There are a wide variety of long-term complications associated with diabetes.

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If you’ve experienced diabetes signs and symptoms, your healthcare provider may have told you about short-term risks of poorly controlled diabetes, among them them diabetic emergencies or diabetic shock.

These aren’t the only reasons, however, that you need to keep your diabetes signs and symptoms tightly controlled. (See also our post “How to Lower Blood Sugar.”) There are a wide variety of long-term complications associated with diabetes. Careful management can help delay or even avoid many of the following conditions.

Cardiovascular Disease

There is a very strong association between diabetes signs and symptoms and all of the different types of cardiovascular disease, including coronary artery disease (which causes heart attacks), stroke, and peripheral arterial disease (narrowing of the arteries of the legs).

The statistics are staggering: People with diabetes are anywhere from two to four times more likely to have heart disease or stroke than people without diabetes; the American Heart Association reports that 65 percent of people with diabetes die from cardiovascular disease; heart disease is the leading cause of death among women with diabetes.

Many people with diabetes, particularly type 2 diabetes, have co-morbid conditions like high blood pressure, obesity, elevated cholesterol levels, and sedentary lifestyles that can contribute to their increased risk of developing cardiovascular disease.

Kidney Disease/Nephropathy

Our kidneys contain millions of tiny blood vessels whose job it is to filter our blood. High blood glucose levels damage these blood vessels over time, causing the kidneys to leak valuable substances like protein and blood cells into the urine. If left untreated, the kidneys will ultimately lose their ability to filter waste products from the blood and patients will require dialysis (filtering of the blood by a machine) or kidney transplant.

The risk of developing kidney disease is increased by high blood pressure (hypertension), which also damages the tiny blood vessels in the kidneys. In a recent study, 44 percent of all cases of kidney failure were caused by diabetes.

Eye Disease

There are several different types of eye disease complications that can occur with diabetes.

• Glaucoma, or a build-up of pressure in the eye, is 40 percent more likely to occur in diabetics than non-diabetics and can lead to blindness if the retina and optic nerve are irreversibly damaged. Treatment for glaucoma can involve pressure-lowering medications such as carbonic anhydrase inhibitors, beta blockers, or alpha analogs and, in some cases, surgery.
• Cataracts, which are characterized by a clouding of the eye’s lens, are 60 percente more common in people with diabetes than those without. Treatment of cataracts involves removing the lens; however, people with diabetes are at increased risk of complications from this surgery, including developing glaucoma and developing/worsening of retinopathy.
• Retinopathy refers to disease of the retina, the part of the eye that records images and sends those images to the brain via electrical signals. There are many small blood vessels that feed the various parts of the retina and these can be damaged by diabetes. There are two types of retinopathy, non-proliferative retinopathy and proliferative retinopathy.

  In non-proliferative retinopathy, the walls of the blood vessels of the retina weaken and balloon, forming pouches that block the flow of blood. In proliferative retinopathy, the blood vessels become completely blocked causing new blood vessels to grow. The new blood vessels can leak blood and cause scar tissue to develop. Treatment for retinopathy includes photocoagulation, in which a laser is used to seal the leaking blood vessels and prevent more growth, and vitrectomy, in which scar tissue and fluid are removed. Statistics collected between 2005 and 2008 revealed that 28.5 percent of diabetics over the age of 40 had diabetic retinopathy.

Nerve Damage/Neuropathy

High blood glucose levels can damage the tiny blood vessels that supply the nerves in the body, resulting in impairment of all of the different types of nerves in the body.

• Peripheral neuropathy, or diabetes feet: In peripheral neuropathy, the nerves to the feet are damaged, causing pain, tingling, and numbness. The inability to feel pain can increase the likelihood of obtaining cuts and sores in the feet, which, in combination with the poor blood flow to the feet seen in some diabetics, can increase the risk of infection. If untreated, these infections can lead to amputation. In fact, 60 percent of non-traumatic lower-limb amputations in people over the age of 20 are due to complications of diabetes.
• Autonomic neuropathy: In autonomic neuropathy, the nerves of the autonomic nervous system, which controls, among other things, the GI tract, bladder, and sexual organs, are damaged. This can result in a loss of bladder control, difficulty with digestion, and erectile dysfunction. The autonomic nervous system is also responsible for important physiologic responses to factors such as stress, pain, temperature, and changes in position. As a result, autonomic neuropathy can affect physical responses (such as sweating or shakiness) to these phenomena.
• Other forms of neuropathy: Diabetic neuropathy can affect all the nerves of the body, resulting in multiple different nerve problems. Examples include neuropathic arthropathy (where the nerves of the joints are affected, resulting in breakdown of the joint); cranial neuropathy (which affects the cranial nerves, particularly those that control the eye muscles); and femoral neuropathy (which affects the nerves to thigh).

Skin Complications

People with diabetes signs and symptoms are at increased risk of developing bacterial or fungal infections of the skin. Itching is common among people with diabetes either because of infection or poor blood flow. There are a number of skin conditions associated with diabetes, the most common of which are:

• Acanthosis nigrans: In this condition, a velvety darkening and occasional thickening of the skin on the back of the neck, armpits, and groin occurs. Acanthosis nigrans can occur in non-diabetics but it is often seen in type 2 diabetics.
• Vitiligo: Vitiligo can be seen in people without diabetes, but when it occurs in diabetics, it typically occurs in those people with type 1 diabetes. It is characterized by patches of discolored, usually pale, skin due to the destruction of the pigment-producing melanin cells.
• Diabetic dermopathy: In diabetic dermopathy, sometimes called shin spots, light brown, scaly patches, caused by damage to the small blood vessels of the skin appear on the front of the lower legs.

Alzheimer’s Disease

Recent studies have suggested a link between type 2 diabetes and the risk of developing Alzheimer’s disease. One theory is that the increased amounts of insulin produced in type 2 diabetics crosses the blood brain barrier and promotes the formation of amyloid plaques found in the brains of people diagnosed with Alzheimer’s.

Hearing Loss

Hearing loss is twice as common in people with diabetes as it is in people without diabetes. The mechanism for this hearing loss is not fully understood, but may be related to damage of the small blood vessels of the inner ear.

Oral Disease

People with diabetes are at greater risk of developing gum disease, oral infections such as thrush, and dry mouth

Eating Disorders

There is evidence suggesting that women with diabetes signs and symptoms are more likely to develop eating disorders. In particular, women with type 2 diabetes are more likely to develop binge eating and women with type 1 diabetes are more likely to develop bulimia. The complications of both diabetes and eating disorders can be life-threatening. Treatment involving both medical and psychological care is important in the management of women who suffer from both diseases.

Originally published in May 2016 and updated.