Sarah Henry
Quick summary
Older adults are at increased risk for many serious, sometimes life-threatening diabetes-related conditions, often the result of years of undetected or untreated high blood sugar levels. That's why it's vitally important that the person you're caring for practice good diabetes management by keeping blood glucose under control, giving up cigarettes, eating well, staying active, maintaining a healthy weight, and taking medications, which together can go a long way toward avoiding or slowing down common complications.
Diabetes-related complications that threaten a patient's heart
1. High blood pressure
What it is: This condition, also known as hypertension, occurs when blood flows through the body's blood vessels with greater than normal pressure. Normal blood pressure is 120/80 millimeters of mercury or below; blood pressure of 130/80 or higher is considered hypertension.
What it does: High blood pressure can place excess strain on the heart, damage blood vessels, and increase the risk of heart attack, stroke, and kidney problems.
How to prevent it: A balanced, low-salt diet; regular exercise; stress management; and moderate alcohol consumption can all help. So can prescription medications. The patient should have her blood pressure checked at every doctor's visit.
2. Heart disease and stroke
What it is: Heart disease, also known as cardiovascular disease or coronary artery disease, damages the arteries and veins of the heart -- and high blood glucose is thought to make this disease worse or more complicated. A stroke is the result of damage to blood vessels in the brain.
What it does: High blood sugar can cause hardening of the heart arteries, known as atherosclerosis, which can lead to heart attack or stroke, depriving the brain of oxygen. That can lead in turn to speech or mobility loss. Heart disease and stroke combined account for about 65 percent of deaths in people with diabetes.
How to prevent it: The person you're caring for should aim to keep her blood pressure and lipid or fat levels -- including cholesterol and triglycerides -- within the recommended range. Lifestyle changes, such as diet and exercise, and medications can also help. The American Diabetes Association recommends that most people with type 2 diabetes take an aspirin a day, as aspirin use has been linked to a lower risk of heart attack. The suggested dose ranges from 81 milligrams (mg) a day, the amount found in baby aspirin, to 325 mg a day, the amount contained in an adult tablet. Using the lowest possible dosage may help reduce such side effects as gastrointestinal problems. But be sure to ask the doctor what he recommends. Heart disease is easiest to treat when detected early, so make sure the patient sees her main diabetes doctor at least two or three times a year.
Diabetes-related complications that threaten a patient's limbs
3. Foot problems
What they are: People with diabetes are prone to a host of foot ailments including calluses, ulcers, and poor blood flow or circulation. These conditions are more likely if the patient also has loss of feeling in her feet due to nerve damage.
What they do: Left unchecked, even the most mundane foot ailments -- like an ingrown toenail -- can get worse and lead to serious infections and other complications.
How to prevent them: Make sure the person you're caring for examines her feet on a daily basis for any cuts, sores, patches of redness, swelling, or hot spots, which should be promptly reported to her doctor. She should also remove her shoes and socks and have her doctor check her feet at every routine doctor's visit. Exercise can help poor circulation. However, infections, ulcers, or foot injuries require her to stay off her feet until the problem heals.
4. Nerve damage
What it is: The most common form of nerve damage in people with diabetes is known as peripheral neuropathy, which mainly affects the lower legs and feet. Nerve damage that affects the stomach is called gastroparesis.
What it does: Neuropathy causes pain, numbness, weakness, or an uncomfortable tingling sensation, which can increase the chance of foot injuries. Gastroparesis may delay or otherwise affect digestion, resulting in nausea, vomiting, or bloating; this can make blood glucose control difficult.
How to prevent it: Lowering blood pressure, losing excess weight if necessary, and -- of course -- managing blood glucose levels can all help ward off neuropathy.
5. Amputation
What it is: The removal of a limb or extremity. The most common amputations for people with diabetes involve the lower legs or feet.
Why it happens: Many people with diabetes have artery damage, which can result in less blood flow to the feet. Many people with diabetes also have nerve disease, which can reduce feeling in the feet. Together, these predicaments make it easy for ulcers or infections to take hold -- and, if left untreated, they may lead to amputation.
How to prevent it: Fortunately, most amputations are preventable with routine self-care, proper footwear, and regular foot checks from a healthcare provider.
Other diabetes-related complications patients need to be aware of
6. Kidney disease
What it is: High blood sugar and high blood pressure can damage the kidneys and lead to a disease known as nephropathy, in which protein leaks out of damaged kidneys into the urine. As a result, the kidneys can no longer remove waste and extra fluids from the blood.
What it does: Left untreated, kidney disease can cause kidney failure, known as end-stage renal disease. Diabetes is the leading cause of kidney failure, and a person with this condition needs long-term dialysis (in which a machine eliminates waste from the blood) or a kidney transplant.
How to prevent it: Keeping blood pressure and blood glucose under control is key, whether through lifestyle changes, medications, or both. Protein in the urine is often the first sign of nephropathy, so your friend or relative should be checked annually for this condition; early intervention with medication may help protect the kidneys from further damage.
7. Gum disease
What it is: Gingivitis is a gum condition characterized by inflammation and bleeding. Left unchecked, this ailment can lead to the more serious gum disorder known as periodontal disease.
What it does: Almost one-third of people with diabetes have severe periodontal disease, which can weaken the gums so much that they can no longer support teeth.
How to prevent it: The person you're caring for needs to brush at least twice a day, floss once a day, and make sure she sees a dentist twice a year for checkups and cleanings. She may be advised to go more often if she already has gum disease.
8. Eye disorders
What they are: Several eye conditions are more frequent in people with diabetes, including glaucoma, an increase in fluid pressure inside the eye; retinopathy, damage to the small blood vessels in the retina; cataracts, a clouding of the lens of the eye; and macular degeneration, damage to the part of the retina responsible for central vision.
What they do: Warning signs of eye trouble include blurred vision, sudden loss of vision, black spots, cobwebs or flashing lights, redness, pain, or pressure in the eye. To avoid any permanent vision loss, you or the patient should call her doctor if she experiences any of these symptoms. Diabetic retinopathy is the leading cause of blindness in adults.
How to prevent them: The patient should have an annual eye exam to catch problems before they begin or treat them before they progress. If she has poorly controlled diabetes, high blood pressure, high cholesterol, or kidney disease, she may need to see an eye specialist more often.
9. Erectile dysfunction
What it is: Erectile dysfunction, also known as impotence, refers to the inability to get or maintain an erection during sexual activity.
What it does: Impotence interferes with sexual pleasure. Men with diabetes are twice as likely to experience this dilemma as men without the disease.
How to prevent it: As with all these disorders, keeping blood sugar within the target range is key. Erectile dysfunction can be a side effect of some diabetes medications; the patient should discuss this with his doctor. Depression, stress, or anxiety can contribute to impotence; he may want to seek professional help for these conditions. Reducing alcohol intake and stopping smoking are also highly recommended.
10. Bladder and vaginal infections
What they are: Cystitis, an inflammation of the bladder that's usually caused by a bacterial infection, and yeast infections, a fungal infection of the vagina, can become recurrent problems if the person you're caring for has a blood glucose level that's higher than recommended.
What they do: Elevated blood sugar levels provide an excellent environment for bacteria and yeast to grow, causing these uncomfortable, even painful, conditions to thrive.
How to prevent them: Glucose control is key. Other self-care measures that may help include drinking enough water, urinating whenever there's an urge to go and emptying the bladder completely, avoiding scented personal hygiene products, and wiping from front to back after using the toilet.
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