Complications of diabetes

PBRC 2013 1

Complications of Diabetes

Pennington Biomedical Research CenterDivision of Education

PPT# 29

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Heart Disease Kidney Disease/Kidney

Transplantation Eye Complications Diabetic Neuropathy and Nerve

Damage

Foot Complications Skin Complications Gastroparesis and Diabetes Depression

Common Potential Complications of Diabetes

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Heart Disease

Caused by a narrowing or blocking of the blood vessels to your heart.

The vessels carry oxygen and nutrients to your heart.

Vessels can become partially or totally blocked by fatty deposits.

A heart attack - when the blood supply to your heart is reduced or cut off.

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Diabetes increases the risk for coronary artery disease, a heart attack or stroke.

Take preventive steps now. Keep your ABCs of diabetes on

target.

Heart Disease and Diabetes

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“A” is for A1C A1C is the blood glucose check “with a memory” over the past 2 to 3 months.

“B” is for blood pressure

The ADA recommends a blood pressure below 130/80.

“C” is for cholesterol

HDL protects your heart. LDL can clog your blood vessels, leading to heart disease. Triglycerides can increase your risk for heart disease.

“The ABCs”

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Kidney Function

Kidneys act as filters. Kidneys remove waste products from the

blood. We create waste products from digestion. Normally, waste products are eliminated in

urine from the body. Protein and red blood cells are too big to

pass through the filter and remain in the blood.

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Kidney Disease

High levels of blood sugar can put extra stress on the kidneys.

After years of damage, the kidneys start to leak. Useful proteins are lost in the urine. Get a condition known as microalbuminuria.

There are several treatments at this point that may keep the kidney disease from getting worse.

When kidney disease is diagnosed later, during macroalbuminuria, end-stage renal disease (ESRD) usually follows.

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Kidney Disease

Kidneys lose their filtering ability. Waste products begin to build up in the

blood. Finally, the kidneys fail. ESRD

kidney transplant or regular visits to a dialysis clinic.

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Who Gets Kidney Disease?

Factors that influence kidney disease development include:

Genetics Blood pressure Blood sugar control

Controlling blood sugar and blood pressure are very important in reducing the chances of developing kidney disease.

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Facts About Diabetes and Kidney Disease

Nephropathy - 10-21% of diabetes cases. ~ 43% of new cases of ESRD are attributed to

diabetes. 12 times higher in people with type 1 diabetes

4 times higher in African Americans, 4 to 6 times higher in Mexican Americans 6 times higher in Native Americans

than in the general population of diabetes patients.

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---Eye Complications---

Higher risk of blindness. Many have minor eye disorders. Early treatments critical.

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Glaucoma

Pressure build-up in the eye. Pinches the blood vessels. Damages nerves. Vision is gradually lost.

40% more likely to suffer from glaucoma.

Risk increases with age and duration of diabetes.

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Cataracts

The eye’s clear lens clouds, blocking light. Wear sunglasses Use glare-control lenses

in eyeglasses. Damaged lens –

remove. transplant.

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Individuals with diabetes are: 60% more likely to develop cataracts

at a younger age faster progression have problems if removal of the lens is

necessary due to the beginning stages of glaucoma

Cataracts

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Retinopathy

Diabetic retinopathy is a general term for all disorders of the retina caused by diabetes.

There are 2 major types of retinopathy: Nonproliferative: This is the common,

mild form. Proliferative: This form is much more

serious.

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There are several factors that influence whether you get retinopathy: Blood sugar control Blood pressure levels How long you have had diabetes Genetics

Almost everyone with type 1 diabetes will eventually develop nonproliferative retinopathy.

Retinopathy

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Diabetic Neuropathy & Nerve Damage

~50% have some form of nerve damage. It’s more common in those who have had

the disease for many years. Blood glucose control can help prevent

or delay nerve damage.

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2 Common Types of Nerve Damage

Sensorimotor neuropathy: Also known as “peripheral neuropathy” Can cause tingling, pain, numbness, or weakness in

hands and feet.

