How to Avoid Diabetes Complications

Good news: The complications of diabetes -- the damage to the body caused by high blood glucose over time -- can be avoided or effectively treated.

Diabetes Complications: Less Common Today

Diabetes does put a person at greater risk for heart disease, kidney disease, blindness, loss of limbs, and other unwanted complications. Fortunately, most diabetes complications can be avoided or effectively treated with early detection and proper care, according to Richard Jackson, M.D., director of medical affairs for health-care services at the Joslin Diabetes Center in Boston.

Despite what you may hear, Jackson says, diabetes itself is not a leading cause of blindness or heart disease in the United States. Rather, poorly managed diabetes is a leading cause of these and other serious health problems.

The Good News: "People with diabetes are living longer and healthier lives than ever," Jackson says. "All of the complications are becoming less common due to all the new tools we have for treatment." You play an important role in prevention. Read on to start looking forward to living well with diabetes.

Diabetes Complications: Causes

When blood glucose is high, over time it causes blood vessels to become inflamed. High blood glucose accelerates the buildup of a waxy, fatty substance called plaque inside the vessels. Inflammation and plaque narrow and can block the blood vessels that supply blood to the heart, eyes, kidneys, and nerves. This causes damage to the body in a slow, gradual process

"It's important to note that nothing happens quickly with diabetes," says Jackson.

Genetics do play a role in the type and severity of complications you might experience. But researchers are still piecing together the exact clues to explain the genetic links.

The Good News: "There's also a lot we can do nowadays to stop the progression of complications once they set in," Jackson says. Things you can directly affect, such as healthful eating, activity, and blood glucose and blood pressure control, make a big difference.

Check out these tips to lower blood sugar.

Diabetes Complications: Body Parts Affected

The damage caused by high blood glucose over time shows up in various parts of the body. The four main areas are the:

  • Heart: Heart damage includes cardiovascular disease, which increases the risk of heart attack and stroke.
  • Eyes: Eye damage includes loss of vision from retinopathy, glaucoma, and cataracts.
  • Kidneys: Kidney damage includes kidney disease or nephropathy and kidney failure.
  • Feet and Limbs: Nerve damage, or neuropathy, in the feet and lower limbs can lead to loss of sensation and/or development of nerve pain. Lack of sensation, along with poor circulation, increases the risk of infections and foot ulcers that may require partial amputation. Nerve damage also affects the digestive system and sexual organs.

The Good News: This scary list is not necessarily a road map for your future with diabetes. "Of course with diabetes you're facing the increased possibility of all this physical damage, but complications are by no means a foregone conclusion," says Jackson.

Keep your eyes healthy with our simple tips.

Diabetes Complications: Symptoms

Diabetic complications can begin without obvious symptoms. You may not be aware of any damage. Five medical tests or exams can help you learn if you're developing complications right now, even with no symptoms. Everyone with diabetes, type 1 or type 2, should have these at least once a year:


  • A1C, the average blood glucose levels over the past 2-3 months
  • blood pressure check
  • blood lipid levels, or fats in the blood (cholesterol and triglycerides)
  • microalbumin in the urine, a measure of kidney health
  • dilated eye exam to assess eye health


The Good News: Five simple tests will give you and your doctor early warning that you may be developing diabetes complications. Make sure you regularly get the necessary tests and checks. To help, print this chart, which lists the tests and targets: Checkup Checklist

Checkup Checklist

Diabetes Complications: Blood Glucose Matters

You can reduce your risk of all potential damage by keeping your blood glucose levels in control. That means staying in your target range (typically, 70-120 mg/dl) on daily blood glucose tests, whether you take oral medication and/or insulin or you manage with diet and exercise alone. To see how you are doing overall, get an A1C blood test at least twice a year. The A1C target is under 7 percent and may be lower for you depending on what your doctor says.

The Good News: Good blood glucose control really helps reduce the risk of diabetic complications, as demonstrated by a major study, the Diabetes Control and Complications Trial, in the 1990s. "And this is true for people who've already developed some complications as well. Keeping your glucose levels in range can help stop the progression of all complications, and improve quality of life -- because you'll feel better, too," says Amparo Gonzalez, CDE, 2008 president of the American Association for Diabetes Educators (AADE).

