Foot Complications

Proper foot care should be an important part of a diabetic's daily routine. High blood glucose levels can damage the blood vessels that carry oxygen and nutrients to the legs and feet. This can lead to nerve damage, poor circulation, infections and foot deformities. Diabetes is often associated with foot problems and amputation. Not including those caused by accidents or trauma, more than 60% of lower-limb amputations performed each year are on people with diabetes.

What to Look For
The American Diabetes Association recommends all individuals with diabetes should receive an annual foot examination to identify high-risk foot conditions. People with one or more high-risk foot conditions should be evaluated more frequently for the development of additional risk factors. People with neuropathy should have a visual inspection of their feet at every visit with a health care professional.

Doctor visit is required in case one experiences any of the following symptoms:

• Pain or less sensitivity in the leg or foot
• Cuts or breaks in the skin
• Ingrown nails
• Changes in the shape of foot
• Corns or calluses

Healthy Diabetic Foot-Care Habits
By keeping blood glucose level within the range recommended by doctor and paying special attention to feet every day, one can be able to prevent long-term complications. For healthy toes and feet, following these simple steps helps:

• Check feet regularly - look for redness, sores, swelling etc.
• Wear comfortable shoes that fit
• Wash your feet daily with soap and lukewarm water
• Moisturize feet daily to avoid dry skin
• Trim toenails straight across and not too short
• Get medical advice early if one notices any change or problem

Centers for complications Control and Prevention. National diabetes fact sheet, 2007. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf.

Preventive foot care in people with diabetes (Technical Review). Diabetes Care 21:2161 - 2177, 1998. Available at http://care.diabetesjournals.org/content/27/suppl_1/s63.full

National Institute of Diabetes and digestive and Kidney Complications. Prevent diabetes problems: keep your feet and skin healthy." Available at: http://diabetes.niddk.nih.gov/dm/pubs/complications_feet/.

Eye Complications

People with diabetes are at elevated risk for several types of eye complications, including retinopathy, cataracts and glaucoma. Any of these complications can lead to blindness over time. Early detection is the key to avoiding or lessening the risk of these complications.

Retinopathy, the most common eye complications in people with diabetes, is caused by damage to the blood vessels of the retina. In some cases, these vessels may swell and leak fluid. This is called non-proliferative, or background, retinopathy. As these areas heal, scarring occurs and abnormal new blood vessels may grow on the retina's surface, causing vision loss or blindness. This is called proliferative retinopathy and has consequences that are more serious. Unfortunately, some level of retinopathy is common, especially in people who have had diabetes for many years. Good control of your blood glucose levels is a simple step which can help in preventing the eye getting affected.

Cataracts cloud the lens of the eye. They are often an early complication of diabetes. An annual eye exam can help detect cataracts before they become severe.

Glaucoma is an increased pressure in the fluid inside the eye. This can damage the optic nerve and lead to vision loss. Glaucoma is more common in people with type 2 diabetes.

Reducing Your Risk for Eye Complications
Taking a few important steps may greatly reduce your risk of diabetes-related eye complications.

• Control blood glucose. As average blood glucose levels rise, so does the risk of retinopathy. Typically, the better a person's blood glucose control, the slower the onset and progression of retinopathy. Proper control may also decrease your chance of getting cataracts.
• Reduce your blood pressure. High blood pressure may increase the risk of retinopathy.
• Stop smoking. Smoking raises your risk of cataracts and many other diabetes-related complications.
• Get an annual dilated-eye exam. People with diabetic eye complications often have no symptoms or pain until a complications becomes advanced. An Optometrist can detect retinopathy before any vision problems. The earlier retinopathy is diagnosed, the better are the chances for preventing further damage to eyes.

High Blood Pressure

Diabetes and high blood pressure are two powerful, yet independent, risk factors leading to many serious complications such as cardiovascular complications states, renal dysfunction and many other cardiovascular complications. High blood pressure, or hypertension, occurs when the force of blood flow inside blood vessels is too high. The heart has to work harder to pump blood through the body, which can contribute to serious health problems.

People with diabetes and high blood pressure have nearly twice the risk of heart complications as people who have only high blood pressure. Unfortunately, hypertension is more frequently seen in a person with diabetes than in the patient who does not have diabetes. Studies also show an increased risk of kidney damage, diabetic eye complications and stroke when hypertension is a factor.¹

Causes of High Blood Pressure
According to the American Diabetes Association, about 73% of adults with diabetes also have high blood pressure or use prescription medications to treat high blood pressure.² The causes of hypertension are unknown, but several factors may play a role in its development:

• Heredity
• Race
• Age
• Inactive lifestyle
• Heavy alcohol consumption
• Salt sensitivity
• Being overweight
• Stress

Identifying High Blood Pressure
High blood pressure has no signs or symptoms. The only way to identify it is by having your blood pressure checked at every visit to your doctor. This is a quick and easy procedure and is something you have probably done many times before.

