Diabetes Complications

Bloodshot eye due to diabetes and high blood pressure.

Diabetes Complications

Diabetes has several complications.  We need to understand that insulin is a growth hormone.   This hormone helps the body to grow, sometimes to the point of obesity.

Diabetes is associated with the following complications:

  • Cardiovascular disease
  • Nerve damage (neuropathy)
  • Kidney damage (nephropathy)
  • Eye damage (retinopathy)
  • Foot damage
  • Amputations
  • Hearing impairment
  • Alzheimer’s disease
  • Diabetes-related skin conditions
  • Stroke

Cardiovascular disease

Insulin is directly associated with LDL cholesterol. (Low-density lipoprotein) This is the type that puts your heart at greater risk for a heart attack from a sudden blood clot that forms there.  The bad cholesterol packets, as well as cholesterol production itself, leading to high cholesterol levels.  Insulin can also lower the good cholesterol, called HDL. This is the case if you have  peripheral insulin resistance. This, of course, is setting the body up for a heart attack. In fact many insurance companies factor this condition in as if somebody has already had a heart attack.

Nerve damage

Excess sugar can injure the walls of the tiny capillaries (blood vessels) that nourish nerves.  This is especially prevalent in legs. The sensation is often described as a tingling sensation or numbness.  It can be a burning feeling or pain that often begins at the tips of the toes or fingers.  It will spreads upwards and outwards. If left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves that are  related to digestive system  can cause problems with nausea, vomiting, diarrhea or constipation.  In men it may lead to erectile dysfunction, ok now do I have your attention.

Nephropathy

Diabetes can cause  kidney disease also called diabetic nephropathy  It  is a complication of type 1 or type 2 diabetes caused by damage to the delicate filtering system in the kidneys.

The human kidneys contain millions of tiny blood vessel clusters called glomeruli.  There function is to filter waste from your blood. Severe damage to these blood vessels can lead to diabetic nephropathy, this may lead to kidney failure or irreversible end-stage kidney disease.  In such cases dialysis is usually required. A kidney transplant can be an option but this is dependent of several factors including the overall health of the recipient.

If you are facing diabetic nephropathy, it’s very important for you to have your kidney function tested and monitored on a regular basis.  You need to keep track of any changes  to prevent it from worsening and reduce your risk of heart disease.

Retinopathy

Diabetic retinopathy is caused by damage  in the blood vessels of the retina.  These blood vessels  may leak blood and grow fragile. When the nerve cells are damaged, vision is impaired.

These changes can result in blurring of your vision.  Hemorrhage may occur  in the eye or even retinal detachment could be the result if left unchecked. Diabetic retinopathy is the most common diabetic eye disease in the United States of America and also a leading cause of blindness.

Retinopathy has a strong association with  high cholesterol, anemia, smoking ,high blood pressure, obesity.  These things are within your control.

Foot damage

Diabetes is one of the most common reasons people seek relief for painful feet. With diabetes, four types of foot problems may arise in the feet.

Peripheral Neuropathy

The nerves are directly affected by diabetes. There are three types of peripheral neuropathy: sensory, motor, and autonomic neuropathy.

Sensory neuropathy is the most common source of discomfort.. Feet become very sensitive to even the slightest touch.  Even doing simple tasks like putting on your shoes can become an ordeal.  Numbness, burning, tingling or a stabbing pain can also play a part.

Pain medication is the first thing most people reach for.  However, the cause is the high blood sugar.  A1c test can give one a better picture of the situation but the bottom line is the cause needs to be addressed.

Hypertension contribute to this type of pain and relief can come from vitamin B massaging your feet with a diabetic foot cream, or using a foot roller.  The pain will not go away but may be abated.

Motor neuropathy

Motor neuropathy can contribute to other painful diabetic conditions. The nerves leading to the muscles become affected by the disease process. The thigh muscle is often the first to be affected and walking imbalances can be the result.

Supportive shoes and foot support inserts make a difference. Foot exercises, massage and using foot rolling devices are excellent ways to help keep those muscles and joints from becoming stiff and inflexible.

Dry and cracked skin will cause calluses and add to the pain.  Bacterial and fungal infection could be more likely so be sure to use toenail oil and foot cream..

The key is to keep the muscles moving and doing more, the trap is that most people do less.

All these conditions are due to the effect of high blood sugars on the arteries, capillaries and veins. Arteries feed oxygen rich blood away from the heart. This blood nourishes and provides oxygen to the tissues. The blood enters and leaves the tissues through capillaries and goes back up to the heart to get refreshed with oxygen and nourishment by way of the veins.

