Diabetic Complications

Complications from diabetes can affect the eyes, feet, and other parts of the body.

Eye Complications

Diabetic retinopathy, glaucoma, macular edema, and cataracts are diabetic eye diseases. With cataracts, the eye’s lens gets clouded. In glaucoma, fluid pressure increases in the eye, leading to damage of the optic nerve. Diabetics are more likely to have these complications (and at an earlier age). When fluid leaks into the macula, then macular edema occurs. The macula is in charge of “sharp, straight-ahead vision” and the leakage and swelling makes the vision blurry. Diabetic retinopathy can cause blindness. The retina is light-sensitive tissue, and the blood vessels may leak fluid due to swelling, or new (abnormal) blood vessels can start to grow on the retina. There are four stages of this disease. In mild nonproliferative retinopathy, microaneurysms form. This means that there are “small areas of balloon-like swelling” in the blood vessels of the retina. The moderate stage has some blood vessel blockage, which deprives parts of the retina of blood supply. In the severe stage, many blood vessels are blocked, and the retina sends out signals to grow new blood vessels. The final stage, proliferative retinopathy, means that the signals from the retina trigger the growth of new blood vessels. These vessels are fragile, and their leakage can cause vision loss.¹

Other Body Parts Affected

Diabetics are also at risk of skin infections and neuropathy (nerve damage). Their feet may become numb. People with diabetes should watch their blood pressure, cholesterol, and glucose to avoid having a stroke, heart disease, or kidney disease (nephropathy). Ketoacidosis (DKA) is another diabetic complication.² In terms of skin conditions, diabetics can be more prone to itching and bacterial and fungal infections. They may also develop diabetic dermopathy (scaly patches), diabetic blisters, eruptive xanthomatosis (itchy bumps), necrobiosis lipoidica diabeticorum (lesions on the lower legs), and more.³ Diabetics’ feet may become dry and callused, get ulcers, and suffer from poor circulation. Amputation may be needed in cases of severe peripheral arterial disease (PAD).⁴ DKA can lead to coma or death when the cells don’t get enough glucose and the body is low on insulin. The body then burns fat to get energy, and that makes ketone acids. Frequent urination, dry mouth, high blood sugar, tiredness, flushed skin, vomiting, and a fruity odor on the breath are signs of DKA.⁵

Treatments and Prevention

Annual eye exams are important for people with diabetes to prevent or treat eye conditions at an early stage. In addition to dilation, comprehensive eye exams will also include a visual acuity test and tonometry (measuring the eye pressure). Patients seeing “floating” or spots in their vision, as well as blurriness, should seek treatment options. Some patients will need “sight-saving laser surgery”. Scatter laser treatment is used for proliferative retinopathy. In this procedure, laser burns are used to shrink the abnormal blood vessels, over two or more sessions. This treatment may reduce color, night, and side vision. In cases of severe bleeding, a vitrectomy may be necessary to remove blood from the center of the eye.⁶ Other treatment options include “intravitreal injections of Anti-VEGF drugs” and repeated “intravitreal injection of triamcinolone”, a steroid.⁷ Focal laser treatment is used for macular edema. Normal blood sugar levels can also help prevent nerve and kidney disease. Controlling cholesterol and blood pressure can also prevent diabetic complications.⁸ Kidney disease may be treated by monitoring glucose, using ACE inhibitor medications (to reduce blood pressure), and making dietary changes to a low-protein diet.⁹ To prevent amputation, regular foot care and proper footwear are necessary. Diabetics should also avoid smoking.¹⁰