Complications of Type 2 Diabetes
There is little doubt that diabetes is a serious disease. There is also little doubt that people with diabetes can live long, healthy, happy lives if they keep their diabetes under control. But do you know that how well you manage your disease on a day-to-day basis can have a dramatic impact on your degree of risk for the complications of diabetes?
The complications of
are both numerous and serious. These include:
Heart Disease and Stroke
Diabetes is one of the major, modifiable risk factors for heart disease and stroke. If you have other risk factors, like high blood pressure and high cholesterol, you have an increased chance of developing problems with your blood vessels. A clogged or narrow vessel in your heart can lead to a heart attack, while the same problem in your brain can lead to a stroke. This means that people with diabetes must not only keep their blood sugar levels under control, but also effectively control their blood pressure and cholesterol levels, as well.
Type 2 diabetes damages the small blood vessels in the eyes. This can put you at increased risk for three types of vision problems:
cataracts, and retinopathy (a general term for disorders of the retina caused by diabetes). Fortunately, most diabetes-related vision problems can be slowed or stopped if caught early and can be prevented with good blood sugar and blood pressure control.
High levels of blood sugar cause the kidneys to overwork. Eventually, this excess strain can cause the kidneys to leak. Eventually, needed protein is lost in the urine and waste products build up in the blood. If diagnosed early, there are several treatments that may prevent your kidney disease from getting worse. If caught later,
this can result in kidney damage and kidney failure. People whose kidneys are no longer working need to have dialysis, a procedure which filters the blood by machine. They may also need a kidney transplant.
Neuropathy (Nerve Damage)
Diabetic neuropathies are a family of nerve disorders caused by diabetes. Neuropathy is the most common complication of diabetes and can be both painful and disabling. Over time, diabetes can damage the nerves throughout the body. This may lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. It may also affect other organ systems, such as the digestive tract and the cardiovascular system.
A common type of neuropathy is called peripheral neuropathy. When the nerves of your foot are damaged, for example, you may not notice ulcers on your foot. These ulcers can lead to serious complications, such as gangrene or
Glucose control seems to play a role in neuropathy. This means that the longer a person has diabetes, the greater their risk of developing nerve damage, particularly if they have difficulty controlling their glucose, cholesterol, and blood pressure levels. Fortunately, maintaining good blood sugar control seems to help prevent or delay neuropathy.
As many as 33% of people with diabetes will have some type of skin disorder during their lifetime. Indeed, skin problems are sometimes the first indication that a person has diabetes. Common, diabetes-related skin disorders include itchy skin, bacterial infections, fungal infections, and diabetic dermopathy (patches of brown, scaly skin). Fortunately, many of these conditions can be either prevented or easily treated if caught early.
If you have diabetes, you are at higher risk for gum disease than people who do not have the disease. To make matters worse, gum disease also raises your risk of heart disease and stroke. This is because diabetes may weaken your mouth's ability to fight germs. And while it’s true that anyone can get gum disease, having diabetes can make it worse and make it more difficult to control. Proper oral care and regular dental visits can help keep gum disease under control.
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder affects about a fifth of people with diabetes. A frozen shoulder, technically known as adhesive capsulitis, often begins as tenderness or soreness in the shoulder joint, usually following a bout with another musculoskeletal condition such as
bursitis. As the shoulder becomes stiffer and more painful, people tend to use it less and less. Unfortunately, this eventually only adds to the stiffness and pain, creating a vicious cycle in which the shoulder’s range of motion decreases while the pain and stiffness increases.
Researchers aren’t sure exactly why diabetes is a risk factor for frozen shoulder. One theory is that uncontrolled levels of glucose in the blood may contribute to abnormal deposits of collagen in the cartilage and tendons of the shoulder. Collegen is a major part of the ligaments that hold the bones together in a joint. This buildup can cause the affected shoulder to stiffen.
How Can You Lower Your Risk?