The arteries most commonly affected are those behind the knee and the calf. These arteries are subject to the same fatty deposits that most people have.  The difference is  that  the process is be accelerated in diabetes. These fatty deposits thicken the walls of the arteries, and may develop calcium deposits.  The blood flow to the feet is then be partially  blocked. Tissues that needs  oxygen sends out pain signals to the body to correct this situation.

Another problem is that sometime there is more blood than the veins can handle. The veins become so full that the valves are stressed and get damaged. Blood flow slows down  in the feet and legs and can leak out into the skin.  This in turn causes  ulcerations.  This is extremely painful.

Short term solutions include support hose, and medication.  Reversal makes use of exercise, massage, physical therapy and most importantly hydrotherapy.

Muscle and Joint Problems

Overall diabetes leads to general discomfort and pain. The muscles have circulation problems and atrophy. The tendons that attaches the muscles to the bones  become stiff and contracted, partly because of the walking imbalance caused by peripheral neuropathy.   The system is out of balance and needs to compensate feet and joints are asked to work in new ways and flex away from pain.  They stiffen in these new bent position.  The excess blood sugar combining with the proteins in the joints set the stage for long term pain. This is called diabetic glycosylation of the joints.  Stiff hammertoes, bunions, spurs, and tiny fractures with dislocation of the bones called Diabetic Charcot Deformity begin to show up. These problems can be sources of pain, infection, ulceration and major medical concerns.

Infections

Bacterial, fungal and yeast infections take advantage of the lack of oxygen and nutrients and grow rapidly, spreading and covering the skin.  This is the ugly side of diabetes.

The skin become irritated, ulcerated, swelling, and tenderness is the result.  Pus is the result.  The infection can often be detected from a distance, the smell can be overpowering.   The infection can external (cellulitis) or internal where it spreads to the bone. Bone infection it is called osteomyelitis.  Numbness in the extremities does not mean that you will not feel this type of pain.

The feeling of pain in a area that was numb previously can mean one of two thing.  Firstly that infection is present.  In such a case you should get medical advice immediately.  The second option is that your circulation is returning to the area.  This will be the result of  hydrotherapy.

Natural remedies include the use of tea tree oil, epsom salts,  sesame oil, garlic, grapefruit seed extract, and gallberry root soaks. Not all diabetics can detect the pain in their extremities. They will need to be extra careful and cautious.  Make a routine inspecting the areas every day.

 Amputations

Small blood vessels go throughout the body and especially the eyes, kidneys, nerves, legs, and even the skin of the feet, are danger zones.  The damage from high blood sugars is one of the most common causes of amputation in America.

  • “Each year, over half of all amputations in the United States are caused by diabetes mellitus and subsequent complications, with most being lower-extremity amputations.
  • From 1980 to 2003, the number of diabetes-related LEA hospital discharges increased from an average of 33,000 to a high of 84,000 in 1997, dropping to 75,000 in 2003 “ http://www.amputee-coalition.org/

Diabetes-related skin conditions

We all like to be comfortable.  Imagine that this was not the case, imagine your skin made it difficult for you to sit down or sleep.  Diabetes affects the whole body and the bodies largest organ, the skin is no exception.

BACTERIAL INFECTIONS

High  blood glucose levels cause people with diabetes to be more susceptible to infection. Their is a disproportionately higher amount of people with diabetes that have skin disorders.  Bacterial infections are common.

Impetigo and ecthyma

Impetigo is contagious.  It is a  superficial skin infection.  The blister is often filled with fluid pus. It can easily be mistaken for pimples.  This infection most often arises on the face, arms, legs, buttocks or  hands.  It prefers skin folds such as the underarms and groin areas.  Impetigo could disappear by itself or if one uses a topical antibiotic.  A good antibacterial soap should be used to stop the spread.

Ecthyma is similar to impetigo and can in fact result from untreated impetigo. Ecthyma is a deep tissue version of  impetigo. It is also more likely to be situated on the legs or buttocks, this is often due to hygienic reasons.  The treatment period for ecthyma is longer and antibiotics are usually prescribed for clearing up the clear up infection and scarring may occur.

Folliculitis, furunculosis, and carbuncles.

All three these infections are located in the hair follicles.  The follicles become infected due to humidity or damage to the follicles.  The nodules become infected, with swollen skin that  break open after a few days.  Carbuncles are the worst degree and may cause fever or illness.  Such lesions often need surgical attention and antibiotics.

Cellulitis and gangrene.

Bacterial infections can cause severe problems, cellulitis and gangrene are the worst  of infection. Cellulitis spreads in the deep layers of skin as well as in the fat.  It is often caused by an topical skin lesion that get infection and is not treated.  The skin becomes hard, red and painfully swollen.  Extremities and facial tissue are easily affected with the legs being three times more likely to be affected than the arms.  This condition calls for medical intervention.  Your doctor will usually prescribe intravenous antibiotics and the infection should clear up within 7 – 24 days.

