EDITOR’S NOTE: In the fourth article of AFMC’s year-long look at diabetes we focus on ways to prevent the many serious complications that diabetes can cause.

Having diabetes puts you at risk for serious problems with your heart, blood vessels, nerves, eyes, kidneys, bones, joints, skin, teeth and gums, as well as emotional problems. Fortunately, lifestyle modifications and carefully following your treatment plan can prevent or delay the development of these complications and the disabilities they cause.

As diabetes continues to increase at epidemic rates, many people with diabetes are spending a significant amount of their lives with disabilities. These disabilities are a key cause of reducing the lifespan of persons with diabetes. Diabetes will shorten the life of a 50-year-old person by more than three years; fewer of their remaining years will be disability-free.

Let’s take a closer look at the major types of complications and learn what you can do to avoid them.

Heart disease

 Having diabetes doubles your risk of heart disease or stroke. Two out of three people with diabetes die from heart disease or stroke, according to the American Diabetes Association (ADA).

Heart disease includes heart attack, hardening of the arteries (coronary artery disease), congestive heart failure, stroke and peripheral arterial disease (narrowed or blocked blood vessels in the feet and legs).

Heart problems may not cause any symptoms. But, if you have any of the following symptoms, contact your doctor immediately:

  • Chest pain or pain or discomfort in your arms, back, jaw, neck or stomach
  • Shortness of breath or difficulty breathing
  • Sweating, nausea or light-headedness
  • Sudden weakness, numbness or loss of balance; especially if on one side of the body; trouble walking
  • Sudden severe headache
  • Confusion, or difficulty talking or understanding
  • Blindness or partial loss of vision in one or both eyes; double vision
  • Leg pain when walking or exercising that goes away with a few minutes of rest
  • Numbness, tingling or coldness in the lower legs or feet
  • Sores or infections that heal slowly
  • Swelling of the feet or legs

To prevent heart disease:

·       See your doctor on a regular basis to be tested for early signs of heart disease.

·       Keep your blood pressure and cholesterol (the amount of fat in your blood) at or below the numbers your doctor asks you to maintain. Your doctor may prescribe both lifestyle changes and medications to get cholesterol and blood pressure under control.

·       If you smoke, quit immediately. Smoking reduces the blood flow to your legs and feet, which can lead to infections and possible amputation. Smoking also directly affects the health of your blood vessels, eyes, nerves and kidneys. There are many ways to quit. Ask your doctor what’s best for you – nicotine gum, medications, support groups or telephone counseling.

·       If you are overweight, start today to lose at least 5 percent of your body weight through portion control, better food choices and regular exercise.


Diabetic neuropathy means diabetes has damaged your nerves, making it hard for nerves to send messages to other parts of the body, especially your brain. Neuropathy usually causes painful tingling or a burning feeling in hands, legs and feet. It can cause muscle weakness, numbness or loss of feeling in some parts of the body, most commonly the legs and feet. The biggest danger with loss of feeling is not being able to feel a sore on your foot or not feel the pain of damaged joints or bones. If the unnoticed sore becomes infected, you may have to have an amputation. Most amputations are caused by diabetes.

To prevent amputations, check your feet every day for cuts, cracks in the skin, sores, red spots, swelling, infected toenails or blisters. Contact your doctor about any swelling, redness or your feet feel warm to the touch, or cuts or sores that are healing too slowly.

Other tips to keep your feet healthy include wearing shoes that fit well and breaking in new shoes slowly. Wear socks or stockings to avoid blisters and sores. Padded, seamless socks that fit well are best. Don’t go barefoot inside or out – it’s too easy to step on something and hurt your feet. Protect your feet from extreme heat and cold.

Diabetic neuropathy can also cause or contribute to erectile dysfunction in men and vaginal dryness in women.

Eye problems

Diabetes is the leading cause of blindness in the United States. It can damage the small blood vessels in the retina, the part of the eye that’s sensitive to light and sends messages to your brain about what you see. This complication is called diabetic retinopathy.

Damaged blood vessels in the eye can cause fluid to leak out and cause another part of your eye – the macula – to swell. A healthy macula provides sharp, clear vision. Swelling of the macula or fluid leaks can cause blurry vision. If not treated promptly, it can lead to blindness.

