Diabetic Complications

Alzheimer’s disease:

Alzheimer’s disease is irreversible and destroys brain cells, causing thinking ability and memory to deteriorate. Alzheimer’s disease is not a normal part of aging.

What is Alzheimer’s disease?

Dr. Alois Alzheimer first identified the disease in 1906. He described the two hallmarks of the disease: “plaques,” which are numerous tiny, dense deposits scattered throughout the brain that become toxic to brain cells at excessive levels, and “tangles,” which interfere with vital processes, eventually choking off the living cells. When brain cells degenerate and die, the brain markedly shrinks in some regions.

Cardiovascular Disease

Cardiovascular disease: generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your heart’s muscle, valves or rhythm, also are considered forms of heart disease.

What is retinopathy?

Over time, diabetes can cause changes in the retina at the back of the eye. Your retina helps you see by acting like a film projector in the back of your eye, projecting the image to your brain. The change is called retinopathy and there are a couple of different types that affect people with diabetes. The macula, which is the part of your retina that helps you to see colour, becomes swollen (macular edema) and this can cause blindness. A second complication is the growth of new weak blood vessels that break and leak blood into your eye so the retina cannot project images to your brain (proliferative diabetic retinopathy). The result is a loss of sight.

Diabetes causes changes in the tiny blood vessels that nourish the retina. In the early stages, known as nonproliferative or background retinopathy, the arteries in the retina weaken and begin to leak, forming small, dot-like hemorrhages (blood flow from the ruptured blood vessel). These leaking vessels often lead to swelling (edema) in the retina and decreased vision. At this stage, vision may be normal or it may have started to blur or change. About one in four people with diabetes experience this problem.

When retinopathy advances, the decreased circulation of the blood vessels deprives areas of the retina of oxygen. Blood vessels become blocked or closed, and parts of the retina die. New, abnormal, blood vessels grow to replace the old ones. They grow along the retina and along the surface of the vitreous (the transparent gel that fills the inner portion of the eyeball). Unfortunately, these delicate vessels hemorrhage easily. Blood may leak into the retina and vitreous, causing “floaters” (spots that appear to drift in front of the eyes), along with decreased vision.

This is called proliferative retinopathy, and it affects about one in 20 people with diabetes. It can lead to severe visual loss or blindness. In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause retinal detachment and glaucoma.

FOOT COMPLICATIONS

People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead toserious complications. Foot problems most often happen when there is nerve damage, also called neuropathy. This can cause tingling, pain (burning or stinging), or weakness in the foot. It can also cause loss of feeling in the foot, so you can injure it and not know it. Poor blood flow or changes in the shape of your feet or toes may also cause problems.

NEUROPATHY

Although it can hurt, diabetic nerve damage can also lessen your ability to feel pain, heat, and cold. Loss of feeling often means you may not feel a foot injury. You could have a tack or stone in your shoe and walk on it all day without knowing. You could get a blister and not feel it. You might not notice a foot injury until the skin breaks down and becomes infected.

Nerve damage can also lead to changes in the shape of your feet and toes. Ask your health care provider about special therapeutic shoes, rather than forcing deformed feet and toes into regular shoes.

DIABETES AND HEARING LOSS

Diabetes and hearing loss are two of the most widespread health concerns. A recent study found that hearing loss is twice as common in people with diabetes as it is in those who don’t have the disease.

Right now we don’t know how diabetes is related to hearing loss. It’s possible that the high blood glucose levels associated with diabetes cause damage to the small blood vessels in the inner ear, similar to the way in which diabetes can damage the eyes and the kidneys. But more research needs to be done to discover why people with diabetes have a higher rate of hearing loss.

Since it can happen slowly, the symptoms of hearing loss can often be hard to notice. In fact, family members and friends sometimes notice the hearing loss before the person experiencing it.

Signs of Hearing Loss

• Frequently asking others to repeat themselves.
• Trouble following conversations that involve more than two people.
• Thinking that others are mumbling.
• Problems hearing in noisy places such as busy restaurants.
• Trouble hearing the voices of women and small children.
• Turning up the TV or radio volume too loud for others who are nearby.

KIDNEY DISEASE (NEPHROPATHY)

Kidneys are remarkable organs. Inside them are millions of tiny blood vessels that act as filters. Their job is to remove waste products from the blood.

Sometimes this filtering system breaks down. Diabetes can damage the kidneys and cause them to fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease.

HOW DOES DIABETES CAUSE KIDNEY DISEASE?

When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes can damage this system. High levels of blood glucose make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

When kidney disease is diagnosed early, during microalbuminuria, several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).

NERVE DAMAGE (DIABETIC NEUROPATHIES)

SKIN COMPLICATIONS

Diabetes can affect every part of the body, including the skin. In fact, such problems are sometimes the first sign that a person has diabetes. Luckily, most skin conditions can be prevented or easily treated if caught early.

Some of these problems are skin conditions anyone can have, but people with diabetes get more easily. These include bacterial infections, fungal infections, and itching. Other skin problems happen mostly or only to people with diabetes. These include diabetic dermopathy, necrobiosis lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis.

