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Uncontrolled diabetes leads to a chronic elevation of glucose levels in your blood, which causes premature aging of your cardiovascular system, kidneys, eyes, and immune system. This premature aging leads to what are called diabetic complications which include heart and kidney disease, stroke, poor circulation, difficulty walking or exercising, vision, and nerve damage; all of which get worse with poor blood glucose control, stress, and increasing age and obesity.

The best way to minimize these complications, and their progression, is to control what you eat, exercise regularly, monitor your blood glucose levels before and after every meal, keep your HbA1c below 6, improve your immune system, and control your blood homocysteine and cholesterol levels.

Some of the common complications, associated risk factors & problem indicators, and what you can do to minimize them are identified below. Always consult with your doctor or healthcare professional before initiating any change in your diabetes treatment protocol.

Complication Risk factor & problem indicator What can you do?
Heart Disease The major cause of death of diabetics is heart disease. High levels of homocysteine and cholesterol levels in the blood are associated with heart disease
  1. Eat a balanced diet, exercise regularly, take your medications, monitor your blood glucose levels to keep your blood glucose levels below 8mmol/L (144mg/dL) at all times, and manage your level of stress
  2. Have your blood homocysteine level checked annually with a goal of keeping it < 8µmol/L
  3. Improve your blood homocysteine level by supplementing your diet with the following vitamins: Folic Acid (2 to 5mg), B6 (50 to 100mg), B12 (0.5 to 1mg), plus a good multivitamin (see Nutrition Action Healthletter, January/February 2003, Vol. 30, No.1)
  4. Take a low-dose aspirin (81mg) once a day
  5. Stop smoking, it is clearly linked to heart disease
  6. Have your lipid levels checked every three months and aim for the following levels: HDL > 1.2; LDL < 2.5; Cholesterol/HDL ratio < 4.0; triglycerides < 2.0
Kidney Disease Diabetes is the most common cause of kidney failure, accounting for more than 40% of new cases. Even when drugs and diet are able to control diabetes, the disease can lead to nephropathy (slow deterioration of the kidneys) and eventually kidney failure.
  1. Eat a balanced diet, exercise regularly, take your medications, monitor your blood glucose levels to keep your blood glucose levels below 8mmol/L (144mg/dL) at all times, and manage your level of stress
  2. Take an ACE inhibitor to help improve the efficiency of your kidneys; may also help lower your blood pressure
  3. Recognise, and act upon, signs of hypertension and have your blood pressure checked at least every 3 months
  4. Recognize, and act upon, signs of urinary tract infections
  5. Have your urine tested for protein (<0.15 g/day), microalbuminuria (<30 mg/day), and creatinine (7.1-15.9 mmol/day) via a 24-hour urine collection once a year
  6. Have your blood tested for creatinine (60-110 µmol/L) every 3 months
Blindness Diabetes is the most common cause of adult blindness in the western world! Retinopathy occurs as a direct result of high blood glucose levels
  1. Eat a balanced diet, exercise regularly, take your medications, monitor your blood glucose levels to keep your blood glucose levels below 8mmol/L (144mg/dL) at all times, and manage your level of stress
  2. Have your eyes checked every year by an ophthalmologist for retinopathy, cataracts, and glaucoma
  3. Recognise, and act upon, signs of hypertension and have your blood pressure checked at least every 3 months
  4. Notify your doctor or healthcare professional immediately of any changes in your vision
Amputation of lower limbs Diabetes causes more than 50% of all lower limb amputations, usually feet. Uncontrolled diabetes causes high blood glucose levels, which eventually damages the nerves and other organs of the body. As the nerve disease advances, people with diabetes feel no pain when they injure a foot or toe. Even minor problems, such as pressure spots from poor-fitting shoes and improperly cut toenails can result in foot ulcers that fail to heal and lead to amputation.
  1. Eat a balanced diet, exercise regularly, take your medications, monitor your blood glucose levels to keep your blood glucose levels below 8mmol/L (144mg/dL) at all times, and manage your level of stress
  2. See my Foot Care page
  3. Read the Canadian Medical Student's Guide to Preventative Foot Care
Sexual problems Many people with diabetes suffer from some form of sexual problems. With men it often takes the form of chronic yeast infections or erectile dysfunction; with women it often takes the form of chronic vaginal yeast infections, a dry or insensitive vagina, or irregular menses
  1. Eat a balanced diet, exercise regularly, take your medications, monitor your blood glucose levels to keep your blood glucose levels below 8mmol/L (144mg/dL) at all times, and manage your level of stress
  2. Check your medications, some antihypertensives and antidepressants can cause problems
  3. Have your hormone levels checked, not enough testostrone or estrogen, or too much prolactin can cause problems
  4. Consider sexual theraphy when psychological or interpersonal issues exist
  5. Consider viagra, penis injections or suppositories, penis vacuum pump or constriction rings, penis implant, and vaginal lubrication
Benign prostatic hyperplasia (BPH) Diabetic men are more susceptible to benign prostatic hyperplasia (BPH) and prostrate cancer Have an annual digital rectal examination (DRE) and PSA blood test (<2.5ng/mL); biopsy needed if PSA > 2.5 
Hypothyroidism or Hyperthyroidism TSH is a protein hormone secreted by the pituitary gland and regulates the thyroid gland. Thyroid hormones affect virtually every body tissue and low hormone levels can have a major impact on the body's use of fats, proteins, carbs, vitamins, other hormones & drugs. A high TSH value can indicate an underactive thyroid gland or pituitary gland problem; a low TSH value can indicate an overactive thyroid gland or damage to the pituitary gland Have a Thyroid -stimulating Hormone Test (sTSH) every 5 years (0.35-5.00 mU/L)
Pneumococcal disease Diabetics are in the high risk category for contracting pneumococcal disease, which can cause bacterial meningitis, blood infection (sepsis), bacterial pneumonia, & upper respiratory tract infections such as ear infection (acute otitis media) & sinusitis Have yourself inoculated with the Pneumococcal vaccine with a one-time boost after 5 years
Influenza Diabetics are in the high risk category for contracting influenza, which is highly contagious & usually results in a cough, fever, chills, sore throat, headache, muscle aches & fatigue that lasts 3-5 days; but it can also lead to pneumonia, hospital, & death  Have an annual flu shot
Overall premature aging of cardiovascular system, kidneys, eyes, and immune system Caused by chronically high glucose levels in your blood
  1. Eat a balanced diet, exercise regularly, take your medications, monitor your blood glucose levels to keep your blood glucose levels below 8mmol/L (144mg/dL) at all times, and manage your level of stress
  2. Check your blood glucose level before and two hours after every meal; aim for < 6mmol/L (108mg/dL) before meals and < 8mmol/L (144mg/dL) 2 hours after meals
  3. Have the level of your glycated hemoglobin, HbA1c, checked every 3 months; aim to keep < 6

Updated: March 17, 2003