People with diabetes are 40 percent more likely to suffer from glaucoma. The risk increases the longer you have diabetes and increases with age. Glaucoma causes pressure to build up in the eye, which pinches the blood vessels that carry blood to the eye. Glaucoma can cause a gradual loss of vision.

Cataracts are more common in people with diabetes. They also happen at younger ages and progress more quickly in people with diabetes. The standard treatment for cataracts is surgical removal of the lens and replacement with an artificial lens. However, in people with diabetes, retinopathy can get worse after lens removal and glaucoma can develop.

The following symptoms could mean serious eye problems that could lead to blindness, according to the ADA. Report them immediately to your doctor.

  • Blurry vision for more than two days
  • Double vision
  • Sudden loss of vision in one or both eyes
  • Flashing lights in your field of vision that aren’t really there, especially in a dark room
  • Floaters – spots, cobwebs or strings that move or drift when you move your eyes
  • Seeing rings around lights or dark spots
  • Eye pain or pressure
  • Eyes get red and stay that way
  • Straight lines don’t look straight
  • Problems with side vision

However, most people with retinopathy have no symptoms. Your eyes can be badly damaged before you notice a change in vision. To prevent eye problems, see your eye doctor at least once a year, including a dilated eye exam.

Kidney damage

Diabetes can damage the blood vessels in your kidneys so they can’t filter out waste. Called diabetic nephropathy, the risk increases if you have diabetes and high blood pressure. People who have diabetes and nephropathy may eventually need dialysis or a kidney transplant.

Symptoms of kidney disease are rare until almost all function is gone. If there are symptoms, they are not specific – fluid buildup, loss of sleep, poor appetite, upset stomach, weakness and difficulty concentrating.

To prevent kidney damage, be sure your doctor checks annually for the first sign of nephropathy: protein in your urine and creatinine in your blood. Keep blood pressure under control because high blood pressure has a dramatic effect on how fast kidney disease progresses. Some doctors recommend a low-protein diet because it reduces how hard the kidneys must work.

Bones and joints

The nerve damage that can be caused by diabetes can also cause your joints to deteriorate, according to the National Institutes of Health (NIH). People with diabetes are at a higher risk for foot deformities, osteoporosis and arthritis.

If you continue to walk with a damaged joint or bone because you cannot feel the pain that would normally prompt you to get medical attention, you could develop Charcot foot. It starts with tingling, numbness or loss of sensation in the affected joints. It can progress to unstable, swollen or permanently deformed joints in the feet. Prevent this disabling condition by checking your feet every day. Osteoarthritis causes a similar breakdown of joint cartilage, pain, swelling, stiffness and loss of movement.

Osteoporosis causes bones to become weak and be at risk of breaking easily. It rarely causes symptoms but with more advanced cases you may develop stooped posture, loss of height and broken bones.


It’s much easier to get common skin problems (bacterial or fungal skin infections and itching) if you have diabetes. There are also several skin problems that can happen only to people with diabetes, according to the ADA.

Contact your doctor for antibiotics if you develop any of these bacterial infections: a boil, sty (infection in the eyelid), infections of hair follicles, nail infections or carbuncles (deep skin/tissue infections). Infected tissue is usually hot, swollen, red and painful.

Fungal infections can cause itchy rashes of moist, red areas surrounded by tiny blisters and scales. The most common infections are jock itch, athlete’s foot, ringworm and vaginal infections that cause itching. Fungal infections are most likely to occur in folds of skin that are warm and moist, such as between fingers and toes, under breasts, corners of the mouth, under the foreskin in uncircumcised men, armpits and groin area.

Skin conditions unique to diabetes can cause these symptoms:

  • Tan or brown raised areas on the sides of the neck, armpits and groin
  • Dull, red, raised area that changes to a shiny scar with a violet border; contact your doctor for treatment if it cracks open
  • Rash, depression or bumps at the sites where you inject insulin
  • Blisters on the backs of fingers/hands, feet/toes, legs or forearms that are painless
  • Tight, thick, waxy skin on the hands/toes accompanied by stiff, hard to move finger joints

Mouth and gums

Diabetes makes you more prone to gum infections because glucose is present in your saliva. When diabetes is not well controlled, high glucose in your saliva helps harmful bacteria to grow. When combined with food, bacteria grow into a sticky film on your teeth called plaque. Plaque causes tooth decay, gum disease and bad breath. Brushing your teeth twice a day and flossing every day will remove plaque.