GENERAL SKIN CONDITIONS

Bacterial Infections

Several kinds of bacterial infections occur in people with diabetes:

• Styes (infections of the glands of the eyelid)

• Boils

• Folliculitis (infections of the hair follicles)

• Carbuncles (deep infections of the skin and the tissue underneath)

• Infections around the nails

Inflamed tissues are usually hot, swollen, red, and painful. Several different organisms can cause infections, the most common being Staphylococcus bacteria, also called staph.

Once, bacterial infections were life threatening, especially for people with diabetes. Today, death is rare, thanks to antibiotics and better methods of blood sugar control.

But even today, people with diabetes have more bacterial infections than other people do. Doctors believe people with diabetes can reduce their chances of these infections by practicing good skin care.

If you think you have a bacterial infection, see your doctor.

Fungal Infections

The culprit in fungal infections of people with diabetes is often Candida albicans. This yeast-like fungus can create itchy rashes of moist, red areas surrounded by tiny blisters and scales. These infections often occur in warm, moist folds of the skin. Problem areas are under the breasts, around the nails, between fingers and toes, in the corners of the mouth, under the foreskin (in uncircumcised men), and in the armpits and groin.

Common fungal infections include jock itch, athlete’s foot, ringworm (a ring-shaped itchy patch), and vaginal infection that causes itching.

If you think you have a yeast or fungal infection, call your doctor.

Itching

Localized itching is often caused by diabetes. It can be caused by a yeast infection, dry skin, or poor circulation. When poor circulation is the cause of itching, the itchiest areas may be the lower parts of the legs.

You may be able to treat itching yourself. Limit how often you bathe, particularly when the humidity is low. Use mild soap with moisturizer and apply skin cream after bathing.

DIABETES-RELATED SKIN CONDITIONS

Acanthosis Nigricans

Acanthosis nigricans is a condition in which tan or brown raised areas appear on the sides of the neck, armpits and groin. Sometimes they also occur on the hands, elbows and knees.

Acanthosis nigricans usually strikes people who are very overweight. The best treatment is to lose weight. Some creams can help the spots look better.

Diabetic Dermopathy

Diabetes can cause changes in the small blood vessels. These changes can cause skin problems called diabetic dermopathy.

Dermopathy often looks like light brown, scaly patches. These patches may be oval or circular. Some people mistake them for age spots. This disorder most often occurs on the front of both legs. But the legs may not be affected to the same degree. The patches do not hurt, open up, or itch.

Dermopathy is harmless and doesn’t need to be treated.

Necrobiosis Lipoidica Diabeticorum

Another disease that may be caused by changes in the blood vessels is necrobiosis lipoidica diabeticorum (NLD). NLD causes spots similar to diabetic dermopathy, but they are fewer, larger, and deeper.

NLD often starts as a dull, red, raised area. After a while, it looks like a shiny scar with a violet border. The blood vessels under the skin may become easier to see. Sometimes NLD is itchy and painful. Sometimes the spots crack open.

NLD is a rare condition. Adult women are the most likely to get it. As long as the sores do not break open, you do not need to have it treated. But if you get open sores, see your doctor for treatment.

Allergic Reactions

Allergic skin reactions can occur in response to medicines, such as insulin or diabetes pills. You should see your doctor if you think you are having a reaction to a medicine. Be on the lookout for rashes, depressions, or bumps at the sites where you inject insulin.

Diabetic Blisters (Bullosis Diabeticorum)

Rarely, people with diabetes erupt in blisters. Diabetic blisters can occur on the backs of fingers, hands, toes, feet and sometimes on legs or forearms. These sores look like burn blisters and often occur in people who have diabetic neuropathy. They are sometimes large, but they are painless and have no redness around them. They heal by themselves, usually without scars, in about three weeks. The only treatment is to bring blood sugar levels under control.

Eruptive Xanthomatosis

Eruptive xanthomatosis is another condition caused by diabetes that’s out of control. It consists of firm, yellow, pea-like enlargements in the skin. Each bump has a red halo and may itch. This condition occurs most often on the backs of hands, feet, arms, legs and buttocks.

The disorder usually occurs in young men with type 1 diabetes. The person often has high levels of cholesterol and fat in the blood. Like diabetic blisters, these bumps disappear when diabetes control is restored.

Digital Sclerosis

Sometimes, people with diabetes develop tight, thick, waxy skin on the backs of their hands. Sometimes skin on the toes and forehead also becomes thick. The finger joints become stiff and can no longer move the way they should. Rarely, knees, ankles, or elbows also get stiff.

This condition happens to about one third of people who have type 1 diabetes. The only treatment is to bring blood sugar levels under control.

Disseminated Granuloma Annulare

In disseminated granuloma annulare, the person has sharply defined ring- or arc-shaped raised areas on the skin. These rashes occur most often on parts of the body far from the trunk (for example, the fingers or ears). But sometimes the raised areas occur on the trunk. They can be red, red-brown, or skin-colored.

See your doctor if you get rashes like this. There are drugs that can help clear up this condition.