Late Effects of Diabetes
What are the potential complications of diabetes?
The physical complications fall into two groups:
- Microvascular complications involve small blood vessels.
- Macrovascular complications involve large blood vessels.
In general, people with type 1 diabetes tend to have problems with small blood vessels at first, but not always. Complications with type 2 diabetes tend to involve the large blood vessels.
The following information can be scary to read. But the more you know, the more you can do to prevent these common complications of diabetes.
Microvascular complications occur only in people with diabetes. They include:
- eye damage (retinopathy) or cataracts in the eye
- kidney damage (nephropathy)
- nerve damage or foot problems (neuropathy)
Macrovascular complications also occur in the general population, but they are much more common in people with diabetes. They include:
- risk of heart attack (cardiovascular disease)
- risk of stroke (cerebrovascular disease)
- poor circulation to the limbs, which may also cause foot problems (peripheral vascular disease)
Remember, though, that not everyone with diabetes develops these problems.
These complications almost never happen in young children and they are not common in teenagers. However, diabetes probably starts to have an effect from the time it begins. The impact may be somewhat less before puberty, but early changes seem to speed up during adolescence. Keeping up a good blood sugar balance right from the time of diagnosis will add to overall long-term health.
Risk factors for complications
In the following situations, a person’s risk of having complications is higher.
Having diabetes for a longer time
Complications are rare in those who have had the disease for less than five years, and before puberty. After that, the longer a person has had diabetes, the more likely it is that complications will arise.
Poor blood glucose control
The Diabetes Control and Complications Trial showed that long-term blood sugar control, and both the start and progression of diabetes-related complications, are closely related. This trial showed clearly that control counts. Excellent blood glucose control reduces the chance that complications will develop. However, that doesn’t mean that someone with poor control will definitely have complications. It also doesn’t mean that someone with excellent control is guaranteed not to have them.
Smoking
Many studies show that smokers with diabetes are at much greater risk of developing complications than non-smokers. Those complications will also worsen more quickly than with non-smokers. Not smoking reduces the risk a great deal.
High blood pressure
People with diabetes who develop high blood pressure (hypertension) are at high risk of complications. This is because of increased pressure on the kidneys, heart, and blood vessels. Lowering the blood pressure with aggressive medical treatment reduces this risk. Regular blood pressure checks are an essential part of diabetes care.
High blood fats (lipids): cholesterol and triglycerides
People with poor blood glucose control develop high blood fat levels (hyperlipidemia). Some people are born with a tendency to develop high blood fat levels. In both cases, these high levels add to the risk of complications. Screening for high blood fats is another important part of diabetes care.
Obesity
People who are very overweight have a greater risk of macrovascular complications. Healthy eating and an active lifestyle reduce the risk and should be encouraged in everyone.
Blood glucose and complications––what’s the connection?
We know that persistently high blood glucose levels are associated with a higher risk of complications. However, the connection between the two is still being heavily researched. It’s likely that a number of different processes are involved. For example, glucose sticks to many proteins (the same way it sticks to hemoglobin, leading to the formation of HbA1c). Over time, this "sticking" may change the way some proteins function and damage different tissues. This is called the glucotoxicity theory.
High blood sugar levels also affect the rate at which certain molecules are produced or removed from tissues. As a result, there may be fewer molecules that are needed for the tissue to function. Or, there may be a build-up of molecules that damage tissues. Some tissues affected this way are the nerves and the lens of the eye.
When poor blood glucose control leads to high levels of fat in the blood, that fat may build up in the arteries. This can cause arteriosclerosis (hardening or the arteries). This is a major risk factor for macrovascular diseases such as heart attack and stroke. People with diabetes are more likely to develop high blood pressure. This increases the risk of arteriosclerosis. It is also in itself a risk factor for macrovascular disease.
Type 1 diabetes: screening for complications
Once puberty has started and your child has had diabetes for three to five years, screening for complications and risk factors should begin. This is important even though complications are rare in children and also in teenagers. If no problems are found, that’s reassuring. If the early stages of complications are detected, interventions can be taken to prevent them from developing, or at least to slow their progression.
Here are some blood and urine tests and examinations that your health care team will recommend on a regular basis. Some of these tests screen for complications. Others monitor blood sugar control. Still others monitor for conditions that occur more often in people with type 1 diabetes. More frequent testing will likely be advised if any problems are discovered.
Test/Examination | How Often |
| Blood pressure | every 3 to 6 months |
| HbA1c to assess metabolic control | every 3 to 4 months |
| Laboratory blood sugar against your own meter, to check your meter’s accuracy | every 3 to 6 months |
| Thyroid function (thyroid stimulating hormone), to see if the thyroid is working too hard or too little | every year if thyroid antibodies are present, otherwise every 2 years |
| Blood fats (cholesterol and triglycerides) | 3 to 6 months after diagnosis and, if normal, once again after puberty |
| Overnight or 24-hour urine collection for microalbuminuria, or albumin: creatinine ratio in a random urine sample, to detect early diabetic nephropathy | ever year after puberty begins and after having diabetes for 3 to 5 years |
| Eye check-up with ophthalmologist, to detect early diabetic retinopathy | every year after puberty begins and after having diabetes for 5 years |
| Dental checkups | every 6 months |
Type 2 diabetes: screening for complications
For those with type 2 diabetes, screening for complications and risk factors should begin as soon as your child or teen is diagnosed, and each year after that. This is important even though complications are rare in children and teenagers. If no problems are found, that’s reassuring. If the early stages of complications are detected, interventions can be taken to prevent them from developing, or at least to slow them down.
Here are some blood and urine tests and examinations that your health care team will recommend. They will likely advise testing more often if any problems are discovered.
Test/Examination | How Often |
| Blood pressure | every year |
| HbA1c, to assess metabolic control | every 3 to 4 months |
| Laboratory blood sugar against your own meter, to check your meter’s accuracy | every 3 to 6 months |
| Blood fats (cholesterol and triglycerides) | every year |
| Overnight or 24-hour urine collection for microalbuminuria, or albumin: creatinine ratio in a random urine sample, to detect early diabetic nephropathy | every year starting at puberty |
| Eye check-up with ophthalmologist, to detect early diabetic retinopathy | every year starting at age 15 |
| Dental checkups | every 6 months |
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