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What to Know About Long-Term Diabetes Complications

The better you control your blood sugar level, the healthier you will be

By Emily Gurnon

Living with diabetes brings many daily challenges and frustrations. You have to watch your blood glucose levels, pay close attention to what and when you eat, and take medications, including insulin. Added to that burden is the realization that if you don’t, your health could be seriously compromised in years to come.

Poorly controlled diabetes can lead over time to a number of complications. Some — like heart disease, stroke and kidney disease — can be life-threatening.

“The biggest one is cardiovascular disease,” said Arch Mainous III, a diabetes researcher and chair of the department of health services research, management and policy at the University of Florida’s College of Public Health and Health Professions.

Unfortunately, some damage may even occur before an individual is diagnosed with diabetes.

“The problem is diabetes takes a long time to develop, and by the time somebody becomes symptomatic, they're kind of down the road on some of these target complications,” Mainous said.

Prediabetes Is a Growing Threat

Because diabetes may hide in the body for years, millions at risk for the disease are not aware of it, Mainous said. In fact, a huge proportion of the American population — 39 percent, or 86 million adults — have prediabetes. And about 90 percent of those cases are undiagnosed, Mainous said.

So there's a whole lot more people at risk for developing diabetes, [but] if you identify these people, you can keep them from progressing to diabetes. You can even reverse them back to a normal blood glucose level,” he said.

Long-Term Diabetes Complications

Complications of diabetes include these, according to the Mayo Clinic and the Cleveland Clinic:

  • Heart disease and stroke. Heart disease is the No. 1 killer of people with diabetes; those with diabetes are up to four times more likely to develop cardiovascular disease than those without it. And people with diabetes are more likely to have other risk factors for heart disease, like high blood pressure and high cholesterol.
  • Nerve damage, or neuropathy. Too much sugar in the blood can cause damage to the tiny capillaries that feed the nerves, leading to damage to the nerves themselves. This is especially common in the legs. It often starts as a tingling, numbness, pain or burning in the toes that may progress up the legs; it can also affect the fingers and arms.
  • Kidney disease. Diabetes causes kidney problems, or nephropathy, by damaging the filtering system the body uses to rid the blood of wastes. Severe kidney disease may cause kidney failure, which requires dialysis or a transplant. Type 2 diabetes is the leading cause of kidney failure among Americans; about half of all people who need dialysis have diabetes.
  • Eye damage. Blood vessel changes can cause retinopathy (damage to the retina), which may lead to blindness. Diabetes can also contribute to glaucoma and cataracts.
  • Foot problems. Damage to the nerves and blood vessels can also lead to a lack of circulation. Even minor cuts and blisters can become seriously infected. When neuropathy is involved, a person with diabetes may not feel pain related to the foot problems, and unwittingly ignore them. Infections that won’t heal may result in toe, foot or leg amputations.   
  • Skin problems. Skin conditions may include fungal and bacterial infections.
  • Digestive issues. In the same way as nerves become damaged in the arms and legs, nerve damage from high blood glucose levels can cause digestive problems like nausea, vomiting, constipation or diarrhea.
  • Erectile dysfunction. Diabetes-caused nerve damage in men can result in difficulty or an inability to have an erection.
  • Mouth problems. Persons with diabetes may be more likely to have cavities, gum disease and dry mouth.

Mainous said there is some evidence that diabetes may also contribute to cognitive impairment in people over 60.

Unfortunately, many of these conditions are all too common. Forty-three percent of Americans with diabetes aged 65 to 74 reported heart disease or stroke as of 2011, according to the Centers for Disease Control (CDC). About 55 percent of those with diabetes aged 75 and older reported those conditions. Approximately one-third of adults with diabetes has chronic kidney disease, the CDC says.

The Best Defense: Take Care of Yourself

The good news is that healthy diet and exercise habits can help prevent future problems.


“There have been some huge trials that suggest that if your glucose is well-controlled, your likelihood of developing complications is significantly decreased,” Mainous said.

A study of people with diabetes called the Diabetic Control and Complications Trial (DCCT) found that strict control of blood glucose reduced the risk of diabetic retinopathy, neuropathy, and kidney disease by nearly 50 percent, the Cleveland Clinic noted. A subsequent study found that good blood-sugar control reduced the risk of a cardiovascular “event” (defined as a heart attack, stroke or needed surgery) by 42 percent.

If you are overweight or obese, lose the weight, Mainous said. But even those at normal weight should be vigilant.

“We can show that people basically 45 or older in the United States who are at normal weight, 33 percent of those people have prediabetes,” Mainous said. “That's a huge number of people who are at risk who don't know they are at risk."

Exercise is also vital. A study in which Mainous was the lead investigator showed that among healthy adults, low levels of physical activity were “significantly associated” with prediabetes and undiagnosed diabetes.

If you have not been diagnosed with diabetes or prediabetes but have concerns, ask your doctor about a simple blood test.

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Emily Gurnon
Emily Gurnon is the former Senior Content Editor covering health and caregiving for Next Avenue. Her stories include a series of articles on guardianship abuse that was funded by the Journalists in Aging Fellows Program. She previously spent 20 years as an award-winning newspaper reporter in the San Francisco Bay Area and St. Paul. Reach her through her website. Read More
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