Prevention | Understanding complications
The Most Important Complications You've Never Heard Of
A look at some of the lesser-known diabetes complications-and what to do about them
Keeping your blood glucose levels in range lowers your risk of developing diabetes complications like vision problems, cardiovascular disease, and kidney and nerve damage. But did you know that this same prevention strategy could help you avoid some of the lesser-known complications, such as autonomic neuropathy, gum disease and skin infections?
"These conditions are less studied than other complications, but most experts believe that their risk is greatly reduced with good glucose control," says Johns Hopkins endocrinologist Todd Brown.
Here are some diabetes complications you may not know about, including information about how to prevent them from becoming serious medical concerns.
Autonomic neuropathy
What it is: A condition that damages the nerves associated with regulation of blood pressure, heart rate, digestion and elimination, and other autonomic functions (those that happen without conscious effort on our part).
Risk: An estimated 60 percent of people with diabetes develop this.
Symptoms: May include dizziness and fainting upon standing, trouble with urination, sexual dysfunction, gastrointestinal disturbances (gastroparesis), cardiovascular problems and heat intolerance.
Treatment: Blood glucose control, medications and smoking cessation.
What you can do: Prevent or minimize your risk by controlling your glucose levels. According to the landmark United Kingdom Prospective Diabetes Study involving patients with Type 2 diabetes, every one percent decrease in A1C reduced the risk of microvascular complications (eye, kidney and nerve damage) by 35 percent! You can also address individual symptoms. If you suffer from gastroparesis, for example, eating smaller, more frequent meals low in fat and fiber (which actually slows digestion) may help. Your doctor may recommend replacing some solid meals with liquid meals to facilitate digestion. Medications can be used to minimize these and other symptoms, from sexual dysfunction to bladder problems to postural hypotension (dizziness upon standing).
Periodontitis
What it is: A bacterial infection that can cause inflammation and deterioration of the gums, bones and ligaments of the mouth. Left untreated, it can lead to tooth loss and other serious dental problems.
Risk: Very high in people with diabetes who have poor glucose control or who smoke.
Symptoms: Bleeding or swollen gums, receding gum line, bad breath and pain in the mouth.
Treatment: Aggressive dental care, at home and at the dentist. Advanced cases require gum surgery.
What you can do: Stop smoking, limit sugary foods (candy and sodas) and practice good dental hygiene, such as flossing daily and brushing the teeth and tongue with a soft nylon brush. Get a dental exam twice a year and be sure your dentist is current on your health history, including your diabetes and any recent infections. Get treatment at the first sign of symptoms.
Skin infections
What they are: Several skin infections are linked to diabetes, particularly when glucose levels are poorly controlled. Bacterial infections include staphylococcus, eye styes and nail infections. Fungal infections include vaginal infections, infections at the corners of the mouth, jock itch, athlete's foot and ringworm.
Risk: Up to one-third of all people with diabetes will have a skin infection at some time.
Symptoms: Depending on the type of skin infection, symptoms may include itching, burning sensations and changes in skin color and texture.
Treatment: Good glucose control is an integral part of the treatment strategy. Antibiotics are used to treat bacterial infections; topical or systemic antifungal medications treat fungal infections.
What you can do: Control your glucose levels. Practice good hygiene, keeping skin clean, dry and moisturized to reduce your risk of infection. Check feet daily. Treat any cuts and abrasions immediately. If a skin inflammation doesn't go away after a few days, report it to your doctor. It could be an abrasion or fungal infection that's slow to heal because of poor glucose control.
Cognitive decline
What it is: Decrease in mental functioning, such as memory or attention problems. In addition, recent studies show that older people with diabetes are at increased risk for dementia, a decline in intellectual function that interferes with daily functioning.
Risk: Uncertain, though the risk appears to be higher in people with poorly controlled diabetes and high blood pressure. Frequent hypoglycemia (low blood glucose) may also cause cognitive decline. Among people 65 and older, the risk for dementia appears to be about double than it is for older people without diabetes.
Symptoms: May include decline in memory, reduced speaking vocabulary or word recognition.
Treatment: Good glucose control and controlling blood pressure may prevent further cognitive decline.
What you can do: Keep glucose levels within range. To lower blood pressure, lose weight if you are overweight, eat a low-salt diet rich in fruits and vegetables, and limit alcohol. It's also important to tell your doctor about any problems you are experiencing with memory loss or intellectual functioning (problems recognizing family members or doing routine calculations, for example). Keep your wits sharp by playing trivia games, solving crossword puzzles, taking up a hobby or simply engaging in conversation.
Musculoskeletal disorders
What they are: Disorders of the muscles, nerves, tendons, ligaments, joints, cartilage and spinal discs. Limited mobility of joints in the hand and shoulder and conditions like carpal tunnel syndrome and trigger finger are more prevalent among people with diabetes.
Risk: About double that of people without diabetes, depending on the particular disorder.
Symptoms: Varies, depending on disorder; may include pain in affected joints, muscles, nerves or ligaments; joint inflammation; muscle weakness; joint stiffness; reduced range of motion.
Treatment: Depends on type and severity; may include physical therapy and steroid treatment. Good glucose control is important.
What you can do: Controlling glucose levels and losing weight are important to reduce your risk and minimize discomfort. Bring any joint or muscle symptoms to the attention of your physician. Engaging in low-intensity exercise, such as swimming or biking, can help control glucose levels and has been shown to reduce the pain of many musculoskeletal problems.
Low testosterone
What it is: Drop in levels of testosterone, a key male hormone.
Risk: About one-third of men with Type 2 diabetes have lower than normal levels of testosterone.
Symptoms: May include one or more of the following: decrease in libido, decrease in strength or endurance, fatigue, feelings of sadness.
Treatment: Lifestyle changes such as quitting smoking, engaging in regular exercise and eating a healthy and, in some cases, testosterone replacement therapy.
What you can do: In men who are overweight or obese, simply losing weight can increase testosterone levels.
A special concern for people with Type 1 diabetes
Certain autoimmune disorders are more common among people with Type 1 diabetes. That's not surprising because this type of diabetes is itself considered an autoimmune disorder. "In autoimmune disorders, the body has difficulty distinguishing self from non-self," Brown explains. As a result, the body's immune system attacks tissues that it mistakenly believes to be foreign substances.
Hypothyroidism (a sluggish thyroid), adrenal insufficiency (inability of the adrenal gland to produce adequate amounts of the hormone cortisol) and celiac disease (allergy to gluten products) are three autoimmune disorders found more often among people with Type 1 diabetes. You may not be able to avoid developing an autoimmune disorder but these medical conditions are treatable, particularly when they are detected early.
Top tips to prevent or minimize diabetes complications
- Keep your glucose levels within your target range. It's the best way to stave off complications.
- Be alert for lesser-known complications. They can be just as serious as more common ones.
- Report any unusual symptoms to your doctor. They could be a sign of a diabetes complication or an unrelated condition requiring prompt attention.
- Watch your weight with sound nutrition and regular physical activity. It's key to controlling your glucose levels.
