Complications of Type 2 Diabetes and Reducing Your Risk of Developing Complications

Hypoglycemia

Hypoglycemia is more common in people who take insulin to control their glucose levels. But, it can also occur in people who take oral medicine. Hypoglycemia can be caused by any of the following:

• Taking too much insulin or oral diabetes medicine
• Skipping or delaying a meal, or eating a smaller meal than usual
• Exercising harder or longer than your usual pattern

Hyperglycemia

Long-term hyperglycemia is the major cause of many of the complications that occur in people with diabetes. Hyperglycemia occurs when you do not have enough insulin to remove the glucose in your blood, or when your body does not use insulin properly. It can be caused by:

• Taking too little insulin or oral medicine
• Eating a larger meal than usual
• Experiencing stress from an illness or from factors in daily life

Hyperosmolar Nonketotic Coma

Hyperosmolar nonketotic coma is a life-threatening complication of hyperosmolar hyperglycemic nonketotic syndrome (HHNS), in which your body tries to get rid of excess blood glucose by passing it through your urine. In severe cases, seizures, coma, and eventually death may occur.

Blindness

Chronic high blood glucose levels, as well as high blood pressure, can lead to damage to tiny blood vessels in the retina of the eye. This damage, called diabetic retinopathy, can occur over a long period of time. Cataract and glaucoma (two other common eye conditions) occur more often and at a younger age in people with type 2 diabetes than in people without this disease. Signs of eye damage include:

• Blurry or double vision
• Halos, flashing lights, or black spots
• Dark or floating spots
• Pain or pressure in one or both of your eyes
• Trouble seeing things

Some people do not have any symptoms until the damage is significant. Therefore, it is essential to see your eye doctor regularly. Diabetic retinopathy can be treated with laser therapy or surgery. Quitting smoking and controlling your blood pressure are important preventive measures.

Kidney Disease

Between 20%-40% of people with diabetes develop diabetic nephropathy (a form of kidney damage).

High blood glucose levels and high blood pressure damage the kidneys' small blood vessels (capillaries). These capillaries are responsible for filtering waste out of the blood. This damage allows protein to leak out of the blood and causes wastes that should be excreted with the urine to build up in your blood. Having small amounts of protein in the urine is called microalbuminuria, the first sign of kidney damage.

As damage continues, more protein is leaked and more wastes build up. Having larger amounts of protein in the urine is called proteinuria or macroalbuminuria. This damage can eventually progress to kidney failure, which requires dialysis or a kidney transplant.

Heart Disease and Stroke

People with type 2 diabetes are more likely to have heart disease or stroke compared to people who do not have diabetes. The most common form of heart disease is called coronary artery disease (CAD), blockage of the arteries that bring oxygen-rich blood to the heart muscles. This condition can lead to:

• Chest pain ( angina)—This pain or pressure typically starts in your chest and radiates to your arms (especially the left). This type of pain may appear when you exercise or after eating a large meal, and it may get better when you rest.
• Cardiomyopathy —This is a general weakening of the heart muscle caused by narrowed, small blood vessels that decrease the blood flow through the heart. This can progress and cause heart failure.
• Heart attack—This is caused by the blockage of a blood vessel in or near your heart. As a result, part of your heart muscle does not receive oxygen and the essential nutrients it needs to function, so it stops working and dies. Symptoms of a heart attack include: chest pain, pressure feeling, nausea, indigestion, extreme weakness, and sweating.

A stroke can also happen as a result of blood not being able to reach the brain. This may be due to a blockage in a blood vessel. Symptoms of a stroke include:

• Sudden weakness or numbness of your face, arm, or leg on one side of your body
• Sudden confusion, trouble talking, or trouble understanding
• Sudden dizziness, loss of balance, or trouble walking
• Sudden trouble seeing in one or both eyes or sudden double vision
• Sudden severe headache

Nerve Disease

Diabetes can also cause mild to severe nerve damage, called diabetic neuropathy. Having high blood glucose for many years can damage the blood vessels that bring oxygen to the nerves. High blood glucose can also damage the covering on the nerves. Damaged nerves may stop sending messages. Or, they may send messages too slowly or at the wrong times. This can lead to symptoms that range from pain or tingling, to numbness and loss of feeling. The longest nerves in the body are often affected first, leaving the hands and feet more susceptible to neuropathy.

The combination of repeated injury, poor blood flow, and poor healing leads to a greater risk of foot infections that are often difficult to treat. In severe cases, when circulation is poor and antibiotics fail to cure the infection, foot or leg amputations may be necessary.

Other, less severe consequences of nerve damage include:

• Drop in blood pressure when you stand
• Diarrhea at night
• Constipation
• Difficulty in emptying your bladder
• Erectile dysfunction

Lower Your Risk of Complications

Take these steps to promote your health:

• Have regular checkups even if you feel fine. Your doctor can often spot early signs of complications.
• Strive to keep your blood glucose levels, hemoglobin A1c (HbA1c) levels, blood pressure, and cholesterol levels within a healthy range at all times. Work with your doctor to determine which levels are safe for you.
• Do not smoke. If you do smoke, quit.
• Get vaccinated against the flu and pneumonia.
• Have a regular exercise routine.
• If you are overweight, talk to your doctor about a safe weight loss program.
• Tell your doctor if you have symptoms of any diabetes complications.
• Ask your doctor if there are any medicines that you should take to prevent complications. For example, find out if daily aspirin therapy is right for you.