Many people with diabetes can also have high cholesterol and high blood pressure. These three factors combined—diabetes, high cholesterol, and high blood pressure, increase the risk of developing a variety of serious medical complications. Some of the symptoms may be obvious, while others may be subtle and develop over time. It is important that you monitor your child for signs and symptoms of medical complications and receive regular screening tests. You should report your concerns to your doctor promptly. The following paragraphs describe some of the medical complications associated with Type 2 Diabetes.
Type 2 Diabetes is associated with an increased risk of heart disease and stroke. Heart disease is the leading cause of death in the United States. Coronary artery disease causes the vessels that carry blood to the heart to narrow. They become completely or partially blocked by fatty deposits. A heart attack occurs when the heart does not receive enough oxygen through the blood. A stroke occurs when the brain does not receive enough oxygen through the blood. A heart attack or stroke can be fatal. They can also cause permanent or temporary disability.
Kidney Disease, also called Nephropathy, can also be caused by diabetes. The kidneys remove waste products from the blood. Diabetes can damage the filtering system of the kidneys resulting in kidney disease or kidney failure. Persons with severe kidney failure may need dialysis, a process in which a machine filters the blood. Some people may even need a kidney transplant.
People with diabetes have a higher risk of eye problems and blindness than people without diabetes. A long history of diabetes and older age are factors associated with developing glaucoma. Glaucoma occurs when pressure builds up in the eye and causes gradual vision loss. People with diabetes tend to develop cataracts at a younger age and at a quicker rate than people without diabetes. Cataracts cause the clear lens in the eye to become cloudy, diminishing vision.
Diabetic retinopathy can also be caused by diabetes. The retina is the part of the eye that receives images. Nonproliferative retinopathy is a condition that affects the capillaries in the retina. Retinal swelling may result in vision loss. In some people, retinopathy progresses to a more serious condition called proliferative retinopathy. The blood vessel damage caused by proliferative retinopathy causes scarring and eventual retina detachment destroys vision.
Nerve damage caused by diabetes is called diabetic neuropathy. Nerves carry messages between the brain and body about pain, temperature, and touch. They also control muscle movements and organ systems, such as the processes for food digestion and urination. Sensorimotor neuropathy and autonomic neuropathy are two common types of nerve damage.
Sensorimotor neuropathy affects sensation and movement. It may cause the feet and hands to feel weak, tingly, numb, or painful. Autonomic neuropathy affects the nerves that regulate involuntary functions or actions that your child cannot directly control, such as his or her heartbeat. Of great concern, it can cause a loss of the typical warning signs of a heart attack or low blood glucose levels. Autonomic neuropathy can cause dizziness or faintness. It can also create problems with digesting food; vomiting, diarrhea, or constipation; bladder function; sex; increased or decreased sweating; and changes in the way the eyes function in the dark or light.
The feet are very vulnerable to diabetes-related complications. There are a variety of foot problems that can occur. Foot problems are the leading reason for diabetes-related hospitalization. Further, diabetes is the leading cause of lower leg and foot amputation. Diabetes-related foot conditions are most frequently caused by poor blood circulation, infection, and nerve damage that can result in ulcers or sores, deformities, and trauma.
Diabetes can often lead to nerve damage called peripheral neuropathy. Peripheral neuropathy is a condition in which nerve function deteriorates in the limbs. This leads to a gradual loss of feeling in the hands, arms, legs, and feet. This is often problematic because pain is what enables people to know when something is wrong. Without pain, people may not realize that they have bruises, cuts, blisters or burns and therefore not seek medical treatment. It is important that people with diabetes receive medical treatment for foot sores because diabetes-related circulation problems can lead to more medical complications.
Peripheral vascular disease is a common diabetes-related circulation disorder. Poor circulation results in reduced blood flow to the limbs. It can restrict the delivery of oxygen and nutrients that are required for normal wound maintenance and repair. As a result, foot injuries, infections, and ulcers may heal slowly or poorly. Minor skin problems on the feet can become worse and lead to infection.
Wounds and injuries can be difficult to heal if diabetes is uncontrolled. This can be especially true of wounds in the feet. Infections tend to get worse or remain undetected, especially in the presence of diabetic neuropathy or vascular disease. Neuropathy can cause people to be unaware of wounds. Additionally, the increased pressure from the feet carrying the body weight aggravates foot wounds. Further, shoes can cause skin friction, rubbing, and tearing. The hot moist environment of shoes is favorable to infection and foot ulcers. Foot ulcers are sores caused by skin breakdown. They can be exacerbated by infection. Foot ulcers tend to develop over areas of high pressure, such as bony prominences or foot deformities.