Gangrene is a potential killer, in fact the mortality rate is high if proper treatment is not given early on.  The condition often develops on the hands or feet.  Gangrene is what happens when cellulitis is not treated.  The skin becomes blue with a tinge of green and blisters appear.  The blisters fill with pus and rupture leaving the skin dead and black.

FUNGAL INFECTIONS

High blood glucose levels can also predispose people with diabetes to developing common fungal skin infections from organisms such as Tinea and Candida.

Fungal infections can occur just about anywhere, including the feet (Tinea pedis), the hands (Tinea manuum), the body (Tinea corporis), and the groin (Tinea cruris). Tinea pedis, or athlete’s foot, usually occurs in the web spaces between the toes or on the soles of the feet. Lesions are itchy and may develop vesicles (sacs filled with air or fluid) or may simply be red and scaly. It is usually contracted by walking barefoot on a contaminated floor. To help prevent athlete’s foot, it is always a good idea to wear slippers or shoes of some sort in public areas such as locker rooms. Tinea manuum is characterized by papules (small, raised pimples or swellings), vesicles, or scaling, typically on the dominant hand, and is associated with touching athlete’s foot lesions.Tinea corporis, or ringworm, presents as multiple red or pinkish circular lesions with a distinct, scaly border. In severe cases, the lesions may merge, forming large, discolored areas on the body. Tinea cruris, or jock itch, results in red to brownish, scaly, itchy lesions that cover the groin and sometimes extend to the pubic region and upper thighs.

Candidiasis of the skin tends to occur in folds of skin such as the underarms, groin, under the breasts, and between the buttocks. This condition begins with pustules on a red base that eventually result in softened, thickened areas of skin.

All of these superficial fungal infections are treated in more or less the same way. Applying antifungal creams two to three times daily for approximately two to four weeks should clear the infection. Keeping the affected areas dry, and using medicated powders in skin folds to reduce friction and moisture are also helpful measures. Infections that don’t respond to topical treatment may be treated with oral antifungal medicines.

SKIN CONDITIONS ASSOCIATED WITH DIABETES

The following skin conditions are strongly associated with having diabetes, but they can occur in people who don’t have diabetes as well.

Acanthosis nigricans.

This condition is characterized by the formation of velvety, brownish, thickened areas of skin in the groin, underarms, under the breasts, and in the creases of the neck. The affected skin may become leathery or warty or develop tiny skin tags. Acanthosis nigricans is common in people who are obese, but it may also be associated with certain forms of cancer as well as endocrine disorders such as polycystic ovarian syndrome (PCOS), acromegaly, Cushing syndrome, and diabetes.

There is no cure for this condition, but it may improve with weight loss, topical bleaches, or a class of drugs known as keratolytics.

Vitiligo.

Vitiligo is a skin disorder that causes white spots or large areas of depigmentation to occur on various areas of the body. About 30% of people with vitiligo have a family history of the condition, and it is more common in people with Type 1 diabetes than Type 2 diabetes. Vitiligo progresses slowly over the years, commonly affecting the backs of the hands, the face, and body folds such as the underarms and groin.

Treatment of vitiligo is necessary only in people who have severe cases or who are considerably distressed by the condition. Treatment involves the use of steroids or chemical agents called psoralens that are either placed directly on the skin or taken orally. The most popular treatment, known as PUVA, uses oral psoralens in combination with phototherapy sessions, in which the person is exposed to ultraviolet light, specifically ultraviolet A.

Granuloma annulare.

A common skin disorder of unknown cause, granuloma annulare manifests as skin-colored or pinkish groups of bumps, or papules, that may be arranged in rings. There are several subtypes of granuloma annulare; the one associated with diabetes is called disseminated, or generalized, granuloma annulare, in which lesions are widespread over the body. The use of steroid creams or ointments or steroid injections is sometimes used to treat lesions. Most, however, disappear on their own within two years.

Diabetic dermopathy.

This skin condition is fairly common.  The visual appearance is in the form of  irregularly light colored skin  lesions. The lesions irregular distribution and shape are its definitive characteristic . The lesions are not painful and can easily be ignored by patients and the fail to report them to their health-care provider.  It is important to do so, this is a sign to your health care provider that things are getting worse.

Diabetic blisters – Bullosis Diabeticorum

As the name indicates this condition shows up as  blisters that occur on the hands and feet.  They may also appear on  the legs and forearms. These  blisters are not caused by trauma or infection.  The  develop spontaneously and grow in size, sometimes the are large.  Once again the fact that they do not cause pain means that they are unreported and overlooked.  They may even disappear completely and show no scarring.