Diabetes mellitus is a disease that – especially if blood sugar is poorly controlled – can lead to a wide variety of complications and secondary diseases in the long term. Many of these consequences occur insidiously, but in most cases, early recognition of symptoms is crucial for successful treatment. Find out what dangers and risks can occur with diabetes.
Consequential diseases of diabetes
In the long term, the high concentration of sugar in the blood can lead to blockage and damage to the blood vessels in diabetics. A distinction is made between damage to the small and large blood vessels (microangiopathy and macroangiopathy). Over time, this results in damage to the nerves, heart, kidneys, legs or eyes, for example. The following complications can occur with diabetes:
- Cardiovascular problems
- Peripheral arterial occlusive disease
- Neuropathy
- Diabetic foot
- Retinopathy
- Nephropathy
- Erectile dysfunction (in men)
- Dental problems
- Hyperglycemia
- Ketoacidosis
- Hypoglycemia
Below we present these complications in more detail.
Cardiovascular problems
Cardiovascular disease is the most common consequence of diabetes. Over time, elevated blood glucose levels cause deposits (plaques) to form on the inner walls of large blood vessels. As a result, these vessels become clogged and blood flow is impaired. Blockage of the large blood vessels, also known as arteriosclerosis or “hardening of the arteries,” is a common sign of aging but occurs comparatively often and early in diabetics. This increases the risk of developing cardiovascular disease. In diabetics, this increases the likelihood of the following diseases:
- Myocardial infarction (often also unnoticed, one speaks then of a silent infarction).
- Coronary heart disease (CHD)
- Heart pain and chest tightness (angina pectoris)
- Cardiac arrhythmias
- Heart failure (cardiac insufficiency)
- High blood pressure
The risk of stroke is also increased by atherosclerosis. Diabetics should therefore not only try to lower their blood sugar, but also avoid high blood pressure and high cholesterol levels as further risk factors for cardiovascular disease. Regular preventive checkups by the attending physician are therefore of great importance. For more information on heart problems in diabetes, click here.
Peripheral arterial occlusive disease
In peripheral arterial disease (pAVD), blood flow to the legs is disrupted by vascular deposits. This results in a lack of blood flow (ischemia) to the feet and legs, especially in the tips of the toes. The condition is also known as shop window disease because sufferers experience pain when walking and often have to stop until the pain passes – some sufferers make this look like window shopping. Typical symptoms include pale or bluish and cold feet. The feet often ache with minor exertion, and even the smallest injuries can cause great pain or lead to widespread inflammation. The healing process is also disturbed, which is why the wounds heal very poorly.
Diabetic neuropathy: nerve damage.
Diabetic neuropathy is damage to the nerves of the peripheral nervous system as a result of diabetes. The peripheral nervous system includes all nerves outside the brain and spinal cord, such as the nerves in the hands or feet. Nerve damage is caused by vascular changes and circulatory disorders, which is why the nerves are no longer properly supplied with nutrients and die. If a particularly large number of nerves are affected, this is also known as diabetic polyneuropathy. As a result, diabetics suffer, for example, from sensory disturbances such as tingling, numbness or the lack of perception of pain and temperature changes. The fine nerve endings of the feet are usually affected. Muscle problems such as cramps or paralysis can also occur. If the so-called autonomic nervous system is affected, possible signs range from disturbed sweat production to heart problems. Detailed information on neuropathy can be found in this article.
Diabetic foot
Diabetic foot (also: diabetic foot syndrome) is a collective term for a wide variety of changes in the feet as a result of diabetes – this can range from an infestation of athlete’s foot to ulcers or tissue death. Diabetic foot occurs either due to diabetic neuropathy or is a consequence of PAOD – or it is caused by a combination of both. The nerve damage and circulatory problems cause the feet to become dry and cracked, making them vulnerable to invasion by pathogens. Small injuries not only occur more easily, they also heal more poorly and open wounds and inflammation quickly develop. At the same time, impaired pain perception can mean that such changes are not noticed or are noticed only late. In the worst case, the tissue dies (necrosis) and amputation of the foot is inevitable. For prevention, therefore, a daily check of the feet, suitable footwear and proper foot care are crucial. Detailed information on diabetic foot syndrome can be found here.
Diabetic retinopathy: damage to the eyes.
If diabetes exists for years, damage to the eyes can be the result. This is because elevated blood sugar damages and closes the smallest blood vessels that supply the retina with nutrients and oxygen in the long term. On the one hand, this results in a deficient supply of nutrients and oxygen to the retina, and on the other hand, small hemorrhages in the retina and the deposition of fatty substances can be the result. With the progression of this disease, visual complaints or, in the worst case, loss of eyesight (blindness) may be imminent. As a rule, the person affected does not notice the changes at first, because his or her vision is not affected at first. Later, visual disturbances such as blurred vision occur. In the early stages, such a change in the retina is still easily treatable. Therefore, preventive examinations by the ophthalmologist are particularly important for diabetics. In addition to diabetic retinopathy, changes in the yellow spot (maculopathy), inflammation of the eyelids, or glaucoma or cataracts can also occur as a result of diabetes.
