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PBRC 2009 1
Complications of Diabetes
Pennington Biomedical Research CenterDivision of Education
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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.
Stye
Athlete’s foot
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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.
PBRC 2009 37
Division of Education
Reviewed by: Beth KalickiEdited : 10/ 2009
Division of EducationPhillip Brantley, PhD, DirectorPennington Biomedical Research CenterClaude Bouchard, PhD, Executive DirectorHeli J. Roy, PhD, RD
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The Pennington Biomedical Research Center is a world-renowned nutrition research center.
Mission: To promote healthier lives through research and education in nutrition and preventive medicine.
The Pennington Center has several research areas, including:
Clinical Obesity Research Experimental Obesity Functional Foods Health and Performance Enhancement Nutrition and Chronic Diseases Nutrition and the Brain Dementia, Alzheimer’s and healthy aging Diet, exercise, weight loss and weight loss maintenance The 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, 2009PBRC # PPT29