Complications of Diabetes Pennington Biomedical Research Center Division

Complications of Diabetes Pennington Biomedical Research Center Division of Education PBRC 2009 1

Common Potential Complications of Diabetes l l Heart Disease Kidney Disease/Kidney Transplantation Eye Complications Diabetic Neuropathy and Nerve Damage l l PBRC 2009 Foot Complications Skin Complications Gastroparesis and Diabetes Depression 2 of 39

Heart Disease l l Caused by a narrowing or blocking of the blood vessels to your heart. The vessels carry oxygen and nutrients to your heart. Vessels can become partially or totally blocked by fatty deposits. A heart attack - when the blood supply to your heart is reduced or cut off. PBRC 2009 3 of 39

Heart Disease and Diabetes l l l Diabetes increases the risk for coronary artery disease, a heart attack or stroke. Take preventive steps now. Keep your ABCs of diabetes on target. PBRC 2009 4 of 39

“The ABCs” “A” is for A 1 C is the blood glucose check “with a memory” over the past 2 to 3 months. “B” is for blood pressure The ADA recommends a blood pressure below 130/80. “C” is for cholesterol HDL protects your heart. LDL can clog your blood vessels, leading to heart disease. Triglycerides can increase your risk for heart disease. PBRC 2009 5 of 39

Kidney Function l l l Kidneys act as filters. Kidneys remove waste products from the blood. We create waste products from digestion. Normally, waste products are eliminated in urine from the body. Protein and red blood cells are too big to pass through the filter and remain in the blood. PBRC 2009 6 of 39

Kidney Disease l l High levels of blood sugar can put extra stress on the kidneys. After years of damage, the kidneys start to leak. Useful proteins are lost in the urine. Get a condition known as microalbuminuria. There are several treatments at this point that may keep the kidney disease from getting worse. When kidney disease is diagnosed later, during macroalbuminuria, end-stage renal disease (ESRD) usually follows. l l PBRC 2009 7 of 39

Kidney Disease l l Kidneys lose their filtering ability. Waste products begin to build up in the blood. Finally, the kidneys fail. ESRD l l kidney transplant or regular visits to a dialysis clinic. PBRC 2009 8 of 39

Who Gets Kidney Disease? l Factors that influence kidney disease development include: l l Genetics Blood pressure Blood sugar control Controlling blood sugar and blood pressure are very important in reducing the chances of developing kidney disease. PBRC 2009 9 of 39

Facts About Diabetes and Kidney Disease l l Nephropathy - 10 -21% of diabetes cases. ~ 43% of new cases of ESRD are attributed to diabetes. l 12 times higher in people with type 1 diabetes l l l 4 times higher in African Americans, 4 to 6 times higher in Mexican Americans 6 times higher in Native Americans than in the general population of diabetes patients. PBRC 2009 10 of 39

---Eye Complications--- l l l Higher risk of blindness. Many have minor eye disorders. Early treatments critical. PBRC 2009 11 of 39

Glaucoma l Pressure build-up in the eye. l l l Pinches the blood vessels. Damages nerves. Vision is gradually lost. 40% more likely to suffer from glaucoma. Risk increases with age and duration of diabetes. PBRC 2009 12 of 39

Cataracts l The eye’s clear lens clouds, blocking light. l l l Wear sunglasses Use glare-control lenses in eyeglasses. Damaged lens – l l remove. transplant. PBRC 2009 13 of 39

Cataracts l Individuals with diabetes are: l 60% more likely to develop cataracts l l l at a younger age faster progression have problems if removal of the lens is necessary due to the beginning stages of glaucoma PBRC 2009 14 of 39

Retinopathy l l Diabetic retinopathy is a general term for all disorders of the retina caused by diabetes. There are 2 major types of retinopathy: l l Nonproliferative: This is the common, mild form. Proliferative: This form is much more serious. PBRC 2009 15 of 39

Retinopathy l There are several factors that influence whether you get retinopathy: l l l Blood sugar control Blood pressure levels How long you have had diabetes Genetics Almost everyone with type 1 diabetes will eventually develop nonproliferative retinopathy. PBRC 2009 16 of 39

Diabetic Neuropathy & Nerve Damage l l l ~50% have some form of nerve damage. It’s more common in those who have had the disease for many years. Blood glucose control can help prevent or delay nerve damage. PBRC 2009 17 of 39