Autonomic neuropathy: Can lead to Digestive problems such as feeling full, nausea Vomiting, diarrhea, or constipation Problems with how well the bladder works Problems having sex Dizziness or faintness Loss of the typical warning signs of a heart attack Loss of warning signs of low blood glucose Increased or decreased sweating Changes in how your eyes react to light and dark

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Keep Your Blood Glucose Levels in Your Target Range

It is important to: Report all possible signs of diabetic

neuropathy Get treatment right away if you have

problems. Take good care of your feet, checking

them every day. Protect your feet. Wear shoes and socks

that fit well and wear them all the time. Purchase special shoes, if they are needed. Be careful with exercising. Some activities

are not safe for individuals with neuropathy.

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Foot complications

Skin Changes

Calluses

Foot Ulcers

Poor Circulation

Amputation

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Skin Changes and Calluses

Skin Changes: Dry skin and feet. Seal remaining moisture in with plain petroleum jelly,

unscented hand cream, or a similar product. It is important not to put oils or creams between toes.

Calluses Occur more often and build up faster. May need therapeutic shoes and inserts. Calluses can lead to ulcers (open sores). Never try to cut calluses yourself– this can lead to

infection. Let your healthcare provider cut them.

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Foot Ulcers and Poor Circulation

Foot Ulcers Every ulcer should be seen by your health care provider

immediately. Can result in infections, potentially leading to loss of a

limb. It is important to keep off of your feet.

Poor Circulation Can lead to infection and delay healing. To improve poor circulation:

Stop smoking and keep blood pressure and cholesterol in check

Exercise improves circulation. It increases blood flow. Exercise is a good idea for individuals who currently do not have any open sores on the foot. Proper shoes are essential.

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Amputation

Highly likely in diabetes. Due to artery disease, which

reduces blood flow to the feet and nerve damage, which reduces sensation.

These can lead to ulcers and infections that may lead to amputation.

Amputations are preventable.

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Amputation - Prevention

Take good care of your feet.

Always follow your health care provider’s advice when caring for foot problems.

Stop smoking! Smoking decreases

blood flow to the feet.

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Skin Complications

Bacterial infections Fungal infections Itching Diabetic Dermopathy Necrobiosis Lipoidica

Diabeticorum Atherosclerosis Allergic Reactions

Diabetic Blisters Eruptive Xanthomatosis Digital Sclerosis Disseminated Granuloma

Annulare Acanthosis Nigricans

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Bacterial and Fungal Infections Bacterial infections, many kinds

Styes Boils Carbuncles Inflamed tissues are usually hot, swollen, red, and

painful Treated by antibiotics

Fungal infections Candida albicans is a yeast-like fungus. Leads to

common fungal infections Can be treated by medication

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Itching and Diabetic Dermopathy Itching

Localized. Can be caused by a yeast infection, dry skin, or poor circulation. Occurs often in the lower parts of the legs. Use mild soap with moisturizer, and apply skin cream after

bathing to help resolve the issue.

Diabetic Dermopathy Changes in the small blood vessels. Looks like light brown, scaly patches. The disorder most often occurs on the front of both legs. The patches do not hurt, open up, or itch. Dermopathy is harmless and does not require treatment.

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Atherosclerosis and Allergic Reactions

Atherosclerosis Thickening of the arteries Occurs at younger ages. Can lead to skin changes. Skin becomes hairless, thin, cool, and shiny. Affected legs heal slowly when the skin is injured.

Allergic Reactions In response to medications, such as insulin or diabetes

pills. If you think you are having a reaction to a medication,

contact your doctor immediately. Report any rashes, depressions, or bumps around the

insulin injection sites immediately.

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Diabetic Blisters and Eruptive Xanthomatosis

Diabetic Blisters Occurs rarely in individuals with diabetes They can occur on the backs of fingers, hands, toes, feet, and on legs

or forearms. They are sometimes large and resemble burn blisters. Painless and with no redness around them, they often heal themselves

within 3 weeks. The only treatment is to bring blood sugar levels under control.