Foot deformities are another common problem associated with diabetes. They occur when the ligaments and muscles that stabilize the foot bones deteriorate. This can cause the bones to shift out of position or an arch to collapse.
A hammertoe deformity is a common condition that occurs most frequently in the second toe, although it can be present in more than one toe. Increased pressure on the tips of the toes and the lack of muscle stability causes a joint in the toe to become permanently flexed with a claw-like appearance. The toe deformity and pressure displacement makes the toe susceptible to skin ulcers.
Charcot foot is another common foot deformity associated with diabetic neurogenic arthropathy. Neurogenic arthropathy is a progressive degenerative arthritis that results from nerve damage. Charcot foot most frequently affects the metatarsal and tarsal bones located in the midfoot and forefoot.
Charcot foot causes the foot muscles, ligaments, and joints to degenerate or break down. Without support, the foot becomes wider and deformed. Without joint stability, the foot becomes unstable, making walking difficult. Inflammation and pressure eventually can cause bone dislocation. The arches in the foot collapse creating a rocker-bottom appearance.
People with Charcot foot have impaired or absent abilities to feel pain, temperature, and trauma. They may not be able to sense the position that their foot is in. This makes them vulnerable to injury, such as fractures, sprains, joint dislocation, bone erosion, cartilage damage, and foot deformity. They may even continue to walk on a broken bone without knowing it, because they cannot feel it.
People with diabetes are generally more prone to skin infections and skin disorders than people without diabetes. People with diabetes have a greater tendency to get bacterial infections, fungal infections, and itchy skin. Some skin problems happen mostly to or only to people with diabetes. Such conditions include diabetic dermopathy, necrobiosis lipoidica diabeticorum, and atherosclerosis.
Bacterial infections tend to manifest as styes on the eyelid, boils, infected hair follicles, deep infections under the skin, and nail infections. Bacterial infections cause the skin to become hot, swollen, red, and painful. Fungus infections are caused by yeast-like organisms. They create itchy rashes in moist areas of the skin. Common fungal infections include jock itch, athlete’s foot, ringworm, and vaginal infections. Both bacterial infections and fungal infections can be treated with prescription medication.
Diabetic dermopathy and necrobiosis lipoidica diabeticorum (NLD) are similar skin disorders caused by changes in the blood vessels. Both conditions cause brown spots to appear on the skin. Diabetic dermopathy is harmless, but NLD can cause the skin to crack and bleed. NLD is a rare condition affecting mostly adult women. Open sores need to be treated by a doctor.
People with diabetes tend to get atherosclerosis at a younger age than people without diabetes. Atherosclerosis causes the arteries to thicken, narrowing the route for blood flow. It results in skin changes. The skin becomes hairless, thin, cool, and shiny. The toes become cold, and the toenails thicken and discolor. Atherosclerosis can also cause wounds to heal slower or become infected because of lack of blood flow.
Another complication of Type 2 Diabetes can be gastroparesis, a stomach disorder in which the movement of food is slowed or stopped. Gastroparesis occurs when high blood glucose levels damage the vagus nerve and the nerves that regulate stomach functioning over a period of time. The muscles in the stomach and intestines stop working properly. Signs and symptoms of gastroparesis include heartburn, nausea, vomiting, feeling full early when eating, weight loss, bloating, erratic blood glucose levels, lack of appetite, reflux, and stomach spasms.
If food stays in the stomach too long it can be dangerous. Delayed stomach emptying can lead to bacterial overgrowth and stomach or intestinal obstructions. Medications and nutritional changes can treat gastroparesis. In severe cases, a feeding tube may need to be inserted to deliver nutrients to the small intestine.
Finally, people with diabetes have a greater risk of depression than people without diabetes. Depression is a real medical condition that can be treated. Depression is not a “normal part” of every day life. You should monitor your child for signs of depression. Symptoms of depression include continually feel sad, irritable, tired, and uninterested in activities that your child used to find enjoyable. Other common symptoms of depression include changes in appetite, having difficulty getting a good night’s sleep, moving the body at a much slower pace, and not being able to remember things or concentrate as easily as before.
Doctors are not exactly sure why people with diabetes are at risk for developing depression. They suspect that people cope with diabetes management differently. Additionally, some of the symptoms of low or high blood sugar can cause symptoms that look like depression. You should discuss your concerns with your doctor so your child can receive appropriate diagnosis and treatment.