Diabetes is a debilitating disease. Not only does it require a lifetime of medication, but it can also lead to serious health complications, and occasionally, even premature deaths. Thus, long-term management of the condition is vital for diabetes patients. This includes prevention of diabetic complications and early intervention to reduce comorbidity, healthcare cost to the patient and healthcare burden for the family.
In this article, we will discuss different complications resulting from diabetes including heart disease, kidney disease, blindness and more. In addition, we will share tips to prevent, delay and manage them.
1. How Does Diabetes Cause Health Complications?
Diabetes is a chronic disease. Blood glucose levels will be persistently high, due to inefficient production of insulin in the pancreas. More about insulin and the causes of diabetes is covered in our Guide to Diabetes in Singapore here.
The condition is known as an invisible disease, with no obvious symptoms in the early stage. In many cases, a person finds out about diabetes due to a complication that has worsened overtime. So how do these complications occur?
Research has shown that regular excess sugar in the blood can cause damage to the blood vessels and the nerves. This occurs through a complex mechanism involving the promotion of injury, inflammation and inhibition of protective functions in the body. These processes may possess an increase in LDL cholesterol levels and lower HDL cholesterol levels. Consequently, this leads to high cholesterol levels. Excess cholesterol can cause hardening and narrowing of the blood vessels.
This can further result in high blood pressure (hypertension), coronary heart disease, damages to the nerves, and an overall compromised immune system. Overtime, diabetes that is uncontrolled can wreak havoc to one or multiple vital organs of the body, resulting in serious complications.
2. What Are The Most Common Diabetes Complications?
There are 2 types of diabetes complications: chronic complications that build up over time and acute complications that can occur at any point in time. Acute complications need to be tended to urgently by medical professionals. An example is hyperosmolar hyperglycemic state (HSS). It happens when blood sugar swiftly rises to an extremely high level, causing severe water loss.
In this article, we will focus on chronic complications. They include:
2.1. Heart Disease and Stroke:
When you have diabetes, high glucose levels in your blood damage the nerves and blood vessels that control your heart. Progressively, the damage leads to heart disease. Compared to people without diabetes, those with diabetes are 2 to 4 times more likely to develop a heart and cardiovascular. Similarly, the risk of having a heart disease at a younger age increases when you have diabetes.
Diabetics are also more susceptible to other risk factors of cardiovascular disease, such as high cholesterol and high blood pressure. As a result, there is a higher risk and/or more severe incidents of cardiovascular disease such as heart attack or a stroke.
2.2. Nerve Damage (Diabetic Neuropathy):
Since elevated levels of blood sugar can cause nerve damage, the affected nerves become less effective in carrying messages or signals from the brain to other parts of the body. When this happens, your ability to move, feel, and hear is impaired. Nerve damage causes pain, numbness, and tingling in your legs, feet, and hands. The impact of this sensory loss is compounded in elderly adults, whose senses are less acute with age. More than 30% of seniors above the age of 60 experience hearing loss as a result of ageing and diabetes.
One particular consequence of neuropathy is numbness in the skin. After which, the patients gradually lose their ability to sense pain. They may not realise when small wounds first appear. Some do not even notice big wounds that have become infectious and painful, posing many health threats, including crush wounds and gangrene wounds.
2.3. Eye Problems (Diabetic Retinopathy):
Diabetics may develop complications in the eye as a result of damages to the nerves or blood vessels linked to the eye. This complication is known as diabetic retinopathy. Small blood vessels present in the lining at the back of the eyeball leak by growing abnormally, leading to vision loss, including complete loss of vision, or blindness.
Unfortunately, eye problems due to diabetes are prevalent and on the rise, especially among the elderly. One in four seniors with diabetes is estimated to develop diabetic retinopathy within 5 years after diabetes diagnosis. The ratio doubles to one in two for elderlies with 10-year or longer term diabetes.
Diabetic retinopathy, if left untreated, causes:
- Macular Edema: Buildup of fluid in the macula, which results in the swelling of the macula. Macula is the central area of the retina possessing the sharpest vision.