2 Common Types of Nerve Damage l Sensorimotor neuropathy: l l l Also known as “peripheral neuropathy” Can cause tingling, pain, numbness, or weakness in hands and feet. Autonomic neuropathy: Can lead to l l l l l Digestive problems such as feeling full, nausea Vomiting, diarrhea, or constipation Problems with how well the bladder works Problems having sex Dizziness or faintness Loss of the typical warning signs of a heart attack Loss of warning signs of low blood glucose Increased or decreased sweating Changes in how your eyes react to light and dark PBRC 2009 18 of 39

Keep Your Blood Glucose Levels in Your Target Range l It is important to: l l l Report all possible signs of diabetic neuropathy Get treatment right away if you have problems. Take good care of your feet, checking them every day. Protect your feet. Wear shoes and socks that fit well and wear them all the time. Purchase special shoes, if they are needed. Be careful with exercising. Some activities are not safe for individuals with neuropathy. PBRC 2009 19 of 39

Foot complications l Skin Changes l Calluses l Foot Ulcers l Poor Circulation l Amputation PBRC 2009 20 of 39

Skin Changes and Calluses l Skin Changes: l l Dry skin and feet. Seal remaining moisture in with plain petroleum jelly, unscented hand cream, or a similar product. It is important not to put oils or creams between toes. Calluses l l l Occur more often and build up faster. May need therapeutic shoes and inserts. Calluses can lead to ulcers (open sores). Never try to cut calluses yourself– this can lead to infection. Let your healthcare provider cut them. PBRC 2009 21 of 39

Foot Ulcers and Poor Circulation l Foot Ulcers l l Every ulcer should be seen by your health care provider immediately. Can result in infections, potentially leading to loss of a limb. It is important to keep off of your feet. Poor Circulation l l Can lead to infection and delay healing. To improve poor circulation: l l Stop smoking and keep blood pressure and cholesterol in check Exercise improves circulation. It increases blood flow. Exercise is a good idea for individuals who currently do not have any open sores on the foot. Proper shoes are essential. PBRC 2009 22 of 39

Amputation l l Highly likely in diabetes. Due to artery disease, which reduces blood flow to the feet and nerve damage, which reduces sensation. These can lead to ulcers and infections that may lead to amputation. Amputations are preventable. PBRC 2009 23 of 39

Amputation - Prevention l l l Take good care of your feet. Always follow your health care provider’s advice when caring for foot problems. Stop smoking! l Smoking decreases blood flow to the feet. PBRC 2009 24 of 39

Skin Complications l l l l Bacterial infections Fungal infections Itching Diabetic Dermopathy Necrobiosis Lipoidica Diabeticorum Atherosclerosis Allergic Reactions l l l PBRC 2009 Diabetic Blisters Eruptive Xanthomatosis Digital Sclerosis Disseminated Granuloma Annulare Acanthosis Nigricans 25 of 39

Bacterial and Fungal Infections l Bacterial infections l l l l Stye Many kinds. Styes. Boils. Carbuncles. Inflamed tissues are usually hot, swollen, red, and painful. Treated by antibiotics. Fungal infections l l l Candida albicans is a yeast-like fungus. Leads to common fungal infections. Can be treated by medication. PBRC 2009 Athlete’s foot 26 of 39

Itching and Diabetic Dermopathy l Itching l l l Localized. Can be caused by a yeast infection, dry skin, or poor circulation. Occurs often in the lower parts of the legs. Use mild soap with moisturizer, and apply skin cream after bathing to help resolve the issue. Diabetic Dermopathy l l l Changes in the small blood vessels. Looks like light brown, scaly patches. The disorder most often occurs on the front of both legs. The patches do not hurt, open up, or itch. Dermopathy is harmless and does not require treatment. PBRC 2009 27 of 39

Atherosclerosis and Allergic Reactions l Atherosclerosis l l l Thickening of the arteries Occurs at younger ages. Can lead to skin changes. Skin becomes hairless, thin, cool, and shiny. Affected legs heal slowly when the skin is injured. Allergic Reactions l l l In response to medications, such as insulin or diabetes pills. If you think you are having a reaction to a medication, contact your doctor immediately. Report any rashes, depressions, or bumps around the insulin injection sites immediately. PBRC 2009 28 of 39