There are other things you can do as well. Click on the next slide for specifics.

Diabetes Complications: The Heart

Anyone with central obesity (extra weight around the waist), abnormal blood lipids (cholesterol and triglycerides) levels, and high blood pressure is at risk for heart disease. People with diabetes are two to four times more likely to develop atherosclerosis and five times more likely to have a stroke than people without diabetes, according to the American Diabetes Association (ADA). In fact, two out of three people with diabetes die from heart disease and stroke. Yet only 18 percent of people with diabetes are even aware that they're at increased risk, according to a 2006 study commissioned by the ADA.

"There's a big gap between what's true and what people who have diabetes are aware of," says Dr. Michael Brownlee, director of the Juvenile Diabetes Research Foundation International Center for Diabetic Complications at Albert Einstein College of Medicine in New York City.

Click on the next slide for specific things you can do to protect your heart.

Keep your heart healthy with low-cholesterol meals.

Diabetes Complications: How to Protect Your Heart

What you can do: There are many things you can do to protect your heart, including:

  • Achieve good blood glucose control. Keeping your blood glucose in control is important for avoiding all complications, including heart problems.
  • Eat right and exercise (even a little helps). Eat more fruits and vegetables, lower salt intake, do aerobic or other continuous physical activity (at least 4 days a week for 30 minutes each time), and try to reduce stress.
  • Snuff out cigarettes. The right level of smoking for a person with diabetes is none at all.
  • Improve cholesterol. Research shows that statins, a class of cholesterol-lowering drugs, are beneficial. Statins further reduce risk of heart attack with diabetes by up to 40 percent.
  • Lower blood pressure. Beyond losing weight, eating right, and exercising, prescription medications called ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) can help.
  • Consider taking an aspirin daily. "Because diabetics have abnormally sticky platelets that make their blood thick, an aspirin a day is also prudent" for protecting the heart, says Brownlee. A children's chewable tablet (81 mg) will do the trick for most adults, but be sure to check with your doctor first.

You can prevent a heart attack or stroke.

Diabetes Complications: The Eyes

Diabetic eye disease refers to three main problems: retinopathy, damage to the blood vessels in the retina in the back of the eye; cataracts, clouding of an eye's lens; and glaucoma, an increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.

Retinopathy is the most common complication, and the most likely to lead to blindness. In the eyes' attempt to circulate more blood, additional abnormal and fragile blood vessels develop that eventually break and leak blood and cloudy fluid. Left alone, this process blurs vision and can eventually blot it out.

You can take action right now to protect your eyes. See the next slide.

Diabetes Complications: How to Protect Your Eyes

What you can do: The steps to prevention are familiar: lowering blood glucose, maintaining the recommended blood pressure, and lowering "bad" cholesterol. Also, you should:

  • Get an annual dilated eye exam every year
    The priority prevention method is an annual examination. Be absolutely sure to schedule a full, dilated eye exam with an ophthalmologist -- a medical eye doctor -- every year. The doctor may take photographs of your retinas to use as a reference point for any later changes.
  • Consider ACE inhibitor medications
    Research shows that ACE inhibitor drugs, which are prescribed to treat high blood pressure, also will protect your eyes if your blood pressure is kept in good target range.

With good eye care in sight, turn your attention to your kidneys.

Diabetes Complications: The Kidneys

Diabetic kidney disease, or nephopathy, stems from the damage to the small blood vessels in the body. The clusters of blood vessels (called glomeruli) that make up the kidney begin to be destroyed. The job of the glomeruli is to filter blood and form urine, which drains into the ureter. When the damaged glomeruli begin to thicken, they can no longer do their job, and the kidneys may start allowing more albumin (protein) than normal in the urine, eventually causing chronic kidney failure.

People with diabetes are 20 times more likely to develop kidney failure than the general population. About 30 percent of those affected are people with type 1 diabetes and 10 to 40 percent are people with type 2, according to the National Kidney Foundation (NKF).