- Glaucoma: This is a condition in which the optic nerve that connects the eye to the brain is damaged, resulting in blind spots in the vision field and high pressure in the eyeball.
- Cataracts: This condition is characterised by the clouding of the lens of the eye.
2.4. Foot Damage (Diabetic Foot):
Damage to the nerves due to diabetes can result in poor blood circulation. The long nerves such as the foot and other limbs are often the most affected. Impaired blood flow to the limbs causes cuts, sores, ulcers and scrapes that take a long time to heal.
Nerve damage can also cause loss of sensation in your feet. Similar to diabetic neuropathy as discussed above, nerve damage exacerbates the risk of overlooking injuries and infections when they start to develop. Without timely intervention, the injury may grow so bad that the only treatment possible is to have the foot removed or amputated.
2.5. Kidney Problems (Diabetic Nephropathy):
When the blood vessels in your kidneys are affected by diabetes, kidney problems can arise. Known as diabetic nephropathy, this complication is the leading cause of kidney failure globally. Kidney disease due to diabetes is a particular concern in Singapore. Two out of 3 kidney failure cases in Singapore are linked to diabetes – the highest rate of diabetes-induced kidney failures in the world.
Both kidney disease and diabetes are silent diseases, which means they can cause irreversible damage to the kidneys for a long time before being noticed and diagnosed. As such, diabetics are recommended to screen for kidney disease annually from the point of diagnosis, even if there are no signs and symptoms of kidney issues.
2.6. Skin and Mouth Infections:
High sugar levels in the blood are an excellent home to fungi and bacteria, resulting in increased infection risk. Common skin infections caused by diabetes include itchy skin, brown or scaly patches on the skin, and yeast infections. Coupled with impairment in the ability of the body to heal itself due to diabetes, a patient may have more frequent bouts of skin infection, or more severe infection that takes longer to heal, or both.
Mouth infections occur because people with diabetes have more sugar in your saliva. The mouth becomes a feeding ground for bacteria. Bacteria produce acids that can attack tooth enamel, causing enamel erosion. Gum infections can happen as a result of the blood vessels in gums being damaged.
2.7. Other Problems:
Depending on where the nerves and blood vessels are weakened by diabetes, other body functions can be negatively affected. For instance, impaired nerves in the digestive tract can cause food to remain in the stomach for an extended period. This disorder is known as diabetic gastroparesis. Patients often experience nausea, vomiting, bloatedness, stomach pain, acid reflux, and heartburn.
Reduced blood flow and nerve damage in the genitals due to high blood sugar levels can cause sexual problems. For males, diabetes causes erectile dysfunction or impotence. The same issue can be applied to the bladder, leading to bladder disorders. Diabetes can also increase the chances of getting a thrush or urinary tract infection (UTI).
3. How to Manage & Prevent Diabetes Complications
Diabetes complications can be avoided. Awareness is the first step you can take in preventing these debilitating health problems. The next step is screening and monitoring, especially for complications you are at high risk for. Below we go into more details of how you can manage each of the diabetes complications:
3.1. Preventing Diabetic Eye:
Blindness is one of the most feared complications of diabetes. Diabetics are encouraged to get a diabetic eye exam every year. This is essential to detect eye problems associated with diabetic retinopathy at an early stage.
During an eye exam, the ophthalmologist may conduct tests to check visual acuity (eye sight), examine the retina, and blood vessels in the eye. The ophthalmologist may also discuss your risk of diabetes-related eye problems such as glaucoma and cataracts and recommend preventive measures.
3.2. Preventing Diabetic Foot:
In addition to managing blood sugar levels, it is important to get regular exams to notice any changes in the feet.
- Foot Care:
Self-examination of your feet involves looking at all parts of the feet to check for any redness, blisters, changes in callus formulation, ulcers, and broken skin. You should take care of your feet by drying your feet after bathing and wearing supportive and comfortable shoes.
- Clinical Examination:
During your clinical exam, the doctor will check the sensation and blood flow to your feet. The doctor will also check for signs and symptoms of diabetic foot such as bluish skin colour, thin skin, athlete’s foot, and ulcers in your feet.