Nephropathy as a result of diabetes: stress on the kidneys
The circulatory problems and narrowing of small blood vessels that often accompany improperly controlled diabetes can also damage the kidneys (diabetic nephropathy). As a result, the kidneys increasingly lose their ability to filter the blood and remove waste products. Over time, this can lead to chronic kidney failure. If the kidneys fail, regular artificial blood washing (dialysis) is required to replace the function of the kidneys. Damage to the kidneys also causes high blood pressure, which must be treated with medication. For more information about diabetic nephropathy, see this article.
Erectile dysfunction: problems in bed
A fairly common consequence in male diabetics with poorly controlled blood sugar is the development of erectile dysfunction. This may be due to a number of reasons:
- Damage to the small and large blood vessels impairs the blood supply to the penis.
- Nerve damage can be the reason that sexual responses are absent or difficult.
- Disturbed hormone balance can cause a lack of testosterone.
- Medications taken, for example, beta-blockers or cholesterol-lowering drugs, can also have an impact on sexual functioning.
- In addition, psychological aspects, such as depression as a result of diabetes, are also considered possible triggers.
Early treatment can help many sufferers with erectile dysfunction.
Dental problems with diabetes
Dental health can also be affected by diabetes. This is because diabetics often have weakened defense mechanisms and reduced salivary flow due to altered sugar metabolism. Vascular deposits in the small vessels can impair blood flow and nutrient supply to the gums, which weakens them and makes them more susceptible to inflammation. As a result, bacterial infections or periodontitis, the inflammation of the tooth bed, occur more frequently. People with diabetes are about three times more likely to develop periodontitis. In addition, inflammation in the mouth can easily affect blood sugar in diabetics and make it more difficult to control.Periodontitis and diabetes mellitus can therefore influence each other. Thorough oral hygiene and regular checkups with the dentist are particularly important for people with diabetes. If gum inflammation, the precursor to periodontitis, is suspected, it is essential to consult a dentist. If wound healing is impaired as a result of diabetes, the preventive administration of an antibiotic may be useful during dental procedures to prevent infections.
Hyperglycemia.
People with diabetes should take care to limit their sugar consumption in everyday life. This is important not only to keep blood sugar at a healthy level in general, but also because acute hyperglycemia can have serious consequences. Signs of hyperglycemia include fatigue, thirst, frequent urination, muscle cramps and sometimes nausea. Drowsiness and eventually unconsciousness may occur. In such cases, the administration of insulin can help to lower blood glucose levels quickly. Especially in type 1 diabetes, hyperglycemia increases the risk of developing ketoacidosis.
Ketoacidosis: when metabolism is out of balance
Ketoacidosis occurs mainly in people with severe insulin deficiency as a result of type 1 diabetes and is then also called diabetic ketoacidosis. It is a metabolic disorder in which there is an excess of ketone bodies (sugar substitutes that the body can produce in the liver) in the blood. As a result, the pH of the blood drops into the acidic range. Typical symptoms, in addition to abdominal pain, fever and vomiting, are the so-called “kissing mouth breathing“, in which affected persons breathe particularly deeply as the body tries to exhale the acidic substances. The breath may smell of acetone (similar to nail polish remover). If the electrolyte balance becomes unbalanced, this can lead to disturbances in kidney function or heart rhythm, as well as water retention in the brain. In the worst case, there is a risk of shock or coma. In this article, you can read in detail about ketoacidosis in diabetes.
Hypoglycemia.
Diabetics should not only be careful not to consume too much sugar, but hypoglycemia can also be dangerous. Possible triggers of such hypoglycemia may include excessive physical exertion, infection, accidental overdose of insulin, or a skipped meal, for example. If blood glucose falls below about 50 milligrams per deciliter (mg/dl), the body’s cells no longer function correctly and symptoms such as restlessness, trembling, fatigue, dizziness or concentration problems, and even seizures or fainting, occur. The risk of hypoglycemia should also not be underestimated in road traffic, as it can increase the risk of car accidents. Dextrose or sugary soft drinks (not light products) can help to quickly raise blood sugar again in the event of hypoglycemia. An alternative in the event of severe hypoglycemia with loss of consciousness is a glucagon emergency kit. Glucagon is a hormone that can be injected by others in such a case, causing the body to release its sugar reserves.
Other secondary diseases of diabetes
In addition to the diseases already mentioned, researchers also suspect links with other diseases, although not all of these have been fully explored. For example, diabetes could promote the development of fatty liver or vice versa. A connection between diabetes and lung diseases such as asthma, COPD or pulmonary fibrosis is also suspected. Furthermore, as a pre-existing condition, diabetes can negatively influence the course of various diseases.
How can diabetics prevent complications?
The be-all and end-all for preventing complications is a well-controlled blood glucose level. The HbA1c value measured at the doctor’s office is particularly important in this regard. The risk of secondary diseases is considered low if this long-term value is below 58 millimoles per mole (7.5 percent). In addition, however, a healthy lifestyle with the right diet and sufficient exercise are also important. Keep a close eye on your body so you notice warning signs early. Regular check-ups with your doctor, ophthalmologist and dentist also help to quickly identify an increased risk of secondary diseases and take appropriate countermeasures. In this way, people with diabetes can effectively reduce the risk of complications.