If you have a high blood pressure reading, your healthcare professional may recommend a series of additional blood pressure tests.

Complications of Hypertension in Patients with diabetes³

Micro vascular complications

• Renal Complications: Hypertension contributes to the risk of renal complications in patients with diabetes
• Autonomic neuropathy
  Sexual dysfunction: Hypertension may contribute to autonomic associated sexual dysfunction in diabetes.
• Eye Complications: Hypertension increases the risk of eye complications in patients with diabetes, including glaucoma and diabetic retinopathy with potential blindness.

Macro vascular complications

• Cardiac Complications: Hypertension in patients with diabetes increases the risk of coronary artery complications, congestive heart failure and cardiomyopathy.
• Cerebrovascular complications: Hypertension increases the incidence of stroke in patients with diabetes. Survival rates and recovery from stroke is reduced in patients with diabetes compared with patients without diabetes.
• Peripheral vascular complications: Hypertension increases the risk of peripheral vascular complications and subsequent foot ulcers and amputation in patients with diabetes.

Reducing and Treating High Blood Pressure

High blood pressure cannot be cured, but it can usually be controlled. Here are some positive steps you can take to reduce blood pressure:⁴

• Maintaining a healthy weight
• Staying physically active
• Eating a healthy diet that includes daily servings of fruits, vegetables and whole-grain foods
• Choosing foods lower in salt and fat
• Choosing lean meats
• Drinking alcohol in moderation
• Quitting smoking

Your doctor may also prescribe medication to control high blood pressure. The type and amount of medication will depend on your specific situation.

¹American Diabetes Association, American College of Cardiology. Hypertension in diabetes. Diabetes and Cardiovascular Complications Review. 2002;2:1-4. Available at: http://www.diabetes.org/uedocuments/ADACardioReview_2.pdf. Accessed October 16, 2008.

²American Diabetes Association. Complications of diabetes in the United States. Available at: http://diabetes.org/diabetes-statistics/complications.jsp. Accessed October 16, 2008.

³Diabetes India. Blood pressure and Diabetes: Double Trouble? Available at: http://www.diabetesindia.com/diabetes/diabetes_and_high_blood_pressure.htm. Accessed March 25,2010.

⁴Diabetes Australia. Diabetes and Blood Pressure. Available at: http://www.diabetesaustralia.com.au/Living-with-Diabetes/Mind--Body/Diabetes--Blood-Pressure Accessed April 23, 2009.

Heart Complications

Diabetes increases the risk of heart complications and stroke. Heart or blood-vessel complications accounts for about 75% of all deaths for people with diabetes.

High blood glucose levels can damage blood vessels, leading to cardiovascular complications, such as high blood pressure, high cholesterol and hardening of the arteries. In addition to risk factors you cannot control-such as heredity, age and gender-you can be at greater risk of heart problems from the following:

• High levels of blood fats, such as cholesterol and triglycerides
• High blood pressure
• Lack of physical activity
• Being overweight
• Stress
• Too much alcohol
• Smoking

One of the most important things to do to reduce the risk of heart complications is to meet with treating doctor to discuss your individual risk factors and how to reduce them.

American Heart Association. Risk factors and coronary heart complications. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4726. Accessed October 16, 2008.

Diabetes Australia. Diabetes and your Heart. Available at: http://www.diabetesaustralia.com.au/Living-with-Diabetes/Mind--Body/Diabetes--Your-Heart/#Reducing%20the%20Risk%20of%20Heart%20Disease . Accessed April 23, 2009.

Kidney Complications

Kidneys filter our blood through millions of blood vessels and then dispose of body waste in our urine. Diabetes can damage these small blood vessels, making it hard for the kidneys to filter the waste in the blood. As a result, diabetes is the leading cause of kidney failure. About 30% of people with type 1 diabetes and 10% - 40% of those with type 2 diabetes will eventually have kidney complications, or nephropathy.

Smoking, uncontrolled blood glucose, or high blood pressure, may increase the risk of kidney complications. Having a family member with kidney complications also increases the risk of developing kidney complications.

Detecting Diabetic Nephropathy
While there are no early symptoms of kidney damage, doctor can test for it, by checking urine for a protein called albumin. This screening can detect nephropathy in its early stages, when treatment can slow or even prevent progression of the complications. If one has diabetes and are between the ages of 12 and 70, one should do a urine protein test at least once a year based on doctors recommendations.

Prevention and Care

• Keeping blood glucose levels close to normal range. Discuss the target range with treating doctor.
• Lowering blood pressure, if it is high. Discuss the normal range and treatment of high blood pressure by doctor. Medications such as ACE inhibitors may both effectively lower blood pressure and protect the kidneys.
• Reduce the protein in urine. If one has protein in urine, doctor will discuss options to treat it-which can be through medication or by limiting protein in your meals-with your doctor.
• Stopping smoking. Smoking increases risk of kidney damage.