3.3. Preventing Cardiovascular Disease:
You can prevent the risk of cardiovascular diseases by going for medical tests or a cardiovascular screening. Cardiovascular health needs to be checked by a professional because it does not manifest through symptoms we can easily see or feel by ourselves. Important measurements to monitor cardiovascular health include blood pressure, LDL cholesterol and triglycerides.
Learning about other risk factors associated with cardiovascular diseases in addition to diabetes, such as family history, smoking, or obesity can also prevent complications. Learn more about risk factors of cardiovascular disease and how to benefit from a heart health check in our article here.
3.4. Preventing Kidney Diseases:
Kidney disease can be prevented and detected early by regular screening, starting as soon as diabetes is diagnosed. The test conducted during diabetic nephropathy screening is usually a urine test. The doctor may also order other tests to assess your kidney function. These include a baseline creatinine blood test and/or a GFR (glomerular filtration rate) test which measures how well your kidneys are filtering wastes and toxins in your blood.
Learn more about chronic kidney disease and kidney failure from our dedicated article here.
3.5. Preventing Infections:
Keeping your skin dry, clean and moisturising it with a body lotion can help prevent skin infections. Do not take hot showers and use dry shower gels. If you notice any infection in your skin, vagina, gums, or feet, call your doctor.
Be sure to brush, floss, and use an antiseptic mouthwash to take care of your gums and teeth. Go for dental check-ups and regular cleanings to prevent dental problems.
3.6. Preventing Other Problems:
Diabetes may weaken immunity, causing different health issues for different people. It is therefore crucial to get general health screening periodically and work with your doctor or healthcare provider to treat any health problem as early as you notice them. Having a regular doctor who is familiar with your diabetic history is also helpful in preventing and treating diabetes-induced health conditions.
Ultimately, keeping your blood glucose levels in check addresses diabetes and its complications at its root. Furthermore, quitting smoking, being physically active, and maintaining a healthy weight can help prevent diabetes from worsening and causing complications.
4. A General Guide to Health Screening For Diabetics
Health screening is essential to monitor the status of diabetes, prevent and detect complications early. A part of this can and needs to be done at home by the patient or caregiver, including daily blood sugar reading, and blood pressure reading for those with hypertension. (Check how to best measure your blood pressure here.)
Blood tests and professional examinations however need to be ordered by doctors during clinic or hospital visits, or a home visit by the doctor.
- A1C Test: A1C tests measure your blood sugar over the past two to three months. Normal A1C value is less than 5.7. A1C higher than 6.5 indicates diabetes.
- ACR: Albumin-to-creatinine ratio is a urine test, which tests for the levels of albumin (ie., protein) in the urine. Albumin level above 30 mg/g indicates kidney disease.
- FPG: The fasting plasma glucose test, which measures blood sugar level when the body has no food for at least 8 hours.
Depending on other symptoms and personal risk profiles, other measurements and tests such as Body Mass Index (BMI), kidney function tests, ECG, eye tests etc may be necessary.
5. Managing Diabetes and Its Complications at Home with Ninkatec
Being a chronic condition, successful management of diabetes depends a lot on the patient’s daily efforts. This can range from strictly following treatment plans, to making healthy lifestyle choices. Consultation and intervention from medical professionals may be necessary every now and then as the condition develops an unexpected or unfamiliar turn. As such, regular follow-ups, screenings and having quick access to medical professionals when you need it are important elements in controlling diabetes and minimising the risk and severity of its complications.
At Ninkatec, we provide care and support for chronic condition management at home. We believe that unless a situation requires in-patient treatment, a home setting where the person is surrounded by loved ones and familiarity is the best environment for healing. Explore our home care services for diabetes and other chronic conditions here.
By sharing knowledge about diabetes, we hope to help diabetics prevent and manage its complications effectively. You can count on us to be your companion in your journey to fight against diabetes. Be it diabetes itself or diabetes-related heart, kidney, eye, foot, or nerve issues, our doctors, nurses and care team are just a phone call or chat message away from you.