In addition to good diabetes management, there are two specific things you can do to protect your kidneys. Turn to the next slide for more information.

Diabetes Complications: How to Protect Your Kidneys

What you can do: Yes, once again lowering blood glucose, maintaining the recommended blood pressure, and lowering "bad" cholesterol help your kidneys do their job. Also, you should:

  • Get a microalbumin test once a year. The ultrasensitive microalbumin test, a urine test, gauges the "leakiness" of the filtration function of your kidneys. It shows changes a full 10 to 20 years earlier than older tests could. "One of the biggest advances in diabetes care is early detection of kidney disease. We can now detect it even before it develops. Yet sadly, the microalbumin test is one of the most neglected in patients with diabetes," says Joslin's Dr. Jackson. All you have to do is pee in a cup, and you needn't fast before the test.
  • See a kidney specialist. If you're over age 45 or have had diabetes for more than 20 years, see a kidney specialist, called a nephrologist, at the first sign of an abnormal microalbumin test result.
  • Seek early treatment. Numerous clinical studies show that when increases in microalbumin are identified early, a variety of treatments can successfully decrease or even eliminate your chance of suffering kidney disease. These interventions include aggressive control of blood pressure, improvement of glucose control, and taking oral blood pressure drugs such as ACE inhibitors and ARBs, which are also proven to protect kidney function.

Diabetes Complications: The Feet

Nerve Damage (Neuropathy)
The feet and lower limbs of those with diabetes can be damaged by diabetic nerve disease, or neuropathy. Neuropathy is an umbrella term for a family of nerve disorders caused by diabetes over time. When small blood vessels are damaged, nerve tissue may be destroyed throughout the body.

The most common type is peripheral neuropathy, which leads to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. "One of the most common problems is damage to your feet that goes unnoticed because you've lost sensation in the nerves there," Jackson says. "People often burn or otherwise injure their feet without noticing. Untreated, these injuries become infected and do not heal properly. In the worst-case scenario, some patients lose a leg this way." An estimated 5 percent of people with diabetes eventually require toe or foot amputation.

An estimated 60-70 percent of people with diabetes have some form of neuropathy, but not all of them have symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

You can start protecting your feet right now. Click on the next slide for steps you can take.

Diabetes Complications: Protect Your Feet

What you can do: There are specific steps you can take to prevent damage to your feet:

  • Inspect your feet every day. Look for blisters or other small injuries that need immediate attention -- even if you believe the nerves in your feet still function well. Also check for hot and cold spots and discoloration. If you find any changes, tell your regular doctor or foot specialist.
  • Wear shoes. Walking around barefoot is taboo, especially if you already have neuropathy. Doctors insist it's just too easy to injure your feet this way or pick up tiny splinters that you don't notice until they cause big problems.
  • Select quality footwear. Doctors suggest wearing moisture-resistant socks and well-fitting shoes with flexible soles and soft leather tops that allow your feet to breathe. To prevent pressure sores on your feet, make sure your socks don't bunch or wrinkle inside your shoes.
  • Get a vibration-sensitivity test. Your doctor should check your feet at least once a year with a tuning fork or filaments. Your doctor may also feel for hot or cold spots. If you don't feel the tuning fork or filaments, this is an early indication that you may be losing sensation in your feet. National Institutes of Health data show that comprehensive foot-care exams can reduce amputation rates by 45-85 percent.

Diabetes Complications: Other Issues

In addition to major complications of the heart, eyes, kidneys, and nerves, diabetes can affect other areas, too. A few other common conditions are infections that won't heal, gum disease (gingivitis and periodontitis), problems with joint mobility (diabetic cheiroarthropathy), and depression.

The Good News: The steps you take to protect your heart, eyes, kidneys, and feet also help reduce your risk of other problems. Monitoring your blood glucose is basic. In addition, what you eat, how often you are active, maintaining a healthy body weight, and taking medications will all work together to help you avoid complications. Improved treatments also can help lessen the severity of any complications people with diabetes develop.

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