Eruptive Xanthomatosis This is a condition caused by diabetes that is out of control. Consists of firm, yellow, pea-like enlargements in the skin. The disorder usually occurs in young men with type 1 diabetes. Like diabetic blisters, these bumps disappear when diabetes control

is restored.

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Digital Sclerosis and Disseminated Granuloma Annulare

Digital Sclerosis Consists of tight, thick, waxy skin on the back of the hands. The finger joints become stiff and can no longer move the way they

should. Rarely, knees, ankles, or elbows also get stiff. Happens to about 1/3 of people with type 1 diabetes The only treatment is to bring blood sugar levels under control.

Disseminated Granuloma Annulare Consists of sharply defined ring-shaped or arc-shaped raised areas on

the skin. Rashes most often occur on parts of the body far from the trunk

(i.e., ears or fingers), but sometimes the raised areas occur on the trunk.

Contact your doctor when rash appears. Certain drugs can help clear up the condition.

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Acanthosis Nigricans

Acanthosis Nigricans This is a condition in which tan or brown raised

areas appear on the sides of the neck, armpits, and groin. Usually strikes people who are overweight. The best treatment is to lose weight. Some creams can help the spots look better.

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Gastroparesis and Diabetes

Due to nerve damage that control the stomach. Leads to poor muscle control of the stomach and intestines.

Movement of food is slowed or stopped.

Signs and symptoms: Heartburn Nausea Vomiting of undigested food An early feeling of fullness when eating Weight loss Abdominal bloating Erratic blood glucose (sugar) levels Lack of appetite Gastroesophageal reflux Spasms of the stomach wall

*These symptoms may be mild or severe, depending on

the person.*

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Complications of Gastroparesis

Gastroparesis makes it harder to manage blood glucose.

Slower digestion can result in:

Bacterial overgrowth due to fermentation Food can harden into solid masses called

bezoars that may cause nausea, vomiting, and obstruction of the stomach

Bezoars can be dangerous if they block the passage of food into the small intestine.

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Treatment of Gastroparesis

The most important treatment goal for diabetes-related gastroparesis is to manage your blood glucose levels as well through the usage of:

Insulin May need to adjust schedule.

Medication May need drugs to treat gastroparesis.

Meal and food changes

Refer to your physician or a dietitian for more information.

Feeding tube

May be used in severe cases.

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Depression Consult your doctor to eliminate any physical cause for your

depression.

Poorly controlled diabetes can cause depression like symptoms: High or low blood sugar during the day can make you feel tired or

anxious Low blood sugar levels can also lead to hunger and eating too much Low blood sugar n the night could disturb sleep High blood sugar in the night can lead to frequent urinating and then

feeling tired throughout the next day

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Conclusions

There are many potential complications of diabetes. Complications can be minimized with good blood glucose

control. Discuss any developments with the physician immediately.

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Division of Education

Edited : 1/13

Heli J. Roy, PhD, RDDivision of EducationPhillip Brantley, PhD, DirectorPennington Biomedical Research CenterSteve Heymsfield, MD, Executive Director

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Pennington Biomedical Research Center

VISIONOur vision is to lead the world in eliminating chronic diseases.  MISSIONOur mission is to discover the triggers of chronic diseases through innovative research that improves human health across the lifespan.  We are helping people live Well Beyond the Expected. The Pennington Center has several research areas, including:Clinical Obesity ResearchExperimental ObesityFunctional FoodsHealth and Performance EnhancementNutrition and Chronic DiseasesNutrition and the BrainDementia, Alzheimer’s and healthy agingDiet, exercise, weight loss and weight loss maintenanceThe research fostered in these areas can have a profound impact on healthy living and on the prevention of common chronic diseases, such as heart disease, cancer, diabetes, hypertension and osteoporosis.  The Division of Education provides education and information to the scientific community and the public about research findings, training programs and research areas, and coordinates educational events for the public on various health issues. We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the Pennington Center in Baton Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at www.pbrc.edu or call (225) 763-3000.

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References

All information used was obtained from: American Diabetes Association

http://www.diabetes.org

Copyright, 2013PBRC # PPT29