Diabetes and Sexual Health

Diabetes can lead to difficulty with sexual performance for men and women.

Issues Affecting Men
Diabetes may cause nerve and artery damage, disrupting the blood flow needed for an erection. Men who have diabetes are 3 times more likely to experience this issue, known as erectile dysfunction or impotence.¹ Experiencing erectile dysfunction is common and can be treated.

A few factors that may increase the possibility of experiencing impotence:

• Poorly controlled blood glucose
• High cholesterol
• High blood pressure
• Smoking
• Drinking too much alcohol

In addition, some medications-such as blood-pressure drugs, anti-depressants and stomach-ulcer medications-may have side effects that contribute to sexual dysfunction. Stress can have an impact as well.

Issues Affecting Women
Sexual dysfunction from diabetes can affect women as well. High blood glucose levels, nerve damage, depression and yeast infections are all relatively common in women with diabetes and can contribute to sexual problems.

MayoClinic.com. Erectile dysfunction and diabetes: take control today. Available at: http://www.mayoclinic.com/health/erectile-dysfunction/DA00045. Accessed March 28, 2008.

Wider, Jennifer. Diabetes Takes a Toll on the Sex Life of Many Women. Available at: http://www.womenshealthresearch.org/site/News2?page=NewsArticle&id=7407. Accessed November 17, 2008.

Nerve Pain and Damage

High blood glucose levels may damage the insulation of nerve cells and nerves may stop sending signals through the body the way they should. This is called neuropathy.

Many people know that nerve damage can affect their hands and feet-that is why doctors check the sensation in feet at every visit. But nerve damage can also affect every organ in the body-from the digestive tract to urinary bladder and sexual organs. Nerve damage can also affect the ability to feel the symptoms of low blood glucose levels (hypoglycemia).

About 60%-70% of people with diabetes have some form of nerve damage. The highest rates are among people who have had diabetes for at least 25 years and among those who have high cholesterol, high blood pressure or weight issues. It is also more prevalent among people with problems controlling their blood glucose levels.

Neuropathy Symptoms
The symptoms of nerve damage depend on the type of neuropathy and which nerves are affected. In some types of neuropathy, there may be no symptoms at all. Because it develops slowly, mild cases can go unnoticed for a long time. Look for the following symptoms:

• Numbness, tingling or pain in the toes, feet, legs, hands, arms and fingers
• Sensitivity to touch
• Indigestion, nausea or vomiting
• Difficulty swallowing
• Diarrhea or constipation
• Dizziness or faintness when you stand or sit up
• Profuse sweating at night or when eating
• Problems with urination
• Sexual issues, such as erectile dysfunction in men and vaginal dryness in women
• Loss of balance or coordination

Treatment for Diabetic Nerve DamageThe treatment for diabetic neuropathy is usually likely to start with tighter blood glucose control. Blood glucose monitoring, meal planning, physical activity and medication may all help as well. Doctors also recommend oral medication or a topical cream for pain relief as necessary.

National Institute of Diabetes and Digestive and Kidney complications. Diabetic neuropathies: the nerve damage of diabetes. Available at: http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/index.htm. accessed October 16, 2009.

Dental and Gum Care

People with diabetes are more likely to have gum complications than people without diabetes. Both gum complications and gum infection are common complications of diabetes. In fact, nearly one-third of people with diabetes have severe periodontal complications. Regular dental checkups and good dental care at home can reduce dental problems.

Types of Problems
In addition to tooth decay and gum complications, you may experience these other problems that occur more often in people with diabetes:

• Thrush (oral candidiasis) is a fungal infection in the mouth that causes white or red spots on the tongue.
• Dry mouth (xerostomia) can be uncomfortable and may lead to infection and tooth decay.

Preventing Gum Complications
Gum complications is preventable. For healthy teeth and gums, do the following:

• Informing dentist of diabetes status
• Brushing teeth twice a day with fluoride toothpaste
• Flossing daily
• Regular dental exams, as often as dentist recommendations
• Eat a well-balanced diet
• Keep your blood glucose levels under control

American Diabetes Association. Complications of diabetes in the United States. Available at: http://www.diabetes.org/diabetes-statistics/complications.jsp. Accessed October 16, 2009.

American Dental Association. Diabetes and oral health. Available at:
http://www.ada.org/prof/resources/pubs/jada/patient/patient_18.pdf. Accessed October 16, 2009.

American Dental Association. Diabetes and your oral health: frequently asked questions. Available at: http://www.ada.org/public/topics/diabetes_faq.asp.
Accessed October 16, 2009. www.idf.org accessed January 2010