Untreated gum disease can cause long-lasting infections and bad breath, changes in your bite and ability to chew food, and loose teeth than may fall out.

Thrush or candidiasis results when the body is unable to control a naturally occurring fungus that leaves your mouth sore, with white (sometimes red) patches on your gums, tongue, roof or sides of your mouth. Always contact your dentist or doctor for medicine to control thrush.

Uncontrolled blood glucose levels can cause a burning sensation in the mouth, dry mouth and a bitter taste.

The NIH advises you to tell your doctor or dentist about these symptoms:

  • Mouth sore or ulcer that does not heal
  • Gums that bleed, look red or are swollen
  • Pain in your mouth, face or jaw that doesn’t go away
  • Loose teeth
  • Pain when chewing
  • Changes in your sense of taste or a bad taste in your mouth
  • Bad breath that doesn’t change after brushing teeth and flossing

Emotional health

Receiving a diagnosis of diabetes, then fully accepting that diagnosis and learning how to manage it is a lot to absorb. When diabetes first enters your life, it’s common to be emotionally upset, angry, deny the diagnosis or even become depressed.

Much of this emotional upset can stem from stress. Unmanaged stress can make diabetes worse. It can cause you to neglect your normal care routine. Prolonged stress can produce hormones that may prevent insulin from working properly, making matters worse.

Take control of stress by setting limits on your time and activities. Prioritize your tasks and do what’s most important first. Learn relaxation techniques that work for you and that you will practice daily. If you aren’t getting plenty of sleep, discuss sleep problems with your doctor.

The ADA says anger is common when people are first diagnosed with diabetes. “Diabetes can make you feel threatened. Life with diabetes can seem full of dangers: insulin reactions or complications. Out-of-control anger can cause more harm than good. But anger can also help you assert and protect yourself. You can learn to use your anger for better diabetes care.”

Anger can be caused by not fully accepting the fact that you have diabetes. Ask your doctor about seeing a counselor or joining a support group of other people with diabetes.

Some people who are newly diagnosed will deny they have diabetes as a way of coping with bad news. However, if denial continues, it can keep you from taking care of yourself and making the lifestyle changes needed to stay healthy. Denial can show up in a variety of ways: not bothering to check your blood glucose, eating foods that aren’t good for you, ignoring daily foot checks or continuing to smoke.

Ask a diabetes educator for help conquering denial. Write down your care plan and goals; be sure you understand why each item is important. Explain your care plan to family and friends and tell them how they can help you stick to it.

People with diabetes have a greater risk of depression than nondiabetics. Stress, frustration and anxiety can build up, making it difficult to follow your care plan. Depression symptoms can include prolonged sadness or apathy, changes in appetite or sleep patterns, loss of energy, nervousness or even suicidal thoughts. If you feel this way for two weeks or more, it’s time to get help. Contact your doctor because there may be a physical cause of your depression. Depression-like symptoms can be caused by poor control of blood sugar, thyroid problems, medication side effects, or alcohol/drug abuse. If your doctor rules out these causes, he or she may prescribe counseling, psychotherapy or antidepressant medication.

Prevent complications

The most important thing you can do to prevent the serious complications of diabetes is to keep your blood sugar level as close to normal as possible.

The ADA offers these tips to help:

  • Follow your doctor’s instructions exactly for taking insulin or medications.
  • Eat a variety of healthy foods, avoiding those that are high in fat, cholesterol, salt and added sugar.
  • Maintain a healthy weight.
  • Keep your blood pressure at or below 130/80 mm Hg.
  • Maintain a healthy cholesterol level under 200 mg.
  • Be physically active on a regular basis.
  • Quit smoking.
  • Take care of your feet and check them every day for signs of injury or infection.
  • See your doctor regularly even if you feel fine and keep up-to-date with your annual health screenings: A1C tested twice a year, cholesterol, kidneys (check urine and blood), dilated eye exam, and dentist twice a year.
  • Stay up-to-date on vaccines, including a flu shot each year, pneumonia vaccine (you may need a five-year booster shot), hepatitis B vaccine if you’re younger than 60 and a tetanus booster every 10 years.
  • Manage your stress.

Links to articles about an overview of diabetes, preventing diabetes and treatment options.