In addition to the above complications, there are many other conditions that have been associated with diabetes. While thinking about your long-term health may feel overwhelming, there are steps that you can take today to reduce your chance of future health problems:
- Have regular checkups and contacting your doctor if you notice any new symptoms, such as a sore on your foot
- Strive to keep your blood sugar under control
- Strive to keep your blood pressure and cholesterol levels under good control
- If you smoke, talk to your doctor about how you can successfully quit
- Getting the recommended vaccines, such as the flu shot and the pneumonia vaccine
- Exercising regularly and maintaining a healthy weight
- Asking your doctor if there are any medications that you should take to prevent complications
The American Diabetes Association
National Diabetes Information Clearinghouse
Canadian Diabetes Association
Complications. American Diabetes Association website. Available at:
http://www.diabetes.org/living-with-diabetes/complications. Accessed November 18, 2013.
Diabetes mellitus type 2. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated November 13, 2013. Accessed November 18, 2013.
Diabetic neuropathies: the nerve damage of diabetes. National Diabetes Information Clearinghouse (NDIC) website. Available at:
http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/index.htm. Updated June 25, 2013. Accessed November 18, 2013.
Gross JL, de Azevedo, Silveviro SP, et al. Diabetic nephropathy: diagnosis, prevention, and treatment.
Diabetes Care. 2005;28:176-88.
Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomized placebo-controlled trial.
Kendall DM, Riddle MC, Rosenstock J, et al. Effects of Exenatide (Exendin-4) on glycemic control over 30 weeks in patients with type 2 diabetes treated with metformin and a sulfonylurea.
Diabetes Care. 2005;28:1083-91.
Kris-Etherton PM, Harris WS, Appel LJ for the AHA Nutrition committee:Omega-3 Fatty Acids and Cardiovascular Disease. Arteriosclerosis, Thrombosis, and Vascular Biology 2003; 23:151-52.
Lipid control in the management of type 2 diabetes mellitus: a clinical guideline from the American College of Physicians.
Annals Internal Med. 2004; 140:644-9.
Living with type 2 diabetes. American Diabetes Association website. Available at:
http://www.diabetes.org/living-with-diabetes/?loc=404. Accessed November 18, 2013.
Molitch ME, DeFranzo, Franz MJ, et al. Diabetic nephrophathy.
Diabetes Care. 2003; 26 (Supp 1):S94-8.
Moor H, Summerbell C, Hooper L, et al: Dietary advice for treatment of type 2 diabetes mellitus in adults.
Cochrane Database of Syst Rev. 2004;2.
Prevent diabetes problems: keep your diabetes under control. National Diabetes Information Clearinghouse (NDIC) website. Available at:
http://diabetes.niddk.nih.gov/dm/pubs/complications%5Fcontrol/index.aspx. Updated August 8, 2013. Accessed October 14, 2003.
Skyler JS, Bergenstal R, Bonow RO et al. Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials.
Standards of medical care in diabetes—2012.
2012;35 Suppl 1:S11-S63..
2/7/2008 DynaMed Systematic Literature Surveillance
EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us: Armstrong DG, Holtz-Neiderer K, Wendel C, Mohler MJ, Kimbriel HR, Lavery LA. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients.
Am J Med.
2/7/2008 DynaMed Systematic Literature Surveillance
EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us: Lavery LA, Higgins KR, Lanctot DR, et al. Home monitoring of foot skin temperatures to prevent ulceration.
Diabetes Care. 2004;27:2642-2647.
2/13/2008 DynaMed Systematic Literature Surveillance
EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us: For safety, NHLBI changes intensive blood sugar treatment strategy in clinical trial of diabetes and cardiovascular disease. NIH News. National Institutes of Health website. Available at:
http://www.nih.gov/news/health/feb2008/nhlbi-06.htm. Accessed November 18, 2013.
2/21/2008 DynaMed Systematic Literature Surveillance
EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us: Major international diabetes study does not confirm increased risk of death reported by US trial. Action in Diabetes and Vascular Disease: PreteraAx and DiamicroN MR Controlled Evaluation (ADVANCE) website. Available at:
http://www.advance-trial.com/static/html/virtual/contents.asp?P=39. Accessed November 18, 2013.
4/10/2008 DynaMed Systematic Literature Surveillance
EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us: The ONTARGET investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events.
N Engl J Med.
6/18/2008 DynaMed Systematic Literature Surveillance
EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us: ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
N Engl J Med.