of getting glaucoma. In this disease, pressure builds up inside the eye, which can decrease blood flow to the retina and optic nerve and damage them. At first, a person may not have symptoms, but if it's not treated, glaucoma can cause vision loss. The risk increases as a person gets older and has had diabetes longer. Treatment for glaucoma includes medications to lower the pressure inside the eye and sometimes surgery.

To help prevent these problems: Keep your child's blood pressure and blood sugar levels in check and make sure that his or her eyes are examined on the schedule prescribed by the doctor.

Kidney Disease (Diabetic Nephropathy)

High blood sugar can damage the blood vessels in the kidneys, leading to kidney disease (or diabetic nephropathy) in which the kidneys, responsible for filtering the body's wastes, stop functioning properly. When this happens, the waste products that aren't being filtered build up in the blood and can affect other organs.

As with diabetic retinopathy and neuropathy, kidney disease:

• is more likely to occur in people who have had poor long-term blood sugar control
• usually doesn't show up before puberty
• is worsened by high blood pressure and tobacco use

In its early stages, kidney disease doesn't cause symptoms, but if it progresses to kidney failure, it can be a serious health threat.

Screening

Doctors usually test kids with diabetes for kidney disease about once a year, if they have reached puberty and have had diabetes for several years.

The test measures the amount of the protein albumin in the urine. Increased albumin leaking from the kidneys into the urine is the earliest sign of possible disease. Screening is important, because if it's detected and treated early enough, the damage can possibly be reversed. If the albumin increases beyond a certain point, or other signs of kidney disease appear, doctors may recommend a biopsy of the kidney to confirm a diagnosis of diabetic nephropathy.

Treatment

Treatments for kidney disease can include limiting the amount of protein in the diet to help prevent further kidney damage and taking medications to reduce damage to the blood vessels in the kidneys. Controlling high blood pressure in those with diabetic nephropathy is very important, as it can worsen kidney disease and may be a sign that the disease is progressing.

If kidney disease gets worse, a person may develop end-stage kidney failure, which requires dialysis (regular use of a machine to clean the blood as the kidneys normally would) or a kidney transplant. But thanks to earlier detection and better treatment, kidney disease now is less likely to result in kidney failure.

To Help Prevent These Problems: The best way to help prevent diabetic kidney disease is to maintain good blood sugar control by following the diabetes treatment plan. Also important are regular blood pressure checks and urine albumin tests. Talk to your child about the dangers of smoking, which can increase the risk of kidney problems and other diabetes complications and health problems.

Nerve Damage (Diabetic Neuropathy)

Another complication that people who have had diabetes for a long time may develop is a type of nerve damage called diabetic neuropathy.

Diabetic neuropathy can involve nerves in many different parts of the body. The most common early symptoms are numbness, tingling, or sharp pains in the feet or lower legs. If untreated, nerve damage can cause other health problems. For example, because of the numbness, a person with neuropathy might not realize that he or she has a cut or an area of irritation on the foot, which could become seriously infected before it's discovered.

Because nerve damage can happen anywhere in the body, problems can occur in almost any organ system, including the digestive tract, urinary system, eyes, and heart. The risk of nerve damage in diabetes increases over time. Diabetic neuropathy is more likely to occur after puberty, but can also happen in younger people with poor blood sugar control.

Diagnosing Neuropathy

Talk to your doctor if your child has any symptoms that might be caused by neuropathy. Doctors usually diagnose nerve damage with a physical exam, but a biopsy of nerve tissue or other special tests might be necessary. The doctor might recommend that the patient see a nerve specialist (neurologist).

To Help Prevent These Problems: Again, since the condition is thought to be linked to having high blood sugar levels over time, doctors believe that controlling blood sugar levels with diet, exercise, and diabetes medications will help reduce risk.