Diabetic Blisters and Eruptive Xanthomatosis l Diabetic Blisters l l l Occurs rarely in individuals with diabetes They can occur on the backs of fingers, hands, toes, feet, and on legs or forearms. They are sometimes large and resemble burn blisters. Painless and with no redness around them, they often heal themselves within 3 weeks. The only treatment is to bring blood sugar levels under control. Eruptive Xanthomatosis l l This is a condition caused by diabetes that is out of control. Consists of firm, yellow, pea-like enlargements in the skin. The disorder usually occurs in young men with type 1 diabetes. Like diabetic blisters, these bumps disappear when diabetes control is restored. PBRC 2009 29 of 39

Digital Sclerosis and Disseminated Granuloma Annulare l Digital Sclerosis l l l Consists of tight, thick, waxy skin on the back of the hands. The finger joints become stiff and can no longer move the way they should. Rarely, knees, ankles, or elbows also get stiff. Happens to about 1/3 of people with type 1 diabetes The only treatment is to bring blood sugar levels under control. Disseminated Granuloma Annulare l l Consists of sharply defined ring-shaped or arc-shaped raised areas on the skin. Rashes most often occur on parts of the body far from the trunk (i. e. , ears or fingers), but sometimes the raised areas occur on the trunk. Contact your doctor when rash appears. Certain drugs can help clear up the condition. PBRC 2009 30 of 39

Acanthosis Nigricans l l l l This is a condition in which tan or brown raised areas appear on the sides of the neck, armpits, and groin. Usually strikes people who are overweight. The best treatment is to lose weight. Some creams can help the spots look better. PBRC 2009 31 of 39

Gastroparesis and Diabetes l Due to nerve damage that control the stomach. Leads to poor muscle control of the stomach and intestines. Movement of food is slowed or stopped. l Signs and symptoms: l l l Heartburn Nausea Vomiting of undigested food An early feeling of fullness when eating Weight loss Abdominal bloating Erratic blood glucose (sugar) levels Lack of appetite Gastroesophageal reflux Spasms of the stomach wall PBRC 2009 *These symptoms may be mild or 32 of 39 severe, depending on the person. *

Complications of Gastroparesis l l Gastroparesis makes it harder to manage blood glucose. Slower digestion can result in: l l Bacterial overgrowth due to fermentation Food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction of the stomach l Bezoars can be dangerous if they block the passage of food into the small intestine. PBRC 2009 33 of 39

Treatment of Gastroparesis l The most important treatment goal for diabetes-related gastroparesis is to manage your blood glucose levels as well through the usage of: Insulin May need to adjust schedule. Medication May need drugs to treat gastroparesis. Meal and food changes Refer to your physician or a dietitian for more information. Feeding tube May be used in severe cases. PBRC 2009 34 of 39

Depression l l Consult your doctor to eliminate any physical cause for your depression. Poorly controlled diabetes can cause depression like symptoms: l l High or low blood sugar during the day can make you feel tired or anxious Low blood sugar levels can also lead to hunger and eating too much Low blood sugar n the night could disturb sleep High blood sugar in the night can lead to frequent urinating and then feeling tired throughout the next day PBRC 2009 35 of 39

Conclusions l l l There are many potential complications of diabetes. Complications can be minimized with good blood glucose control. Discuss any developments with the physician immediately. PBRC 2009 36 of 39

Division of Education Phillip Brantley, Ph. D, Director Pennington Biomedical Research Center Claude Bouchard, Ph. D, Executive Director Heli J. Roy, Ph. D, RD Reviewed by: Beth Kalicki Edited : 10/ 2009 PBRC 2009 37

l The Pennington Biomedical Research Center is a world-renowned nutrition research center. l Mission: To promote healthier lives through research and education in nutrition and preventive medicine. l The Pennington Center has several research areas, including: l l l Clinical Obesity Research Experimental Obesity Functional Foods Health and Performance Enhancement Nutrition and Chronic Diseases Nutrition and the Brain Dementia, Alzheimer’s and healthy aging Diet, exercise, weight loss and weight loss maintenance The research fostered in these areas can have a profound impact on healthy living and on the prevention of common chronic diseases, such as heart disease, cancer, diabetes, hypertension and osteoporosis. l The Division of Education provides education and information to the scientific community and the public about research findings, training programs and research areas, and coordinates educational events for the public on various health issues. l We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the Pennington Center in Baton Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at www. pbrc. edu or call (225) 763 -3000. PBRC 2009 38 of 39

References l All information used was obtained from: l American Diabetes Association l http: //www. diabetes. org Copyright, 2009 PBRC # PPT 29 PBRC 2009 39 of 39