Heart and Blood Vessel Diseases (Cardiovascular Diseases)

People with diabetes have a higher risk of developing certain cardiovascular diseases, including heart attack (caused by a blockage of the blood vessels supplying blood to the heart); stroke (caused by a blockage of the blood vessels supplying the brain); and blockage of blood vessels in the legs and feet, which can lead to foot ulcers, infections, and even loss of a toe, foot, or lower leg.

Blood sugar problems probably play a role in these problems, although the connection to cardiovascular disease isn't as clear as it is for some of the eye, kidney, and nerve complications of diabetes. It is known, though, that whether a person has diabetes or not, the risk for these problems is greater if someone smokes, is obese, or has abnormal levels of blood lipids (triglycerides or cholesterol), hypertension, or a family history of heart attack or stroke before age 50.

To Help Prevent These Problems: If your child is overweight, your doctor can suggest ways to achieve and maintain a healthy weight. The doctor may also check blood lipid levels (cholesterol and triglycerides) and blood pressure regularly to be sure they're in a healthy range. Kids can achieve the best possible diabetes control by following a good meal plan, getting regular exercise, and taking diabetes medications as prescribed to help prevent or delay the development of heart and blood vessel problems. In addition, discuss the dangers of smoking, which can increase the risk of heart and blood vessel problems, as well as other diabetes complications.

Periodontal Disease (Gum Disease)

People with diabetes are more likely than others to develop gum disease because they may have:

• more plaque and produce less saliva
• higher blood sugar levels (which results in having more sugar in the mouth)
• some loss of collagen, a protein that's in gum tissue
• poor blood circulation in the gums

All of these factors can contribute to gum disease. Signs and symptoms of gum disease include bleeding, sensitive, painful, receding, or discolored gums. Dentists can diagnose gum disease during regular checkups.

To Help Prevent These Problems: Gum disease is preventable. It's important for kids with diabetes to manage their blood sugar levels, take good care of their teeth by brushing and flossing daily, and get regular dental checkups.

Foot Problems

Adults who have had diabetes for many years can have foot problems because of poor blood flow in the feet and nerve damage (diabetic neuropathy). These things make it harder for someone to avoid foot injuries or irritation, and easier for wounds on the feet to heal improperly or become infected.

Starting at puberty, doctors will regularly check your child's feet for any signs of problems. Tell the doctor about any foot problems, such as ingrown toenails, calluses, dry skin, or evidence of irritation of the feet due to improper footwear or repetitive injury from sports or other physical activities.

To Help Prevent These Problems: Preventive foot care includes wearing comfortable shoes that fit properly and keeping the toenails trimmed to the shape of the toe. Exercise, which increases blood flow to the feet, also can help keep feet healthy. Smoking raises the risk and severity of diabetes foot problems, so this is another reason to make sure your child or teen quits smoking or doesn't start in the first place. The diabetes health care team will discuss good foot care habits that can help prevent problems.

Talking to Your Child

Whether they're 7 or 17, kids think in the present, so you can't necessarily expect them to consider the long-term health complications of diabetes as they go about their daily activities. But helping them manage diabetes now lays the groundwork for a lifetime of good habits and health.

When you talk to your child about long-term health risks, keep it simple. It's important to clearly and honestly answer questions and provide information in a way he or she will understand.

Put long-term complications in the same context as health issues that apply to kids without diabetes: Everyone needs to have healthy habits to live long, healthy lives. You might explain that everyone has some risk of things like heart disease or vision problems as we get older. Emphasize that healthy actions taken now — eating right, exercising, taking medicines, and not smoking — will help keep your child active down the road.

You also can help prevent long-term complications by discussing any problems or concerns with the diabetes health care team and making sure your child keeps regular appointments with them.

Having a child with diabetes may seem overwhelming at times, but you're not alone. Your diabetes care team is a great resource for dealing with medical issues and for supporting and helping your family cope with diabetes.

Reviewed by: Steven Dowshen, MD
Date reviewed: October 2010